Baseline Staging Imaging for Distant Metastasis in Women with Stages I, II, and III Breast Cancer

Abstract

Background In Ontario, there is no clearly defined standard of care for staging for distant metastasis in women with newly diagnosed and biopsy-confirmed breast cancer whose clinical presentation is suggestive of early-stage disease. This guideline addresses baseline imaging investigations for women with newly diagnosed primary breast cancer who are otherwise asymptomatic for distant metastasis.
 Methods The medline and embase databases were systematically searched for evidence from January 2000 to April 2019, and the best available evidence was used to draft recommendations relevant to the use of baseline imaging investigation in women with newly diagnosed primary breast cancer who are otherwise asymptomatic. Final approval of this practice guideline was obtained from both the Staging in Early Stage Breast Cancer Advisory Committee and the Report Approval Panel of the Program in Evidence-Based Care.
 Recommendations These recommendations apply to all women with newly diagnosed primary breast cancer (originating in the breast) who have no symptoms of distant metastasis Staging tests using conventional anatomic imaging [chest radiography, liver ultrasonography, chest–abdomen– pelvis computed tomography (ct)] or metabolic imaging modalities [integrated positron-emission tomography (pet)/ct, integrated pet/magnetic resonance imaging (mri), bone scintigraphy] should not be routinely ordered for women newly diagnosed with clinical stage i or stage ii breast cancer who have no symptoms of distant metastasis, regardless of biomarker status. In women newly diagnosed with stage iii breast cancer, baseline staging tests using either anatomic imaging (chest radiography, liver ultrasonography, chest–abdomen–pelvis ct) or metabolic imaging modalities (pet/ct, pet/ mri, bone scintigraphy) should be considered regardless of whether the patient is symptomatic for distant metastasis and regardless of biomarker profile.

Cancer diagnosis in primary care

“…12 Asymptomatic early-stage breast cancer and prostate cancer do not require staging investigations. 13,14 Computed tomography scans with contrast are generally used to assess the thorax, abdomen, and pelvis, 15 12 either CT scan, which might be easier to obtain, or MRI, which can detect 2 to 3 times more lesions than CT scan, especially those less than 5 mm. Brain MRI is superior for identifying leptomeningeal disease and cranial nerve involvement.…”

Staging Investigations in Asymptomatic Early Breast Cancer Patients at the Cancer Centre of Southeastern Ontario

“…Since our study timeline in 2017, Cancer Care Ontario has published and updated their evidence-based practice guideline regarding baseline staging imaging for distant metastasis in women with stage I, II and III Breast Cancer [ 12 ]. For asymptomatic stage I and II breast cancer patients, there is no need for any radiological staging, irrespective of their biomarker profile.…”

“…Similarly, the European Society of Medical Oncology (ESMO) guideline does not support radiological staging in asymptomatic EBC (aEBC) [ 11 ]. The updated CCO guideline [ 12 ] and ASCO Choosing Wisely campaign [ 13 ] continue to recommend against routine staging in patients without symptoms.…”

Diagnostic de cancer en première ligne

“…Les examens de détermination du stade doivent refléter la distribution typique des métastases du cancer en question, de même que tout symptôme signalé par le patient (Encadré 3) 12 . Les cancers du sein et de la prostate asymptomatiques au stade précoce n'exigent pas d'examens de détermination du stade 13,14 .…”