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Centre for Evidence-
Based Medicine

Diagnosis: Clinical Scenario

You see a 44 year old lady in your multidisciplinary follow-up breast clinic. She had a wide local excision and axillary clearance for a 1.7cm Grade 2 ductal carcinoma 2 years ago. Two of 17 axillary nodes were positive for tumour, and she recieved postoperative radiotherapy to the breast tissue, sandwiched with 6 cycles of CMF chemotherapy. Ever since the radiotherapy, the area under the surgical scar has been very firm. A routine follow-up mammogram show increasing density and architectural distortion in this area, and there is a concern about local recurrence. A core biopsy was unsatisfactory because of the very hard consistency of the tissue. Because of the size and site of the mammographic abnormality, a diagnostic excision biopsy is likely to leave a very poor cosmetic result. The patient is very keen to avoid a mastectomy if at all possible. You explain that you cannot be sure whether she has local recurrence or not. She asks (a) What is the best method of investigating this without further surgery? (b) How good is this method?

Together, you formulate the question:
In a patient with a history of breast cancer and breast conserving surgery what is the best method for detecting local recurrence? AND How accurate is it?

You search Medline using the terms 'breast neoplasms' and 'screening' and 'mastectomy'. You find an article by Drew et al and decide to review it. Ann Surg Oncol 1998;5:265-70

Read the article and decide:

  1. Are the results of this study of diagnosis valid?
  2. Are the results of the study important?
  3. Can you apply this valid, important evidence about diagnosis to the treatment of your patient?

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