Staging Investigations in Breast Cancer: Collective Opinion of UK Breast Surgeons

Abstract

Introduction. Certain clinicopathological factors are associated with a higher likelihood of distant metastases in primary breast cancer. However, there remains inconsistency in which patients undergo formal staging for distant metastasis and the most appropriate investigation(s). Aims. To identify UK surgeon preferences and practice with regard to staging investigations for distant metastases. Methods. A survey was disseminated to members of the Association of Breast Surgery by e-mail regarding surgeon/breast unit demographics, use of staging investigations, and local policy on pre/postoperative staging investigations. Several patient scenarios were also presented. Results. 123 of 474 (25.9%) recipients completed the survey. Investigations routinely employed for patients diagnosed with early breast cancer included serological/haematological tests (72% respondents), axillary ultrasound (67%), liver ultrasound (2%), chest radiograph (36%), and computed tomography (CT) (1%). Three areas contributed to decisions to undertake staging by CT scan: tumour size, axillary nodal status, and plan for chemotherapy. There was widespread variation as to criteria for CT staging based on tumour size and nodal status, as well as the choice of staging investigation for the clinical scenarios presented. Conclusions. There remains variation in the use of staging investigations for distant disease in early breastcancer despite available guidelines.

Value of routine staging imaging studies for patients with stage III breast cancer

“…Clinical or radiological involvement of one or more axillary lymph nodes was the most common indication for a preoperative CT scan. Nearly half of respondents obtained preoperative CT scans for T3 or T4 tumors . In the current study, patients with T4 disease were more likely to undergo RSIS, most commonly prior to neoadjuvant chemotherapy.…”

Role of bone scan in addition to CT in patients with breast cancer selected for systemic staging

“…However, improved sensitivity and specificity for axillary ultrasonography in detecting axillary nodal metastases before surgery has increased the number of patients being designated as at least clinical stage IIB and, although the NCCN does not recommend routine staging, it is likely that many of these patients will nevertheless undergo systemic staging owing to patient or physician preference. A 2013 survey revealed that 86 per cent of responding breast surgeons in the UK would perform staging CT in the event of clinical or radiological evidence of nodal involvement.…”

The Benefit of Baseline Staging–Risk Assessment of Distant Breast Cancer Metastases by Tumor Stage

“…Although it is generally accepted that the likelihood of metastasis is extremely low in asymptomatic early breast cancer, routine use of baseline staging still varies considerably (7). Risk assessment of each tumor stage will Figure 1.…”