Staging of breast cancer: What standards should be used in research and clinical practice?

Abstract

The present study suggests that breast cancer patients can be divided into three subgroups with different detection rates for distant metastases at staging (0.59%, 2.94% and 15.53%), and that the standard practice should be changed. In the first (T1N0 and T1N1 patients with < or = 3 positive lymph nodes--41.13% of the patients) and the second group (T2N0, T2N1 with < or = 3 positive lymph nodes, T3N0 and T3N1 patients with < or = 3 positive lymph nodes--33.49% of the patients) there is no need for a complete set of staging procedures, whereas full procedural staging is needed in the third group of patients (T4, N1 with > 3 lymph nodes and N2, 25.37% of the patients).

Patient perceptions and expectations regarding imaging for metastatic disease in early stage breast cancer

“…The challenges around controlling excessive staging imaging for metastatic disease in asymptomatic early stage breast cancer are well recognised (McWhirter et al 2007; Puglisi et al 2005; Gerber et al 2003; Dillman and Chico 2000; Simos et al 2013; Schnipper et al 2012) and despite guidelines recommending against routine imaging is still frequently over utilised (Barrett et al 2009; McWhirter et al 2007; Puglisi et al 2005; Gerber et al 2003; Dillman and Chico 2000; Samant and Ganguly 1999; Ravaioli et al 1998; Al-Husaini et al 2008; Simos et al 2013). While most reports focus on diagnostic accuracy of the imaging test (the balance between true and false positive detection rates), (Barrett et al 2009; Puglisi et al 2005; Simos et al 2013; Brennan and Houssami 2012), relatively few have attempted to evaluate the performance of an imaging test on patient outcomes including the potential for harm both to the patient (e.g.…”

“…Patients with asymptomatic, newly diagnosed early stage breast cancer frequently undergo imaging for distant metastases (Simos et al 2013; Barrett et al 2009; Al-Husaini et al 2008; McWhirter et al 2007; Puglisi et al 2005; Gerber et al 2003; Dillman and Chico 2000; Samant and Ganguly 1999; Ravaioli et al 1998). Many groups have shown that the probability of detecting such metastases is low (Barrett et al 2009; Puglisi et al 2005; Gerber et al 2003; Dillman and Chico 2000; Samant and Ganguly 1999; Ravaioli et al 1998; Al-Husaini et al 2008; Simos et al 2013) with a recent meta-analysis reporting the median prevalence of metastases as 0.2%, 1.2% and 8% in patients with stage 1, 2 and 3 disease respectively (Brennan and Houssami 2012).…”

“…Many groups have shown that the probability of detecting such metastases is low (Barrett et al 2009; Puglisi et al 2005; Gerber et al 2003; Dillman and Chico 2000; Samant and Ganguly 1999; Ravaioli et al 1998; Al-Husaini et al 2008; Simos et al 2013) with a recent meta-analysis reporting the median prevalence of metastases as 0.2%, 1.2% and 8% in patients with stage 1, 2 and 3 disease respectively (Brennan and Houssami 2012). As this prevalence is significantly lower than the reported false positive rate of contemporary imaging (Brennan and Houssami 2012; Simos et al 2013), local (Laing 2012; Myers et al 2001; Alberta Health Services clinical practice guideline BR-012 version 2 effective July 2012), national (National Comprehensive Network (NCCN) clinical practice guidelines in oncology – Breast Cancer version 1 2014), and international (Senkus et al 2013) practice guidelines all generally recommend against the routine use of imaging.…”

Need for Routine X-Ray Chest and Ultrasonography of Liver in Workup, Diagnosis and Staging of Early Carcinoma of Breast in Patients Presenting First Time: A Prospective Single Institutional Study

“…In a retrospective analysis of 250 patients with operable breast cancer, Samant et al 10 in 1999 observed that it was rare to find metastatic disease at the time of diagnosis in symptom-free patients with low disease staging (pT1-2, N0-1). Ravaioli et al 21 in 1998, in a case series of 406 breast cancer patients reported a low detection rate of 1.5% and 1% for CXR and LUS respectively and concluded that there is no need for routine use of these staging procedures, especially in Early stage breast cancers. Dillman et al 22 in 2000, retrospectively studied the routine usage of radiological tests in 1167 breast cancer patients who were classified as having stage IIA, stage IIB or stage III disease on the basis of TN criteria yielding 1.2%, 6.8% and 17% true positive results respectively and concluded that these tests are overused in patients with newly diagnosed, early-stage breast cancer.…”

Routine Liver Imaging is Unnecessary in the Work-Up of T1-2 NO-1 Breast Cancer

“…The detection rate of LI was 0.59%, 2.94%, and 15.53%, respectively, and recommended full procedural staging for the third group. 10 A survey done by the American Society of Clinical Oncology (ASCO) revealed that practice patterns among ASCO member physicians with regards to follow-up of postmenopausal women with early breast cancer (stage I and II) was in accordance with the society guidelines. 11 The extent of preoperative work-up is not standardized by most professional organizations except for a few.…”