Study on early diagnosis strategy for radiation-associated breast angiosarcoma after breast cancer radiotherapy

Objective: To develop an early diagnosis strategy for radiation-associated breast angiosarcoma after breast cancer radiotherapy (RABASBCR) and to avoid the misdiagnosis of this disease. Methods: A systematic search of PubMed for published reports of RABASBCR cases was performed. The clinical manifestations and radiological features in the early stage of disease, as well as biopsies, were analyzed to screen out valuable markers for early diagnosis and develop the early diagnosis strategy for RABASBCR. Results: Fifty-five original articles involving 80 RABASBCR patients were selected for this analysis. Twenty-four (30%) of the 80 patients were misdiagnosed; the median time of misdiagnosis was 3 months (1-24 months). The earliest symptom was skin changes in 76(95%) of the 80 patients. The misdiagnosis rates of ultrasound, mammography, computed tomography, and magnetic resonance imaging for RABASBCR were 9/9, 31/32, 2/2, and 1/5, respectively. The misdiagnosis rates of fine needle biopsy, core needle biopsy, and incisional biopsy were 7/14, 12/25, and 10/26, respectively. Conclusions: By analyzing published case reports, we have set up the early diagnosis strategy for RABASBCR with reference to the Cahan criteria. (authors)