Contrast-Enhanced Chest Computed Tomography for In-Breast Recurrence Detection: Clinical and Imaging Predictors of Visibility

Purpose: Routine surveillance chest CT is not recommended by current guidelines; however, its use has been increasing with improved accessibility. This study aimed to evaluate the utility of surveillance contrast-enhanced chest computed tomography (CT) in detecting in-breast recurrence among survivors, focusing on imaging and clinicopathological features that enhance tumor visibility. Additionally, this study sought to determine which patient populations may derive benefit from contrast-enhanced chest CT. Materials and Methods: A retrospective analysis was conducted on records of patients diagnosed with in-breast recurrence through biopsy during follow-up after breast cancer surgery between January 2016 and August 2022. Patients who underwent contrast-enhanced chest CT within one month of diagnosis were included. Two radiologists reviewed the chest CT scans for breast cancer lesions by consensus, and their findings were validated by two other radiologists blinded to tumor locations. Statistical analyses were performed to evaluate associations among clinicopathological factors, image features, and visibility. Results: Eighty-nine recurrent tumors in 85 patients were included. Fifty-eight recurrent tumors were identified by radiologists who were not blinded. The blinded radiologists independently identified 50 and 56 recurrences, with substantial inter-observer agreement (kappa-value = 0.768, p < 0.001). The visible group had a significantly higher rate of invasive ductal carcinoma (IDC) compared to the non-visible group (81.0% vs. 54.8%, p = 0.002). Additionally, the visible group exhibited larger tumors than the non-visible group (mean +/- SD: 1.9 +/- 1.5 cm vs. 1.3 +/- 0.6 cm, p = 0.018). Tumors located in fatty backgrounds demonstrated significantly greater visibility on chest CT than those in glandular backgrounds (67.2% vs. 16.1%, p < 0.001). Recurrent breast cancer was also more frequently visible on chest CT in patients who had undergone mastectomy compared to those who had received breast-conserving surgery (p < 0.001). Conclusions: Contrast-enhanced chest CT can aid in the detection of in-breast recurrence, particularly in patients who have undergone mastectomy, as a complementary imaging modality. Tumors in fatty backgrounds, large tumors, mass-type tumors, and IDCs are better visible on chest CT.