283P - Modest value of staging investigations in heavily node positive early breast cancer patients

Date 01 October 2012
Event ESMO Congress 2012
Session Poster presentation III
Topics Breast Cancer, Early Stage
Imaging, Diagnosis and Staging
Presenter Amandeep Dhadda
Authors A.S. Dhadda1, B. Sethugavalar1, K. Grover2, P. Kneeshaw2, P. McManus2
  • 1Oncology, Castle Hill Hospital, HU16 5JQ - Hull/UK
  • 2Breast Surgery, Castle Hill Hospital, HU16 5JQ - Hull/UK

Abstract

Background

Staging investigations for metastatic disease are not recommended for asymptomatic patients with early breast cancer. However, it is relatively common practice to perform staging in patients who are heavily node positive (4 or more nodes involved). This study explored the benefit of routine investigations in this patient group.

Methodology

All patients operated in Castle Hill Hospital, Hull, UK between January 2005 and December 2011 for early breast cancer and found to have 4 or more nodes involved on pathological assessment were identified. Staging investigations, consisting of CT chest, abdomen and pelvis and isotope bone scan, were reviewed. The need for additional investigations was recorded.

Results

A total of 231 patients were identified. 59 patients were excluded as no staging investigations were performed. In the remaining 172 patients staging investigations were positive in 12% (21/172). An additional 17% (29/172) required further investigations for equivocal scans and were not found to have metastatic disease. On univariate analysis with chi-square T stage (T1 3%, T2 9%, T3 14%, T4 38%; p < 0.001), number of nodes involved (4-6 4%, 7-9 9%, 10+ 21%; p = 0.009) and ratio of involved/uninvolved nodes (<0.5 2%, >0.5 16%; p= 0.037) were significant for predicting positive staging investigations (see table). On multivariate analysis using logistic regression only T4 breast cancers were significantly associated with positive staging investigations (p = 0.008).

Conclusions

Routine staging investigations have a modest pick up rate of metastatic disease in heavily node positive patients. Importantly 1 in 6 patients will require further investigations to exclude metastatic disease. Staging is recommended for all patients with locally advanced/inflammatory breast cancers but is probably not necessary in every pN2 patient.

Univariate analysis of factors predictive of positive staging investigations

Positive Staging scans
T Stage 1 2.7% (1/37) p= 0.001
2 8.9% (7/79)
3 14.3% (5/35)
4 38.1% (8/21)
Grade 1 0% (0/4) p = 0.751
2 12.7% (9/71)
3 12.3% (12/97)
ER Pos 11.8% (14/118) p = 0.838
Neg 13.0% (7/54)
HER2 Pos 16.7% (7/42) p = 0.284
Neg 10.5% (13/124)
LVI Pos 13.7% (14/102) p= 0.636
Neg 10% (7/70)
Age <50 10.7% (6/56) p= 0.806
>50 12.9% (15/116)
Nodes + 4-6 nodes 4.4% (3/68) p= 0.009
7-9 nodes 9.1% (3/33)
10+ nodes 21.1% (15/71)
NAC Y 10.3% (7/68) p= 0.637
N 13.5 % (14/104)
Node Ratio <0.5 2.1% (1/48) p= 0.037
>0.5 16.3% (20/123)

Disclosure

All authors have declared no conflicts of interest.