The value of preoperative staging chest computed tomography to detect asymptomatic lung and liver metastasis in patients with primary breast carcinoma

Abstract

Little is known about the benefits of preoperative staging chest computed tomography (CT) in patients with asymptomatic breast cancer. We therefore investigated the clinical value of preoperative chest CT in detecting lung and liver metastases by retrospectively reviewing the records of 1,703 patients who underwent preoperative chest CT in a single institution between January 2006 and June 2009. Abnormal CT findings, including suspected metastases and indeterminate nodules in the lung or liver, were found in 266 patients (15.6%). Among these, 26 patients (1.5% of all patients and 9.8% of patients with abnormal CT findings) had true metastases, including 17 in the lungs, 3 in the liver, and 6 in both. True metastases were detected in 1 (0.2%), 0 (0%), and 24 (6.0%) patients with stage I, II, and III disease, respectively. The sensitivity, specificity, and positive predictive value of chest CT were 100, 89.1, and 11.3%, respectively, for lung metastasis and 100, 97.6, and 18.4%, respectively, for liver metastasis. All true metastatic lung lesions were all small-sized nodules, ranging from 0.2 to 1.5 cm in largest diameter, and could not be detected on chest X-rays. In conclusion, our results demonstrate the lack of usefulness of routine preoperative chest CT in detecting asymptomatic liver and lung metastasis in patients with early breast cancer. Chest CT, however, upstaged 6.0% of stage III patients to stage IV.

Use and Yield of Baseline Imaging and Laboratory Testing in Stage II Breast Cancer

“…In fact, although a greater portion of patients with HER21 BC and TNBC underwent extra testing as part of their staging evaluation, the percentage identified to have distant metastases did not differ by subtype; 2.2% (95% CI, 0.5%-6.4%) identified to have de novo metastatic disease were ER/PR-positive and HER2-negative, 1.9% (95% CI, 0%-9.9%) to have HER21 disease, and 2.1% (95% CI, 0.1%-11.1%) to have TNBC. Although the overall rate is higher in this stage II cohort than what had previously been reported in the literature (1.8% for Washington University [4] and 0% for the Korean study [9]), this rate may be explained by our younger population and/or inclusion of patients who received neoadjuvant therapy, but it nonetheless remains low and does not justify the use of CT in this population.…”

“…In our cohort, 20.2% of patients who had LFT did not receive neoadjuvant or adjuvant chemotherapy. With respect to imaging, our data contribute to previous work indicating that the yield of CT to detect metastases in early BC is approximately 1% [4,[8][9][10]. Despite these data, many physicians have continued to order imaging; our data demonstrate that in practice, factors such as nodal status and tumor subtype (e.g., HER2 or TNBC subtype) influence the likelihood of baseline testing.…”

“…Despite these data, many physicians have continued to order imaging; our data demonstrate that in practice, factors such as nodal status and tumor subtype (e.g., HER2 or TNBC subtype) influence the likelihood of baseline testing. Some of this may relate to perceived limitations of prior studies, including patient characteristics (e.g., studies from the Surveillance, Epidemiology, and End Results-Medicare database have included only patients age $65 years), exclusion of patients receiving neoadjuvant chemotherapy, unavailability of tumor subtype, and lack of long-term follow-up to allow understanding of the natural history of indeterminate lesions [2-4, [8][9][10][11].…”

Use of contrast-enhanced computed tomography in clinical staging of asymptomatic breast cancer patients to detect asymptomatic distant metastases

“…No clear evidence supports the routine use of imaging techniques to detect metastases in patients with early-stage operable breast cancer (12)(13)(14) and NCCN guidelines suggest that staging investigations should only be considered in patients with disease beyond stage IIIA (T3, N1, M0) or in those who show symptoms thereof (1). In agreement with the results of the current study, the ability to detect metastatic lesions by plain CT was increased in asymptomatic patients with stage III disease (5). It should be noted that the patients with disease beyond stage IIIA accounted for almost 60% of all the cases that were upstaged to stage IV.…”

“…Conventionally, patients with suspected distant metastases are screened for occult metastases using plain chest radiography, liver ultrasonography and bone scintigraphy (1,3), with computed tomography (CT) used in certain patients (4,5). Although the value of CT for asymptomatic patients and/or those with small tumors has not been clarified, its use in clinical staging is on the increase in clinical practice.…”