breast imaging and the conservative treatment of breast cancer

Breast imaging and the conservative treatment

of breast cancer

D. David Dershaw, MD

Breast Imaging Section, Department of Radiology, Memorial Sloan-Kettering Cancer Center,

1275 York Avenue, New York, NY 10021, USA

When the breast containing cancer is treated by

mastectomy, issues of multifocality and multicen-

tricity of disease are obviated by removal of the

entire breast. When breast conservation is per-

formed, however, it is presumed that residual cancer

may be present postoperatively in the breast and can

be sterilized with postoperative radiation. The suc-

cess of radiation in eradicating residual tumor

depends, at least partially, on the volume of residual

disease within the breast. Therefore, it is necessary

for the breast imager to determine, as accurately as

possible, the extent of disease within the breast

undergoing treatment. After treatment, the breast is

monitored to detect recurrent tumor, if it occurs, at

the earliest stage possible. Additionally, the opposite

breast is screened because of its increased risk of

developing carcinoma.

Whereas the goal of both mastectomy and con-

servation is to cure, conservation also considers the

cosmetic result. Unnecessary biopsy of the treated

breast can compromise cosmesis; therefore, the

breast imager should be able to differentiate the

usual benign sequelae from possible malignant dis-

ease to minimize the likelihood of unnecessary

biopsy. Also, physicians need to understand the

appropriate role of needle biopsy techniques in this

population, sparing these women additional surgery

when possible.

Evidence supporting breast conservation

From 1972 to 1989, six prospective randomized

trials of 4108 women were conducted comparing the

outcome of women with invasive breast carcinoma

treated with breast-conserving surgery and whole-

breast radiation versus mastectomy. Results are

shown in Table 1 [1–6]. Mastectomies performed

were either radical or modified radical mastectomies.

Breast-conserving surgery was classified as local or

wide excision or quadrantectomy. Except for the

Danish Breast Cancer Group, which included women

with stage III tumors, studies included only women

with stage I (Milan I, Gustave-Roussy) or stage I-II

(EORTC, NCI, NSABP B06) breast cancers. All

trials included whole-breast irradiation of 45–50

Gy. Except for the NSABP study, in which no boost

dose was given, conservation treatment in the other

five studies included radiation to the primary tumor

site boosting the total dose at this site to � 60 Gy. In

these trials, there was no significant difference in the

outcomes of women treated with conservation or

mastectomy (Table 1). Patterns of local recurrence

reported in these trials show 3% to 20% recurrence at

3 to 18 years of follow-up.

Multiple single institutions have also reported

retrospective data of their experience with breast con-

servation [7]. Among the 5600 women included in

these studies, 10-year results showed overall survival

rates ranging from 63% to 86%, with disease-free

survival rates ranging from 63% to 74%. Local recur-

rence rates were 8% to 20% at 10 years and 17% to

18% at 15-year follow-up. Again, these data support

the comparable survival rates of women treated with

0033-8389/02/$ – see front matter D 2002, Elsevier Science (USA). All rights reserved.

PII: S0033 -8389 (01 )00003 -3

E-mail address: [email protected] (D.D. Dershaw).

Radiol Clin N Am 40 (2002) 501–516

conservation versus mastectomy and a roughly 1% lo-

cal recurrence rate in the first 15 years after treatment.

Selection of women for breast conservation

Clinical contraindications to breast conservation

are listed in Table 2. These contraindications are

based on the inability to deliver radiation to the

breast, the inability to resect tumor with a cosmeti-

cally acceptable result, or the inability or unreliability

of the patient to complete a course of radiation

(Fig. 1). Note that there is no contraindication based

solely on tumor size. Active collagen vascular disease

increases the breast’s sensitivity to radiation and may

make it impossible to deliver a therapeutic dose. If

collagen vascular disease is inactive, this is frequently

not a problem. Also, the presence of palpable, non-

matted axillary adenopathy does not contraindicate

breast conservation.

Preoperatively, it is the role of breast imaging to

accurately determine the extent of tumor within the

breasts. This assessment may be accomplished in

some women with mammography. In others, the use

of sonography and MRI may more accurately evaluate

the extent of tumor. Accurate preoperative assessment

can save the patient multiple surgeries necessitated by

repeatedly positive margins of the excised tissue.

Failure to detect multicentric disease can result in

local treatment failure and the need for mastectomy.

