Expanded criteria for pretreatment staging CT in breast cancer

Abstract

Background There is wide variation in the approach to staging for distant metastatic disease in breast cancer. This study sought to identify factors predictive of distant metastatic disease at presentation to enable appropriate selection of patients for pretreatment CT. Methods Data were collected retrospectively for all patients with newly diagnosed breast cancer (screening and symptomatic) over 3 years (2014–2017). Detailed demographic, pathological, biological, and management data were recorded at presentation, and outcome data were recorded after follow-up. Binomial logistic regression was used to identify variables independently associated with distant metastatic disease at presentation. Results A total of 1377 patients with newly diagnosed breast cancer were identified, of whom 1025 had complete data; 323 staging CT examinations were performed. Distant metastases were identified at presentation in 47 (4.6 per cent). Some 30 of 47 patients with metastatic disease met established criteria for staging (T4, recurrence, symptoms of possible distant metastases), leaving 17 patients with metastatic disease potentially missed by use of these criteria alone. Multivariable analysis showed that tumour size at least 3 cm combined with sonographically abnormal axillary lymph nodes predicted a high probability of distant metastatic disease at presentation (positive predictive value 18.8 per cent, odds ratio 4.83, P < 0.001). Addition of this criterion increased the positive CT rate to 17.1 per cent. Conclusion Selective pretreatment CT staging can be further optimized with the addition of tumour size at least 3 cm with abnormal axillary nodes to established staging criteria.

Selective use of radiological staging in node‐positive stage II breast cancer patients may have a role in treatment

“…The necessary cascade of follow-up radiographic tests to assess change and characterization are often time-and cost-consuming, and emotionally exhausting for patients. 22 To our knowledge, since ASCO's 'Choosing Wisely' campaign, there have not been many studies apart from those cited 7,23 that examine the relationship between positive axillary disease and rates of DM. Our study adds to some existing evidence that this select group of stage II patients may benefit from baseline radiological staging.…”

“…For the above group of patients, the percentage of patients with DM was 18.8%, and based on data modelling, the inclusion of this criterion would reduce the rate of missed diagnoses of DM from an estimated 36% to 16%. 7 Diagnosis of DM in breast cancer patients is important to their appropriate management. There is emerging evidence that surgery and radiation do not extend survival in newly diagnosed metastatic breast cancer.…”

“…8 With the evidence showing that certain groups of stage II breast cancer patients have a higher risk of DM, radiological staging of this group may lead to improved diagnostic rates of DM and therefore result in more appropriate treatment for those patients who are upstaged to stage IV breast cancer. 7 The present study aim to determine the proportion of nodepositive stage II breast cancer patients who have DM at initial evaluation prior to treatment. We also wish to evaluate our radiologic staging patterns across stage II-III breast cancer patients at our centre.…”

Prediction for Distant Metastasis of Breast Cancer Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging Images under Deep Learning

“…Computer aided diagnosis (CADx) systems use systematic interventions that quantify tumor characteristics, enabling the use of more reproducible descriptors. The CADx system has been used for the diagnosis of thin-slice CT pulmonary nodules and multiparametric MRI [ 14 ] prostate lesions. Especially in the case of different interpretations by doctors, the results of AI have greater auxiliary reference value.…”

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“…According to the Royal College of Radiology (RCR) guidelines, the criteria for whole body staging in patients with breast cancer include T3 and T4 primary cancers, greater or equal to four abnormal nodes at axillary ultrasonography (USS) or greater or equal to four macro metastatic nodes at axillary surgery, and if symptoms raise the suspicion of metastatic disease [2]. At present, there is no evidence for carrying out staging prior to neoadjuvant chemotherapy in patients with T2 or less tumors with N1 or less disease [3]. The contrast-enhanced CT of the chest, abdomen, and pelvis, incorporating the supraclavicular fossae and proximal femora, is the modality of choice in most cases.…”