Bone Scan for Baseline Staging in Invasive Breast Cancer at the Time of Primary Presentation

Puglisi, Fabio; Andreetta, Claudia; Fasola, Gianpiero; Cattaruzzi, E.; Geatti, Onelio

doi:10.1159/000111546

Cited by 5 publications

(3 citation statements)

References 44 publications

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“…The reasons given for this are the low prevalence of distant metastases in asymptomatic patients and the resulting lack of cost effectiveness [18]; furthermore, the high rate of false-positive results not only entail additional costs but can also impair the quality of life of asymptomatic patients [19]. …”

Section: Discussionmentioning

confidence: 99%

Staging of Primary Breast Cancer Is not Indicated in Asymptomatic Patients with Early Tumor Stages

et al. 2014

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Background: The routinely practiced staging for distant metastasis in patients with primary breast cancer has been increasingly questioned. Patients and Methods: Data from 742 patients with breast cancer who had completed staging (chest x-ray, liver ultrasound, and bone scan) were retrospectively analyzed. Present findings were transferred to a dataset of a voluntarily monitored benchmarking project by the West German Breast Center that included patient data of 179 breast cancer centers. Results: Routine staging examinations revealed in 1.2% (n = 9) distant metastasis and in 38.8% (n = 288) suspicious results. In total, 15 patients (2%) had distant metastases confirmed by additional diagnostics. The existence of distant metastases correlated with tumor size, nodal state, and lymphatic vessel spread. Tumor size and nodal state were independent predictors for disseminated disease. The risk of exhibiting distant metastases was 0.77% for patients with tumor stage pT1 pN1. Based on these findings, in 159,310 patients 41,728 chest x-rays, 43,950 liver ultrasounds, and 39,037 bone scans could have been avoided. Conclusion: Asymptomatic patients with tumor stages ≤ pT1 pN1 do not benefit from staging of primary breast cancer. Suspending staging examinations for these patients could reduce cost without restricting oncologic safety.

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Section: Discussionmentioning

confidence: 99%

Staging of Primary Breast Cancer Is not Indicated in Asymptomatic Patients with Early Tumor Stages

et al. 2014

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“…The most common first sites of distant metastases are bone, lung, brain and liver; up to 10% of patients with metastatic disease will have lesions at multiple sites (Patanaphan et al, 1988). Conventionally, high-risk patients have been screened for occult metastases in these organs by using chest radiographs (CXR), liver ultrasound (US) and bone scintigraphy (BS) (Puglisi et al, 2007). More recently, techniques such as computed tomography (CT), magnetic resonance imaging and 18 FDG-positron emission tomography (Avril et al, 2007) have started to be used in certain circumstances, or for problem-solving.…”

mentioning

confidence: 99%

Radiological staging in breast cancer: which asymptomatic patients to image and how

et al. 2009

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Background:Approximately 4% of patients diagnosed with early breast cancer have occult metastases at presentation. Current national and international guidelines lack consensus on whom to image and how.Methods:We assessed practice in baseline radiological staging against local guidelines for asymptomatic newly diagnosed breast cancer patients presenting to the Cambridge Breast Unit over a 9-year period.Results:A total of 2612 patients were eligible for analysis; 91.7% were appropriately investigated. However in the subset of lymph node negative stage II patients, only 269 out of 354 (76.0%) investigations were appropriate. No patients with stage 0 or I disease had metastases; only two patients (0.3%) with stage II and ⩽3 positive lymph nodes had metastases. Conversely, 2.2, 2.6 and 3.8% of these groups had false-positive results. The incidence of occult metastases increased by stage, being present in 6, 13.9 and 57% of patients with stage II (⩾4 positive lymph nodes), III and IV disease, respectively.Conclusion:These results prompted us to propose new local guidelines for staging asymptomatic breast cancer patients: only clinical stage III or IV patients require baseline investigation. The high specificity and convenience of computed tomography (chest, abdomen and pelvis) led us to recommend this as the investigation of choice in breast cancer patients requiring radiological staging.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Tanaka

2012

Oncol Lett

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Abstract. The use of computed tomography (CT) with regards to the clinical staging of patients with asymptomatic breast cancer has been on the increase in clinical practice. However, the benefits of routine CT have yet to be fully clarified. This study investigated the value of employing contrast-enhanced CT (CECT) to screen for distant metastases in patients with asymptomatic breast cancer. The clinical records of 483 patients with asymptomatic breast cancer who underwent CECT at a single institution between April 2006 and January 2011 were reviewed retrospectively. The CECT results were classified into normal, true-positive (metastases) or false-positive findings. Abnormal CECT findings, including true-and falsepositive results, were detected in 65 patients (13.5%). Of these, 26 patients (5.4%) showed confirmed true metastatic disease, including 18 lung metastases, 11 liver metastases and 13 bone metastases. Upstaging to stage IV due to the results of the CECT scan occurred in 0 of 155 patients at stage I, 5 of 261 patients (1.9%) at stage II and 21 of 67 patients (31.3%) at stage III. The false-positive rates were 7.7, 9.0 and 8.7% in stages I, II and III, respectively. The size of the lung or liver metastasis was significantly larger than the false-positive lesion. Routine CECT did not appear to be useful for detecting distant metastases in completely asymptomatic patients. Conversely, a small number of patients were upstaged from early to stage IV and a predictive factor beyond T and N stage alone appears to be needed in order to predict which asymptomatic patients have distant metastases.

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Bone Scan for Baseline Staging in Invasive Breast Cancer at the Time of Primary Presentation

Cited by 5 publications

References 44 publications

Staging of Primary Breast Cancer Is not Indicated in Asymptomatic Patients with Early Tumor Stages

Staging of Primary Breast Cancer Is not Indicated in Asymptomatic Patients with Early Tumor Stages

Radiological staging in breast cancer: which asymptomatic patients to image and how

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

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