Complete evaluation of the breast with mammog-

raphy may require additional views, including mag-

nification. Comparison with prior studies may make

subtle changes caused by carcinoma more obvious.

Care should be taken to be certain that nothing

suspicious is present in the contralateral breast.

Several studies have suggested that additional

imaging techniques may be of value in detecting

otherwise hidden carcinoma in women with a known

malignant lesion in the breast. In women with known

breast carcinoma, sonography has detected foci

of carcinoma not apparent on mammography [8].

Although these additional sites of carcinoma are

usually caused by invasive disease, areas of ductal

carcinoma in situ (DCIS) have also been identified.

For MRI, the reported sensitivity in the diagnosis of

invasive carcinoma has approached 100%, with sen-

sitivity for DCIS ranging from 40% to 100% [9]. This

level of sensitivity has made it possible to perform

more accurate preoperative staging of local disease

within the breast with MRI than with mammography

or physical examination in some women. However,

false-positive MRI examinations make it necessary to

have histologic confirmation of positive MRI findings

if they will change the treatment of the disease. One

group has demonstrated that, whereas MRI results

changed therapy in 14% of women with breast cancer,

3.5% of studies led to an unnecessary open biopsy

[10]. MRI may be particularly useful in the preoper-

ative staging of invasive lobular carcinoma. One study

found that, whereas mammography was able to accu-

rately delineate the extent of this tumor within the

breast in only 32% of cases, MRI was accurate in 85%

[11]. MRI may also be useful in determining the

involvement of the pectoralis major muscle in women

with posterior breast cancers [12].

Specimen radiography

In women with nonpalpable cancers or with

tumors that have areas extending beyond the area of

the palpable tumor, specimen radiography is useful to

determine if the suspicious lesion has been excised or

if some tumor remains within the breast. It also is

useful in directing the pathologist to the areas of

interest in the excised specimen.

Specimen radiography can be performed with

mammography equipment or with special specimen

Table 1

Survival results of prospective randomized trials of breast

conservation

Overall

survival (%)

Disease-free

survival (%)

Study

Conser-

vation

Mastec-

tomy

Conser-

vation

Mastec-

tomy

Gustave-Roussy [1] 73 65

Milan I [44] 65 65

EORTC [42] 65 66

NCI [22] 77 75 72 69

NSABP B06 [14] 63 59 50 49

Danish Breast

Cancer Group [3]

79 82 70 66

Table 2

Contraindicators to breast conservation

Absolute contraindications

First or second trimester of pregnancy

History of prior breast therapeautic radiation

Large tumor-to-breast ratio

Multiple, synchronous carcinomas, especially if widely

separated or in different quadrants

Relative contraindicators

Collagen vascular disease

Inability to travel to radiation facility

Unreliable to complete course of treatment

D.D. Dershaw / Radiol Clin N Am 40 (2002) 501–516502

radiography units [13]. Especially for uncalcified

areas of tumor, compression of the specimen may

be helpful in identifying the tumor. Views of the

specimen obtained in multiple projections can help

identify tumor extending to the margin of resection

(Fig. 2). When areas of worrisome calcification are

not found by the pathologist on histopathologic

slides, radiography of the tissue imbedded in paraffin

Fig. 1. Craniocaudal view of a breast of a woman who presented with a palpable mass at 12 o’clock. The mass was caused by

two adjacent spiculated masses (two central arrows). Mammography revealed two additional spiculated carcinomas (two

peripheral arrows). Although the central masses could be removed with conservation, the presence of multiple masses over a

wide volume of the breast necessitated mastectomy.

Fig. 2. Specimen radiography shows areas of calcification at (thick arrow) and near (thin arrow) the margin of resection.

Removal of additional tissue from at the time of surgery was performed for in situ and invasive ductal carcinoma.

D.D. Dershaw / Radiol Clin N Am 40 (2002) 501–516 503

can assist in locating foci of calcification that have

not been sliced and stained so that additional slides of

these areas can be prepared (Fig. 3).

