Baseline Staging of Newly Diagnosed Breast Cancer – Kuwait Cancer Control Center Experience

Abstract

Objective: To determine the value of staging investigations in detecting metastases in newly diagnosed asymptomatic patients with breast cancer. Materials and Methods: A retrospective review of patients’ files with newly diagnosed breast cancer in the period from 1993 to 1998 was performed. Due to inadequate information, thirty-eight files were excluded leaving 785 files for analysis. Results: Of the total 785 patients, we found distant metastases at the time of primary diagnosis in 36 (4.6%) patients, bone metastases in 29 (3.7%) patients, pulmonary metastases in 6 (0.8%) patients and liver metastases in 5 (0.6%) patients. Overall, 0.7% of patients with clinical stage I and II disease had metastases compared with 16.2% of patients with clinical stage III disease (statistically significant p = 0.0001). Conclusion: The results confirm the low yield of routine bone scans, liver ultrasound and chest X-ray among patients with asymptomatic early-stage breast cancer. These tests are therefore not recommended for such patients, although intensive investigations are appropriate for more advanced tumors.

Repeat Hepatectomy for Breast Cancer Liver Metastases

“…Long-term survival is almost never achieved when liver metastases remain unresected (3-16 months). [4][5][6][7][8]32 Notably, these results reflect the multidisciplinary management of BCLM in an experienced center with thorough historical documentation of the cases.…”

Baseline staging tests based on molecular subtype is necessary for newly diagnosed breast cancer

“…In our patient population, liver metastasis rate was increased with advance in clinical stage (0%, 0.07%, and 1.07% for stage I, II and III). Lung metastasis rate of stage I, II, and III disease could be ranged from 0–0.1%, 0.2-0.4%, 1.0-4.3%, respectively [2,4,23,24]. Although many anesthesiologists consider CXR as necessary prior to general anesthesia, there is no strong medical evidence to support that routine CXR is necessary before surgery for breast cancer patients without symptoms of distant metastases [24-26].…”

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

“…Puglisi et al 6 in 2004 reviewed 516 cases of newly diagnosed breast cancer to get a low detection rate of 0.72% and 0.93% true positive results for liver and lung metastasis on LUS and CXR respectively and concluded that a complete diagnostic workup to detect metastases is unnecessary in the majority of patients with newly diagnosed breast cancer, whereas it may be indicated for specific patient categories such as those with stage III disease. A retrospective study at Kuwait Cancer Control Centre in 2007 by Abuzallouf et al 25 reported an incidence of 0.6% liver metastases and 0.8% pulmonary metastases at the time of primary diagnosis in asymptomatic breast cancer patients and an overall incidence of 0. Almost all the studies show a very low detection rate of metastatic disease (< 1%) with the routine use of Liver Ultrasonography and Chest x-ray in staging workup of early breast cancer patients.…”

“…In our opinion in patients with locally advanced breast cancer, metastasis detection rate is relatively high and in this group metastatic workup must be standard. [6] Retrospective 516 80 83 0.93 0.72 Ravaioli et al [15] Retrospective 1218 99 99 0.7 0.8 Dolly et al [19] Retrospective 231 81 60 0 0.72 Schneider et al [23] Retrospective 497 Routine CXR and LUS 0.4 1 Abuzallouf et al [25] Retrospective 823 Routine CXR and LUS 0.8 0. 6 Table 9: Showing the Comparison Between the Present and Other Studies CONCLUSIONS A careful review of the available literature shows that the procedures used in the staging of breast cancer have been widely discussed and criticised in the last two decades with a move towards a more selective approach to decide which patients should undergo instrumental analysis because of the low incidence of metastases at the onset of disease.…”