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

Barrett, Tristan; Bowden, David J.; Greenberg, David; Brown, C. B.; Wishart, Gordon; Britton, P

doi:10.1038/sj.bjc.6605323

Cited by 63 publications

(86 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients themselves often request staging procedures under the false assumption that these examinations might give them the best possible certainty. Since mammography screening became routine, the median T-stage of primary breast cancer has decreased; thus, assuming this trend continues, distant metastasis at time of diagnosis will increasingly become a rarity [3,6]. With rising cost pressures in the health care system, however, it is essential to consider changing practices and research alternatives.…”

Section: Discussionmentioning

confidence: 99%

“…Patients that benefit most from examinations are those with an increased risk of metastasis, defined by the presence of e.g., large tumors, negative hormone receptors, HER2 overexpression, and high nodal status [3,4,5,6,7,8,9,10]. In addition, suspicious or even false-positive staging results lead to expensive further diagnostics and generate anxiety and uncertainty in patients [5,7].…”

Section: Introductionmentioning

confidence: 99%

“…The routine performance of these time-consuming and expensive examinations has increasingly been questioned, particularly in asymptomatic patients with early-stage breast cancer, because very few of these patients actually exhibit distant metastases in the skeleton, lungs and liver [3]. Patients that benefit most from examinations are those with an increased risk of metastasis, defined by the presence of e.g., large tumors, negative hormone receptors, HER2 overexpression, and high nodal status [3,4,5,6,7,8,9,10].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2014

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2014

View full text Add to dashboard Cite

show abstract

“…[4][5][6][7][8] Despite these evidence-based guidelines, imaging for distant metastases in patients with a new diagnosis of breast cancer remains common. 2,[9][10][11][12] In response to the Choosing Wisely campaign of the American Board of Internal Medicine Foundation, 13 the American Society of Clinical Oncology (ASCO) published its inaugural "top 5" list for choosing wisely in oncology. 14 It recommended against routine imaging for staging purposes in women with early breast cancer, because "such imaging adds little benefit to patient care and has the potential to cause harm."…”

mentioning

confidence: 99%

Imaging for distant metastases in women with early-stage breast cancer: a population-based cohort study

Simos

Catley

Walraven

et al. 2015

CMAJ

View full text Add to dashboard Cite

Interpretation: Despite recommendations from multiple international guidelines, most Ontario women with early-stage breast cancer underwent imaging to detect distant metastases. Inappropriate imaging in asymptomatic patients with early-stage disease is costly and may lead to harm. The use of population datasets will allow investigators to evaluate whether or not strategies to implement practice guidelines lead to meaningful and sustained change in physician practice. AbstractCMAJ Podcasts: editor's summary at soundcloud

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

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

Cited by 63 publications

References 11 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

Imaging for distant metastases in women with early-stage breast cancer: a population-based cohort study

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

Contact Info

Product

Resources

About