Structural, pathophysiological and clinical aspects of diagnostic imaging in breast recurrence: the breast after treatment

In the last decades the outcome of women with breast cancer has been significantly modified partially as a result of screening which has facilitated earlier diagnosis and consequently allowed a conservative surgical approach. Today diagnostic imaging is generally based on Mammography (Mx), with a minor role for ultrasounds and Magnetic Resonance (MR). In this scenario, dominated by morphostructural techniques, there is a secondary role for radionuclide procedures both using gamma emitters or Positron Emission Tomography (PET) with F-18 Fluorodeoxyglucose (FDG) or other radiotracers beyond FDG. After surgery and allied treatments, including radiotherapy, the diagnosis of breast recurrence has become a difficult challenge, because of the several factors simultaneously and/or sequentially involved. In the diagnosis of local recurrence, Mx remains the first diagnostic step together with a clinical visit, as alternative approaches yield more unsatisfactory results. Nevertheless as Mx is affected by a low sensitivity, it is important to better evaluate the capabilities of functional imaging utilizing MR and Nuclear Medicine, to allow an earlier and more accurate detection. In this paper we analyze structural, pathophysiological and the clinical background to diagnostic imaging in local breast recurrence to better understand basic problems, to facilitate more effective utilization of diagnostic tools.