Identifying patients most likely to benefit from routine postoperative mammography after breast-conserving surgery

Routine postoperative mammography (RPM) may be performed after breast conserving surgery (BCS) in patients who presented with malignant calcifications in order to rule out residual malignancy. However, clinical utility and optimal application of RPM is uncertain. A retrospective cohort study at Sheba Medical Center of the University of Tel Aviv (Israel) was carried out to identify patients most likely to benefit from RPM after BCS. During the study period (2018-2022), 2054 patients underwent BCS, of whom 306 (15%) had a postoperative mammogram within three months of surgery, and 218 fitted the final inclusion category. Suspicious residual calcifications after BCS were identified in 22 of 218 patients (10%), of whom 19 underwent biopsy and 3 proceeded directly to surgery. Residual malignancy was confirmed by biopsy in 9 patients (4%). Multivariate analysis demonstrated that younger age and the extent of calcifications on preoperative mammograms were indepently associated with residual malignancy on RPM. The authors conclude that RPM was more beneficial for patients aged 50 years or younger, and for patients with extensive calcifications on preoperative mammograms. Tailoring RPM use to these subgroups may improved diagnostic efficiency and reduce unnecessary interventions.