Clinical role of breast ultrasound surveillance in detecting locoregional recurrences after bilateral mastectomies

PURPOSE: This study evaluates the effectiveness of breast ultrasound in detecting locoregional recurrences specifically after bilateral mastectomies, a population underrepresented in existing surveillance guidelines. METHODS: This retrospective cohort study analyzed 130 female breast cancer survivors who underwent 1,599 consecutive breast ultrasound examinations following bilateral mastectomies between January 2005 and March 2023. Ultrasound examinations were performed by experienced sonographers targeting the chest wall and regional nodes. Ultrasound diagnostic accuracy was assessed as ultrasound pathology or 24-month clinical follow-up. The ultrasound characteristics of recurrent cancers were analyzed. RESULTS: The cohort (mean age 53.3 years; range 31-80) comprised 130 patients who underwent bilateral mastectomies: 62 (47.7%) with synchronous bilateral breast cancer, 62 (47.7%) with sequential bilateral cancer, and 6 (4.6%) with unilateral cancer with contralateral prophylactic procedures. Median follow-up was 6.2 years (range 1.5-15.3 years). Patients received an average of 12.3 ultrasound examinations. Suspicious lesions were identified in 1.3% of ultrasound exams. Locoregional recurrence occurred in 11 patients (8.5%), with ultrasound detecting 81.8% (9/11) of cases; the remaining 18.2% (2/11) were not reported on ultrasound. Most recurrences (63.6%, 7/11) occurred within five years after bilateral mastectomies. Younger patients (≤45 years) and those with axillary lymph node metastasis at diagnosis had significantly higher recurrence risks (p = 0.02 and p = 0.03, respectively). CONSULTATIONS: Younger patients (≤45 years) and those with prior axillary metastasis have higher locoregional recurrence risk after bilateral mastectomy, and breast ultrasound is valuable for detecting these locoregional recurrences.