At the time that the specimen radiograph is

interpreted, the preoperative mammogram should be

available so that the mammographic characteristics of

the carcinoma can be compared with the findings on

the specimen radiograph. Areas of architectural dis-

tortion and asymmetry can be difficult to appreciate

on specimen radiography, and the specimen radio-

graph is least useful for tumors presenting with these

imaging characteristics [14]. The specimen radio-

graph should be examined while the patient is still

in surgery. Absence of the area of suspicion should

result in the removal of more tissue to successfully

biopsy the suspicious lesion. Extension of tumor

mass or calcifications to the margin of the specimen

suggests that tumor has been transected. Removal of

more tissue from that margin of the biopsy cavity is

appropriate to obtain negative margins at the time of

the original surgical procedure. The excised specimen

can be marked with surgical clips to orient the

Fig. 3. Biopsy was performed in this patient for suspicious calcifications that could not be identified on initial examination of the

pathology specimen. Radiography of tissue slices allowed the pathologist to identify the sites of calcification (arrows), which

were caused by ductal carcinoma in situ.


Fig. 4. A postlumpectomy mammographic view shows residual tumoral calcifications (arrows) next to the lumpectomy site. At

re-excision, residual ductal carcinoma in situ was found associated with the calcifications.

Fig. 5. A persistent seroma underwent sonography because of clinical concern over failure of the seroma to resolve. Although

there was no residual carcinoma, the irregular echo pattern of seromas makes it impossible to exclude malignancy.


margins of the specimen to the walls of the lumpec-

tomy cavity.

In addition to specimen radiography, margins of the

excised specimen are routinely painted with India ink,

and the inked margins are examined by the pathologist

to determine if tumor is present at or near the margin.

The specimen radiograph may not show margin

involvement because of the orientation of the speci-

men to the x-ray beam or because of mammographi-

cally inapparent carcinoma. Also, the pathologist

samples only some of the inked edges of the specimen,

possibly failing to sample sites with tumor involve-

ment. Therefore, these two techniques are complimen-

tary in evaluating the margins of the excised tissue.

For lesions that are identified only on sonography,

sonography of the excised specimen can confirm

removal of the lesion and localize it within the speci-

men [15]. Because MRI identification of carcinoma is

dependent upon contrast enhancement, no method of

MRI specimen assessment is currently available.

Immediate postoperative mammography

For women whose carcinomas contain calcifica-

tions that are detectable by mammography, complete

determination of the adequacy of excision of the

tumor includes a postoperative mammogram, usually

done before radiation therapy commences. Adequacy

of excision cannot be reliably determined on the basis

of the specimen radiograph [16]. This assessment is

appropriately performed by mammography following

tumorectomy [17]. These films are usually done 2 to

4 weeks after surgery and before radiation therapy is

initiated (Fig. 4). They can, however, be done as soon

as the same day as surgery, if necessary. Routine

mediolateral oblique (MLO) and craniocaudal (CC)

views of the breast should be obtained. If no residual

tumoral calcifications are seen, then magnification

mammography may demonstrate residual calcifica-

tions that are not apparent on the routine views.

Images should be compared with preoperative mam-

mograms so that the morphology of calcifications

associated with the patient’s carcinoma is known.

Although these postoperative mammograms are not

of value for women whose tumors did not contain

calcifications, it may be worthwhile to schedule all

patients undergoing conservation to have mammo-

graphy before radiation so that women for whom

these studies are valuable always have them done. If

re-excision of residual calcifications is performed,

postoperative mammography must again be done

before radiation to be certain that all worrisome cal-

cifications have been removed.

Fig. 6. (A) Conservation was performed on this patient with

invasive ductal carcinoma (arrow). (B) Mammography

done 1 year after treatment shows architectural irregularity

and ill-defined density at the lumpectomy site caused by

surgery. Skin thickening and stromal coarsening are

secondary to radiation.


Completeness of tumor excision cannot be deter-

mined on the basis of these images. Although all

tumoral calcifications may have been excised, resid-

ual, uncalcified tumor can be present in the breast

[18]. The presence of this tumor can be suggested by

positive histologic margins of the lumpectomy speci-

men. Also, because benign and malignant processes

containing calcifications can coexist, the presence of

residual calcifications, particularly when they are few

in number and not of BI-RADS 5 type, can be caused

Fig. 7. Postoperative seromas at the lumpectomy may take long periods to involute. (A) Preoperative mammography shows a

small invasive ductal carcinoma (arrow) in the lateral aspect of this breast. (B) Mammogram done 1 year later shows clips at the

surgical site, surrounding ill-defined density that is centrally caused by a seroma. (C) Mammogram 2 years after surgery shows

partial involution of the seroma.


by benign entities [17]. Therefore, some re-excisions

for residual calcifications will fail to find tumor in

the breast.

