Routine Liver Imaging is Unnecessary in the Work-Up of T1-2 NO-1 Breast Cancer

Abstract

M Akasheh, A Telfah, Routine Liver Imaging is Unnecessary in the Work-Up of T1-2 N0-1 Breast Cancer. 2002; 22(3-4): [247][248] Approximately 180,000 women are diagnosed with breast cancer annually in the United States, and accounts for approximately 30% of all incident cancers among women.1 In response to increasing demands to control cost, health care providers are re-examining their current methods of patient care to optimize the utilization of resources, in addition to allaying patients' psychological distress resulting from undergoing further investigations and falsepositive results. Professional organizations, including the American Society of Clinical Oncology and the National Comprehensive Cancer Network (NCCN), recommend postoperative surveillance strategies.2,3 However, recommendations on how extensive metastatic work-up can be, especially in early breast cancer, are not compelling. We postulated that it might be possible to identify a low-risk subset of patients from whom omission of liver imaging (LI) might be appropriate. The current study was undertaken to re-evaluate LI in patients with T1-2 N0-1 breast cancer, a subset of patients in whom the diagnostic yield has been suggested to be minimal. Materials and MethodsAll consecutive T1-2 N0-1 breast cancer patients diagnosed between January 1997 and October 2000 were identified by the King Hussein Medical Center (KHMC) Tumor Registry (group A). All the patients had pathological documentation of T1-2 N0-1 postoperatively. Their medical records were reviewed to identify documentation of LI reports. Patients with a concomitant history of other documented malignancies were excluded. The latest version of the American Joint Committee on Cancer tumor-node-metastasis staging system 4 at the time of entry into the KHMC Tumor Registry was used to identify patients with T1-2 N0-1 who were upstaged to stage IV by liver imaging, including liver ultrasound (US) and liver CT scans. All patients with T1-2 N0-1 M1 (based on liver metastasis) were identified by the Tumor Registry (group B). The total cost and charges for LI and healthcare provider visits were calculated based on the population under study, using fiscal year 2001 cost and charges. ResultsGroup A consisted of 620 patients of which 41 records could not be located. Of the 620 patients, 577 (93%) had medical records available for review, with radiological documentation which including 155 CT scans and 422 US scans. Group B consisted of two patients with stage IV disease presenting with T1-2 N0-1 but had positive LI on initial work-up. Liver US was performed in both group of patients. Both patients had epigastric pain requiring analgesia on initial presentation. Their liver biopsies proved to be metastatic breast carcinoma. Upon reviewing the medical records for symptomatic patients with upper abdominal discomfort and pain, 132 patients had undergone LI, and except for the aforementioned two patients, all LI were negative. The distribution of patients according to their T and N staging is shown in Table 1....