The incidence of metastases detected on a staging CT scan prior to neoadjuvant chemotherapy in early stage breast cancer

Date 03 May 2019
Event ESMO Breast Cancer 2019
Session Poster lunch
Topics Imaging
Breast Cancer
Presenter Rachel Broadbent
Citation Annals of Oncology (2019) 30 (suppl_3): iii34-iii38. 10.1093/annonc/mdz097
Authors R. Broadbent1, S. Ralston2, A. Armstrong1, C. O'Brien1, A.M. Wardley1, G. Wilson1, S. Howell2
  • 1Medical Oncology, The Christie NHS Foundation Trust, M20 4BX - Manchester/GB
  • 2Faculty Of Biology Medicine And Health, The University Of Manchester, Manchester/GB

Abstract

Background

The role of neoadjuvant chemotherapy (NACT) in the treatment of early stage breast cancer is well established. Guidelines differ in their recommendation for staging work-up prior to NACT. Our institutional guidelines recommend CT thorax abdomen and pelvis scan for all such patients and we sought to evaluate the rate of metastatic disease by breast cancer stage.

Methods

All cases identified for potentially curative NACT by the Multidisciplinary Team between 1/1/15-31/12/17 were included. Clinical records were reviewed. Those without a CT, inoperable when referred, with a diagnosis other than breast cancer or with loco-regional recurrence were excluded. Rates of metastases by tumour size (greatest by MRI, USS and mammography), lymph node stage (MRI and USS), receptor status and multifocality were calculated.

Results

185 patients were identified and 22 were excluded (no CT scan (6), inoperable (5), referred for adjuvant therapy (7), locoregional recurrence (3) and angiosarcoma (1)). 104/163 (64%) patients had a normal CT scan. 7/163 (4%) patients had definite metastases identified on their staging CT and 52/163 (32%) had an equivocal scan with further imaging required. Following additional imaging a further 10 patients had metastatic disease confirmed giving an overall incidence of of 10% (17 patients). The incidence of metastatic disease by stage (M1/total), (N + = node positive): T0N+ 0/1; T1N0 0/11; T1N+ 0/12; T2N0 1/42 (2%); T2N+ 9/53 (17%); T3N0 1/8 (12.5%);.

Conclusions

The incidence of metastatic disease detected on imaging during work-up for NACT was 10%. The rate of metastatic diagnosis increases with T stage in patients with clinical N0 disease. Staging can be omitted in patients T1/2N0 at diagnosis. Omission of staging CT scans in the T1-2N0 cohort would have reduced the imaging frequency across all modalities by 30% when both initial and additional imaging are considered.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

Sacha Howell.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.