Expanded criteria for pretreatment staging CT in breast cancer
Expanded criteria for pretreatment staging CT in breast cancer
BACKGROUND: There is wide variation in the approach to staging for distant metastatic disease in breast cancer. This study sought to identify factors predictive of distant metastatic disease at presentation to enable appropriate selection of patients for pretreatment CT. METHODS: Data were collected retrospectively for all patients with newly diagnosed breast cancer (screening and symptomatic) over 3 years (2014-2017). Detailed demographic, pathological, biological, and management data were recorded at presentation, and outcome data were recorded after follow-up. Binomial logistic regression was used to identify variables independently associated with distant metastatic disease at presentation. RESULTS: A total of 1377 patients with newly diagnosed breast cancer were identified, of whom 1025 had complete data; 323 staging CT examinations were performed. Distant metastases were identified at presentation in 47 (4.6 per cent). Some 30 of 47 patients with metastatic disease met established criteria for staging (T4, recurrence, symptoms of possible distant metastases), leaving 17 patients with metastatic disease potentially missed by use of these criteria alone. Multivariable analysis showed that tumour size at least 3 cm combined with sonographically abnormal axillary lymph nodes predicted a high probability of distant metastatic disease at presentation (positive predictive value 18.8 per cent, odds ratio 4.83, P < 0.001). Addition of this criterion increased the positive CT rate to 17.1 per cent. CONCLUSION: Selective pretreatment CT staging can be further optimized with the addition of tumour size at least 3 cm with abnormal axillary nodes to established staging criteria.
Roszkowski, N
203ee322-f503-445e-9e50-cad5210d9d33
Lam, S S
ccd40872-3c0f-4b65-b1f7-37538a2be112
Copson, E
a94cdbd6-f6e2-429d-a7c0-462c7da0e92b
Cutress, R I
68ae4f86-e8cf-411f-a335-cdba51797406
Oeppen, R
44f4a607-a347-43d7-8bd4-c59e0d772f56
March 2021
Roszkowski, N
203ee322-f503-445e-9e50-cad5210d9d33
Lam, S S
ccd40872-3c0f-4b65-b1f7-37538a2be112
Copson, E
a94cdbd6-f6e2-429d-a7c0-462c7da0e92b
Cutress, R I
68ae4f86-e8cf-411f-a335-cdba51797406
Oeppen, R
44f4a607-a347-43d7-8bd4-c59e0d772f56
Roszkowski, N, Lam, S S, Copson, E, Cutress, R I and Oeppen, R
(2021)
Expanded criteria for pretreatment staging CT in breast cancer.
BJS Open, 5 (2).
(doi:10.1093/bjsopen/zraa006).
Abstract
BACKGROUND: There is wide variation in the approach to staging for distant metastatic disease in breast cancer. This study sought to identify factors predictive of distant metastatic disease at presentation to enable appropriate selection of patients for pretreatment CT. METHODS: Data were collected retrospectively for all patients with newly diagnosed breast cancer (screening and symptomatic) over 3 years (2014-2017). Detailed demographic, pathological, biological, and management data were recorded at presentation, and outcome data were recorded after follow-up. Binomial logistic regression was used to identify variables independently associated with distant metastatic disease at presentation. RESULTS: A total of 1377 patients with newly diagnosed breast cancer were identified, of whom 1025 had complete data; 323 staging CT examinations were performed. Distant metastases were identified at presentation in 47 (4.6 per cent). Some 30 of 47 patients with metastatic disease met established criteria for staging (T4, recurrence, symptoms of possible distant metastases), leaving 17 patients with metastatic disease potentially missed by use of these criteria alone. Multivariable analysis showed that tumour size at least 3 cm combined with sonographically abnormal axillary lymph nodes predicted a high probability of distant metastatic disease at presentation (positive predictive value 18.8 per cent, odds ratio 4.83, P < 0.001). Addition of this criterion increased the positive CT rate to 17.1 per cent. CONCLUSION: Selective pretreatment CT staging can be further optimized with the addition of tumour size at least 3 cm with abnormal axillary nodes to established staging criteria.
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zraa006
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Accepted/In Press date: 27 August 2020
e-pub ahead of print date: 14 March 2021
Published date: March 2021
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© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.
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Local EPrints ID: 448570
URI: http://eprints.soton.ac.uk/id/eprint/448570
ISSN: 2474-9842
PURE UUID: 062b705c-9a96-4da0-b8eb-f16933cf78de
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Date deposited: 27 Apr 2021 16:39
Last modified: 16 Mar 2024 11:55
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Author:
N Roszkowski
Author:
S S Lam
Author:
R Oeppen
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