Clinical stage III and IV breast cancers require imaging
MedWire News: Only patients with clinical stage III or IV breast cancer require baseline investigation for metastases, a review of radiological staging practice in asymptomatic breast cancer patients reveals.
Local guidelines at the Cambridge Breast Unit in the UK state that patients with T4 tumors or malignant lymphadenopathy should be considered for pre-operative staging with chest radiographs, liver ultrasound and bone scan, while patients with more locally advanced breast cancer should have investigations directed at finding underlying asymptomatic metastases where this may influence management.
In the present study, Peter Britton (Cambridge University Hospitals NHS Foundation Trust) and team assessed practice in baseline radiological staging against these guidelines for asymptomatic newly diagnosed breast cancer patients presenting to the Cambridge Breast Unit over a 9-year period.
As reported in the British Journal of Cancer, 2612 patients were eligible for analysis, of which 91.7% were appropriately investigated. All 413 patients with stages II-ii (stage II with four or more involved nodes), III and IV disease were appropriately investigated compared with 1985 (90.3%) of 2199 patients with stage 0, I and II-i (stage II with three or less involved nodes) disease. However, only 269 (76%) of 354 investigations among lymph node-negative stage II patients were appropriate.
No patients with stage 0 or I disease had metastases and only two (0.3%) patients with stage II-i disease had metastases. Conversely, 2.2%, 2.6%, and 3.8% of these groups, respectively, had false-positive results.
The incidence of occult metastases increased by stage, being present in 6%, 13.9% and 57% of patients with stage II-ii, III and IV disease, respectively. The rate of false positives among these patients was 13.1%, 12.8% and 0%, respectively.
Of note, computed tomography was the only modality in which the percentage of true-positive results was higher than the false-positive results.
“These results prompted us to propose new local guidelines for staging asymptomatic breast cancer patients: only clinical stage III or IV patients require baseline investigation,” conclude Britton and co-authors.
They add: “The high specificity and convenience of computed tomography (chest, abdomen and pelvis) led us to recommend this as the investigation of choice in breast cancer patients requiring radiological staging.”
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By Laura Dean