Staging of Breast Cancer: New Recommended Standard Procedure

Abstract

The standard staging procedures to detect metastatic disease at breast cancer diagnosis require modification. On the basis of the literature data and our findings, the full staging procedure is appropriate in the second group of patients.

The Role of Radiotracer Imaging in the Diagnosis and Management of Patients with Breast Cancer: Part 1—Overview, Detection, and Staging

“…The presence of distant metastases, outside the breast and regional nodes, is an important factor predicting prognosis and directing the intensity of care, because metastatic (stage IV) breast cancer has a low likelihood of cure. Because of the low yield, cost, and distress associated with investigating detected abnormalities that are-for the most part-falsepositives, baseline systemic staging is neither performed nor recommended (54) before surgery and axillary staging in patients with early-stage breast cancer (56,98,99). In the patients with more advanced disease (such as LABC or inflammatory breast cancer), however, some evidence supports the use of systemic imaging staging at the diagnosis to rule out stage IV disease, which would significantly alter treatment options because of the high likelihood of distant metastases (30,100).…”

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

“…On the contrary, several studies reported a limited value of breast cancer baseline staging, suggesting that complete diagnostic workup should be limited to patients with higher pre-test probability of distant metastases. 6,15,16 In particular, it has been shown that the prevalence of detectable metastatic disease in newly diagnosed breast cancer patients is exceedingly low and increases from stage I to stage III. 15,16 LUS detected liver metastasis very rarely in pathological stage I-II disease and approximately 2-3% in stage III disease.…”

“…6,15,16 In particular, it has been shown that the prevalence of detectable metastatic disease in newly diagnosed breast cancer patients is exceedingly low and increases from stage I to stage III. 15,16 LUS detected liver metastasis very rarely in pathological stage I-II disease and approximately 2-3% in stage III disease. 17,18 Chest x-ray has the lowest detection rate of all staging investigations.…”

“…In a retrospective analysis of 1218 consecutive breast cancer patients by Ravaioli et al 15 in 2002, a very low detection rate of 0.7% for CXR and 0.8% for LUS was observed, which lead to the conclusion that a more selective approach to decide which patients should undergo instrumental analysis because of the low incidence of distant metastases at the onset of disease is very essential. Schneider et al 23 in 2003 reported a low detection rate of 0.4% pulmonary and 1% liver metastases and suggested that chest x-ray and liver ultrasonography can be omitted in the staging of asymptomatic early breast cancer patients.…”

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

“…Additonally, the National Comprehensive Cancer Network (NCCN) guidelines recommended the use of imaging only in cases with locally advanced disease or signs/symptoms that are suggestive of distant metastases (1). Notably, approximately 4% of breast cancer patients have detectable metastatic disease at the time of primary diagnosis and the majority of these patients exhibit symptoms of metastasis (2). However, if primary surgical treatment is performed after overlooking occult metastases in an asymptomatic patient, the delay in beginning systemic pharmacotherapy may affect the prognosis.…”