For women with positive margins histologically,

assessment of residual disease within the breast can

also be done with MRI. This is particularly valuable

for women whose carcinomas are uncalcified and

whose breasts are dense. In one study of 47 patients,

contrast-enhanced MRI had a positive predictive

value for residual tumor of 82% and a negative

predictive value of 61% [19]. Among women included

in this study, 4 of 14 with residual multifocal or diffuse

carcinoma had their treatment changed from conser-

vation to mastectomy. These results have been sup-

ported by other investigators [20].

The normal, acute postoperative pattern at the

lumpectomy site is a thin rim of enhancement around

the seroma cavity. Clumped enhancement at the

margins of the seroma and enhancing lesions else-

where in the breast suggest residual tumor; how-

ever, in some instances, clumped granulation tissue

around the seroma cavity can have a pattern suggest-

ing residual disease. Also, nonmalignant lesions

within the breast can show patterns of enhancement

that are identical to those seen in carcinomas. Treat-

ment decisions should be made on the basis of

histologic assessment of enhancing lesions suggest-

ing tumor and should not be made solely on the basis

of MRI findings.

Sonographically, the tumorectomy bed appears as

a complex mass. The extent of solid material within

the seroma cavity is variable. However, irregularity of

the seroma wall and variability of the echo pattern

within the lumpectomy site usually make sonography

of little value in assessing completeness of tumor

excision (Fig. 5).

Long-term follow-up: usual mammographic

changes

The long-term follow-up of the irradiated breast is

performed to detect any recurrence of carcinoma in

the breast. The breast imager needs to be familiar with

the expected changes in the conservatively treated

breast so that these are not mistaken for recurrence.

Unnecessary biopsy of these breasts can compromise

the cosmetic result of conservation. Because of the

compromise of microvasculature by radiation, exag-

gerated patterns of scarring can occur after surgical

biopsy. It is important to identify recurrence as early

as possible to optimize the likelihood of cure [21,22].

The first post-treatment mammogram of the irra-

diated breast is usually done 3 to 6 months after

radiation [23]. Bilateral mammography is then per-

formed 12months after the preoperative mammogram.

At this time, the untreated breast undergoes its annual

screening, and assessment of the treated breast is

synchronized with the contralateral side. Thereafter,

screening can be performed annually, although some

radiologists have recommended mammography of the

treated breast every 6 months for the first 3 years.

Post-treatment changes should be most pro-

nounced on the first postradiation mammogram

[24,25]. Changes may show stability, regression, or

return to normal with the passage of time. Increases

in these changes on studies done after the first

posttreatment mammogram should not be accepted

as normal, and the reason for any increase in these

findings should be investigated because the cause can

be new or recurrent carcinoma.

The usual alteration in the mammogram after

treatment consists of an increase in breast density,

architectural distortion and scar formation, and the

Fig. 8. Dystrophic calcifications commonly develop at the

lumpectomy site after radiation. Three years after treatment,

coarse and punctate calcifications are present in this patient.


development of calcifications (Fig. 6). In any single

patient, all, some, or none of these changes can occur.

Density changes are identical to those that can be

seen with inflammatory carcinoma, mastitis, obstruct-

ed lymphatic or venous drainage, and diffuse infiltra-

tion by lymphoma. Differentiation from these other

entities is based on clinical history.

Increase in density of the treated breast is initially

caused by postoperative edema. After radiation, post-

radiation inflammation occurs, followed by postradia-

tion fibrosis [26]. All of these processes have an

identical mammographic pattern. Skin thickening

may be present, and this is the most common post-

treatment change found on these mammograms

[27,28]. It is best appreciated by comparison with

the nontreated breast or the pretreatment mammo-

gram. In addition to skin changes, the stromal pattern

of the breast can become coarsened. Ductal and

glandular elements can also become thickened. These

individual changes contribute to a pattern of diffusely

increased mammographic density of the treated breast.

Architectural distortion and scar formation are

caused by the surgical intervention. On the initial

postoperative mammograms, it is common to see a

postoperative seroma. These are round or oval soft-

tissue-density masses. Resorption of seroma fluid can

be slow, and these masses can persist for many

months and occasionally for 2 or more years [24]

(Fig. 7). If they are studied with sonography, they

appear as a complex mass, and the findings do not

differentiate them from carcinoma. Their presence

should not be a cause of concern, however. If

aspirated, they will reaccumulate. Therefore, their

persistence over extended periods should not lead to

intervention. On serial examination, they should

decrease in size (or at least not increase). As they

regress, fibrosis of the surgical cavity can develop as

a scar forms at the operative site. Although the

pattern may be grossly spiculated, the volume of

the changes at the operative site should be stable or

decreasing. These changes can become more obvious

as postsurgical edema resolves. It is the volume of the

changes that is significant; as long as the size of the

area of surgical change is stable or decreasing, these

changes should not be a cause of concern.

