Clinicopathologic Features Predictive of Distant Metastasis in Patients Diagnosed With Invasive Breast Cancer

Abstract

PURPOSE National Comprehensive Cancer Network and European Society for Medical Oncology guidelines suggest screening for distant metastasis (M1) in symptomatic patients or those with locally advanced breast cancer. These guidelines are based on studies that often used pathologic staging for analysis. Physician variability in screening for M1 has also resulted in overuse of diagnostic tests. We sought to identify clinicopathologic features at diagnosis that could guide testing for metastatic disease. METHODS Patients diagnosed with invasive breast cancer between January 2014 and December 2015 were identified from our institutional database. Demographic and clinical variables were collected, including receptor profiles and clinical TNM staging. Rates of upstaging for each clinical stage and rates of concordance of pathologic and clinical staging were analyzed. Univariate analysis and multivariate regression analysis ( P < .05) identified predictors of upstaging to stage IV disease. RESULTS A total of 370 patients met the inclusion criteria. Seventy patients (18.9%) had metastatic disease at diagnosis. The rate of upstaging for stages I, IIA, IIB, and III were 0%, 5.6%, 18.8%, and 36.6%, respectively. Advancing clinical stage, tumor size, and nodal status resulted in a significantly higher rate ( P < .001) of upstaging to M1 disease. Age and hormone receptor status were not associated with upstaging to stage IV disease. Clinical stages I-III were concordant with pathologic staging in 65(42.8%) of 152 patients (kappa’s index, 0.197; P < .000). CONCLUSION Advancing clinical stage, tumor size, and nodal status at diagnosis were predictive of upstaging to M1 disease in patients with breast cancer. Distant metastatic workup should be considered in patients with clinical stage IIB disease or higher.

Locally advanced breast cancer

“…Patients with apparent stage III disease have a sufficiently high incidence of simultaneous distant disease to warrant diagnostic imaging. With conventional staging procedures (chest x-ray, abdominal ultrasonography, and bone scan), the incidence of simultaneous metastases was >10% and up to 37% if chest and upper abdominal CT-scans were used [2]; [3]; [4]. Staging with 18 FDG-PET/CT is probably superior to conventional staging with a higher rate of detection of distant metastases.…”

Innovative Surgical Approaches That Improve Individual Outcomes in Advanced Breast Cancer

“…With conventional staging procedures (chest radiography, abdominal ultrasonography, and bone scan), the incidence of simultaneous metastases was >10% and up to 37% if chest and abdominal CT scans were used. 6 …”

Nomogram for predicting distant metastasis and prognosis in HR+/HER2- breast cancer patients without lymph node metastasis

“…(20) As T stage increases, the probability of de novo metastasis also increases signi cantly. (21,22) Central location of the primary site and high pathological grade have also been shown to be signi cantly associated with increased risk of de novo metastasis. (23,24) An interesting nding in this study was that PR negative was signi cantly associated with de novo metastasis in patients with HR + breast cancer.…”