Journal time. October 2012 issue of Plastic and Reconstructive Surgery Journal was full of interesting studies as always. This one really drew my attention. “Differentiating Fat Necrosis from Recurrent Malignancy in Fat Grafted Breasts: An Imaging Classification system to Guide Management.
English translation:
When you transfer fat to a breast, the newly transferred fat can die. When fat dies it can form a calcification. This tends to be a microcalcification- you can’t feel it, but you see it on mammogram. A big issue with fat transfer in patients with a strong family history of breast cancer, a personal history of breast cancer, or issues with breast imaging, is if you do fat transfer and get calcifications or palpable masses, how can you tell what calcifications are from the fat transfer and which ones could mean breast cancer?
Big issue. This is why fat transfer to the breast had not been done for so long. So this study is looking at the films
Is there a way to create a standard for mammograms to distinguish
which lesions are benign (not cancer) from malignant (cancer) after fat grafting?
Study:
- 286 breast reconstruction patients who had fat grafting from 2006-2011
- anyone with imaging of clinically palpable masses was evaluated
- these images were reviewed by a blinded radiologist
- Lesions were classified using a standard radiology ultrasound lexicon
- solid mass, hypoechoic
- solid mass, isoechoic
- solid mass, hyperechoic
- solid mass complex echogenicity ******
- anechoic mass with posterior acoustic enhancement
- cystic mass with internal echoes
- negative
- These images were correlated with histology/pathology results
Findings?
- Only the solid mass with complex echogenicity was found to be a cancer. This mass also showed vascularity and angular margins on ultrasound.
- IF there was no vascularity and IF the margins were circumscribed, the negative predictive value for malignancy was 100%
- Follow up done by ultrasound on lesions done at 6 months showed NO CHANGE in vascularity or size
So, they conclude ultrasound analysis and a standardized classification system is reliable at telling the difference between benign fat necrosis and a malignant breast cancer after patients have had breast reconstruction using fat transfer.
This study was done on palpable masses.
The authors suggest if doing fat transfer in someone who has a history of breast cancer, follow up should be done at regular intervals, with ultrasound analysis and an objective classification of the palpable lesion, and integrated care by a team of the patient, an experienced radiologist, a breast surgeon, and the plastic surgeon.
I applaud this study and those like it. We need to keep demonstrating patient safety is not compromised for improved aesthetic results. Fat transfer, to be widely accepted as a breast cancer reconstructive technique, needs to continue to alleviate concerns of risk. This study shows a simple classification framework can help distinguish benign masses from recurrent cancer.