Calcifications can be caused by radiation with

dystrophic calcifications and fat necrosis calcifica-

tions developing in about one third of women under-

going breast irradiation [23–25,29] (Fig. 8). These

may not appear until 3 to 5 years after treatment.

Coarse calcifications, characteristic of fat necrosis,

should cause no problems in the interpretation of

Fig. 9. Heavy, linear calcifications with rounded regions at the lumpectomy site are caused calcified, knotted suture material.


Fig. 10. (A) The upper portion of this mediolateral oblique view shows surgical clips surrounding a lumpectomy scar. (B) One

year later, 3 years after conservation, a new mass (arrow) has developed, caused by recurrent invasive ductal carcinoma.

Identification of the recurrence would be difficult without the prior post-treatment mammogram for comparison.

Fig. 11. (A) The upper portion of a mediolateral oblique view shows postsurgical distortion in the tail of the breast 1 year after

treatment. (B) One year later, three masses have developed at the lumpectomy site caused by recurrent invasive ductal carcinoma.


mammograms of these patients. Calcified suture

material and surgical clips at the lumpectomy site

can also be seen (Fig. 9). These are also not a cause of

concern. The development of pleomorphic micro-

calcifications within the breast, however, raises the

possibility of local treatment failure. Their workup is

addressed in the following section.

Local treatment failure

Recurrence of carcinoma in the treated breast

occurs at a constant rate of 1% to 2% per year during

the first 2 to 8 years after treatment [30,31]. Local

recurrence rates of 5% to 10% at 5 years and 10% to

15% at 10 years for adequately treated cancers should

be expected. Women who are at increased risk for

local treatment failure include those with positive

margins [32,33], those not treated with radiation

[34], those with multiple cancers in the breast at the

time of initial presentation [35], and those whose

tumors have an extensive intraductal component

without a large negative surgical margin [36]. Some

also believe that those who are treated at a young age

are at greater risk for recurrence [37]; however, the

possibility of recurrent tumor exists in any breast

previously treated with conservation.

Local treatment failure that occurs within the first

5 to 7 years after treatment is most likely to be located

at or near the site of the original cancer [38,39]; it is

caused by recurrence of the original carcinoma that

was not fully eradicated. The greatest tumor burden

within the breast is usually near the site of the original

carcinoma, and the ability of radiation to sterilize the

tumor is related to tumor volume. Therefore, if tumor

cells are present in the breast after radiation, they are

Fig. 12. Six years after treatment for invasive ductal carcinoma, new microcalcifications (arrows) developed in the region of

coarse, fat necrosis calcifications at the site of prior lumpectomy. Biopsy revealed ductal carcinoma in situ.


most likely present at the site of the original carci-

noma. Local failure after 5 years is commonly caused

by carcinomas growing elsewhere in the breast. Small

tumors present within the breast that were undetected

at the time of treatment of the original cancer are

usually sterilized by postoperative radiation. There-

fore, growth of tumor outside the area of the original

cancer requires that new tumors form and grow for a

long enough time to become detectable.

Because of this pattern of recurrence, the breast

imager should attempt to include the entire site of

lumpectomy on follow-up mammograms, especially

in the first decade after treatment. This often requires

additional views beyond the routine MLO and CC

views. Routine magnification of the lumpectomy bed

is not necessary unless there are findings on non-

magnification views that warrant magnification [40].

If the surgeon has placed clips around the lumpec-

tomy cavity at the time of tumorectomy, identification

of all of these clips on the mammographic images is

helpful in documenting that the lumpectomy site has

been completely examined. It is helpful to establish

which extra views are needed on the first posttreat-

ment mammogram and to include these on all follow-

up studies, which makes it possible to compare the

size of the scar and other changes in the same

projection on serial examinations.

