Radiation-induced breast changes

Changed by Bruno Di Muzio, 14 Apr 2019

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Radiation-induced breast changes are a consequence of radiotherapy toxicity over the breast tissues either related to targeted breast cancer treatment or other thoracic malignancies (eg. lung cancer).

Radiographic features

The radiation-induced breast changes may be seen in either dedicated breast imaging or CT chest performed for follow-up of other thoracic malignancies.

skin thickening
- commonly seen within 6 months of the completion date
- slowly resolve until a certain point where a fibrotic thickening may persist
interstitial oedema
- diffuse trabecular thickening representing engorged lymphatics
oil cysts/fat necrosis
dystrophic calcifications
focal skin retraction
glandular atrophy
- asymmetry of the glandular parenchyma noted when compared to contralateral breast
- decreased breast size
breast fibrosis

Treatment and complications

Radiation-induced breast malignancy is rare ^1-3and possible induced tumours include:

Differential diagnosis

Differential diagnosis is mainly considered in those patients treating breast cancer, as it may be difficult to distinguish the above-mentioned breast changes from:

local breast recurrence
inflammatory breast cancer
breast infection

-Radiation-induced breast changes are a consequence of <a title="Radiotherapy" href="/articles/radiation-therapy">radiotherapy</a> toxicity over the breast tissues either related to targeted <a title="Breast cancer" href="/articles/breast-neoplasms">breast cancer</a> treatment or other thoracic malignancies (eg. <a title="Lung cancer" href="/articles/lung-cancer-3">lung cancer</a>). <h4>Radiographic features</h4>The radiation-induced breast changes may be seen in either dedicated breast imaging or CT chest performed for follow-up of other thoracic malignancies. <ul>
+Radiation-induced breast changes are a consequence of <a href="/articles/radiation-therapy">radiotherapy</a> toxicity over the breast tissues either related to targeted <a href="/articles/breast-neoplasms">breast cancer</a> treatment or other thoracic malignancies (eg. <a href="/articles/lung-cancer-3">lung cancer</a>). <h4>Radiographic features</h4>The radiation-induced breast changes may be seen in either dedicated breast imaging or CT chest performed for follow-up of other thoracic malignancies. <ul>
~~-<a title="Skin thickening on mammography (differential)" href="/articles/skin-thickening-on-mammography-differential">skin thickening</a><ul>~~
+<a href="/articles/skin-thickening-on-mammography-differential">skin thickening</a><ul>
~~-<a title="Causes of breast oedema (mnemonic)" href="/articles/causes-of-breast-oedema-mnemonic">interstitial oedema</a><ul><li>diffuse trabecular thickening representing engorged lymphatics</li></ul>~~
+<a href="/articles/causes-of-breast-oedema-mnemonic">interstitial oedema</a><ul><li>diffuse trabecular thickening representing engorged lymphatics</li></ul>
~~-<a title="Oil cysts" href="/articles/oil-cyst-breast">oil cysts</a>/<a title="Fat necrosis (breast)" href="/articles/fat-necrosis-breast-2">fat necrosis</a>~~
+<a href="/articles/oil-cyst-breast">oil cysts</a>/<a href="/articles/fat-necrosis-breast-2">fat necrosis</a>
~~-<li><a title="Dystrophic calcification within the breast" href="/articles/dystrophic-calcification-within-the-breast">dystrophic calcifications</a></li>~~
+<li><a href="/articles/dystrophic-calcification-within-the-breast">dystrophic calcifications</a></li>
~~-<li>decreased breast size </li>~~
+<li>decreased breast size</li>
~~-<li><a title="Focal breast fibrosis" href="/articles/focal-fibrosis-of-the-breast">breast fibrosis</a></li>~~
+<li><a href="/articles/focal-fibrosis-of-the-breast">breast fibrosis</a></li>
~~-<li><a title="Invasive ductal carcinoma" href="/articles/invasive-ductal-carcinoma">invasive ductal carcinoma</a></li>~~
~~-<li><a title="Angiosarcoma of breast" href="/articles/angiosarcoma-of-breast">angiosarcoma</a></li>~~
+<li><a href="/articles/invasive-ductal-carcinoma">invasive ductal carcinoma</a></li>
+<li><a href="/articles/angiosarcoma-of-breast">angiosarcoma</a></li>
~~-<li>local breast recurrence </li>~~
~~-<li><a title="Inflammatory breast cancer" href="/articles/inflammatory-carcinoma-of-the-breast">inflammatory breast cancer</a></li>~~
+<li>local breast recurrence</li>
+<li><a href="/articles/inflammatory-carcinoma-of-the-breast">inflammatory breast cancer</a></li>

References changed:

1. Yi A, Kim HH, Shin HJ, Huh MO, Ahn SD, Seo BK. Radiation-induced complications after breast cancer radiation therapy: a pictorial review of multimodality imaging findings. (2009) Korean journal of radiology. 10 (5): 496-507. <a href="https://doi.org/10.3348/kjr.2009.10.5.496">doi:10.3348/kjr.2009.10.5.496</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/19721835">Pubmed</a>
2. Zeynep N. Yilmaz, Colleen H. Neal, Mitra Noroozian, Katherine A. Klein, Baskaran Sundaram, Ella A. Kazerooni, Jadranka Stojanovska. Imaging of Breast Cancer–Related Changes After Nonsurgical Therapy. (2014) American Journal of Roentgenology. 202 (3): 675-83. <a href="https://doi.org/10.2214/AJR.13.11518">doi:10.2214/AJR.13.11518</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24555607">Pubmed</a>
3. Marcelo F. Benveniste, Daniel Gomez, Brett W. Carter, Sonia L. Betancourt Cuellar, Girish S. Shroff, Ana Paula A. Benveniste, Erika G. Odisio, Edith M. Marom. Recognizing Radiation Therapy–related Complications in the Chest. (2019) RadioGraphics. 39 (2): 344-366. <a href="https://doi.org/10.1148/rg.2019180061">doi:10.1148/rg.2019180061</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30844346">Pubmed</a>
4. Rajesh Krishnamurthy, Gary J. Whitman, Carol B. Stelling, Anne C. Kushwaha. Mammographic Findings after Breast Conservation Therapy1. (1999) RadioGraphics. 19 Spec No: S53-62; quiz S262-3. <a href="https://doi.org/10.1148/radiographics.19.suppl_1.g99oc16s53">doi:10.1148/radiographics.19.suppl_1.g99oc16s53</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/10517443">Pubmed</a>

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