The ability of mammography to detect local recur-

rence is compromised by the presence of postoper-

ative distortion and increased density of the irradiated

breast. Mammography is able to detect only two thirds

of recurrences [23,38]. Therefore, the physical exami-

nation is of increased importance in detecting tumor

within the conservatively treated breast, and subtle

findings on physical examination should be carefully

correlated with subtle changes on mammography.

Patterns of recurrence on mammography are

generally those findings that are suspicious for car-

cinoma in the nonirradiated breast superimposed on

findings of lumpectomy and radiation. These include

suspicious microcalcifications and new masses not

caused by a simple cyst (Figs. 10, 11). Inflamma-

Fig. 13. An axillary view shows adenopathy (arrow) in the low axilla. This was new 5 years after conservation and was caused

by an axillary recurrence.


tory recurrences can appear as diffusely increas-

ing breast density. Subtle or obvious enlargement

of the lumpectomy scar also can herald recurrent

carcinoma [38].

Calcifications that are associated with recurrences

tend to be highly suspicious (BI-RADS 5 category)

(Fig. 12) [41,42]. Less worrisome calcifications can

sometimes indicate the presence of recurrent tumor,

however. Recurrent DCIS is almost always indicated

by the development of microcalcifications. Detecting

these microcalcifications on mammography was

found to be the method of detecting recurrence in

92% of DCIS recurring as pure DCIS [43]. If an

immediate postoperative mammogram has not been

obtained for women whose cancers contain mammo-

Fig. 14. (A) Five years after conservation, this view of a

lumpectomy bed had been stable over several years,

showing unchanged architectural distortion and fat necrosis.

(B) One year later, a new mass (arrow) was evident near the

lumpectomy bed. Biopsy showed only fat necrosis.

Fig. 15. Sonography was performed for this woman with a

questionable new mass near her scar. (A) Sonogram of the

scar shows an angulated, spiculated, echo-poor shadowing

mass. (B) The palpable mass near the scar has similar

sonographic characteristics. It was caused by recurrent

carcinoma. Differentiation of scar and recurrence based on

their echo pattern is not possible.


graphically evident microcalcifications, the signifi-

cance of microcalcifications at the lumpectomy site

on the first post-treatment mammogram cannot be

determined. These can be caused by residual tumor or

recurrent disease or may indicate decreasing tumor

that is responding to treatment.

Although enlarging axillary nodes can appear

acutely postoperatively and are reactive, the presence

of axillary nodal enlargement later after treatment can

be caused by an axillary recurrence (Fig. 13). It is

necessary to determine the reason for developing

adenopathy. This might require biopsy, often done

using fine needle aspiration.

Benign sequelae resembling recurrent tumor

Fat necrosis and other dystrophic changes caused

by radiation can resemble tumor recurrence. Other

entities, such as sclerosing adenosis, can also occur

and produce findings that are also worrisome for new

or recurrent carcinoma. It is important to determine the

cause of these findings, without surgical intervention if

possible. When necessary for a definitive diagnosis,

however, surgical biopsy should be performed.

The characteristic pattern of fat necrosis is that it

develops at or near the lumpectomy site, usually

approximately 2 years after treatment. Because

enlargement of the surgical scar is a sign of recur-

rence, findings on physical examination and mam-

mography are suspicious for cancer (Fig. 14). MRI

may assist in the differentiation between scar and

recurrence. Because postoperative scarring is avascu-

lar after 18 months and recurrent breast carcinoma,

especially if invasive, is hypervascular, recurrences

will enhance with gadolinium on MRI, and enlarging

areas of fibrosis are generally nonenhancing [44,45].

Stereotactic core biopsy of suspicious areas has also

been demonstrated to be accurate in differentiating

scar from recurrence [46].

Sonographically, scars and carcinoma usually are

hypoechoic and ill defined (Fig. 15). The differentia-

tion of the two using sonography is therefore not

possible; however, sonography can be useful in

guiding needle biopsy of suspicious areas. Some have

also found it to be of value in following the size of

scars that are located in areas of the breast that are

difficult to fully image with mammography.

Summary

Breast conservation, where appropriate, offers

effective treatment for breast cancer while preserving

the breast. The increased use of mammographic

screening has led to increased detection of small,

curable breast cancers that are amenable to breast-

conserving surgery. Mammography and other imag-

ing modalities, such as sonography and MRI, assist in

the determination of the appropriateness of breast

conservation and in the differentiation of recurrence

from benign sequelae of treatment.

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breast imaging and the conservative treatment of breast cancer

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