Chapter 1 - Diagnosis and Staging of Breast Cancer and Multidisciplinary Team Working
Summary
- Frequent BC symptoms and signs include a palpable breast lump, skin or nipple retraction, bloody discharge from the nipple, changes in breast size or shape, skin rash, ulceration, erythema and eczema of the nipple–areola complex
- The gold standard for diagnosis is the triple diagnostic approach consisting of clinical examination, breast imaging and needle biopsy of suspicious lesions
- The diagnostic accuracy of CNB is superior when compared with FNAC. Moreover, hormone receptor and HER2 status can be determined from CNB, especially relevant if neoadjuvant systemic treatment is considered
- Breast MRI is beneficial when planning breast conservation in patients with invasive lobular cancer, when assessing response to neoadjuvant treatment and in surveillance of high-risk women with genetic propensity for BC
- Axillary ultrasound and needle biopsy from suspicious nodes is an essential part of the diagnostic procedure
- Sentinel node biopsy is the gold standard in patients without evidence of axillary nodal metastases in the pre-treatment ultrasound examination of the axilla
- Staging by imaging to detect distant metastases is considered for high-risk patients
- PET-CT scan may detect distant metastases undetected by other imaging methods but should not be used routinely
- The pathologist’s report should include all data needed for the planning of further locoregional and systemic adjuvant treatments. As a minimum: histological type and grade of invasive cancer, size, lymph nodes, lymphovascular invasion, oestrogen receptor, progesterone receptor, HER2 and cell proliferation
- The main goal of the multidisciplinary team meeting is to optimise the treatment for each patient. It is mandatory for all BC patients
Further Reading
Del Turco MR, Ponti A, Bick U, et al. Quality indicators in breast cancer care. Eur J Cancer 2010; 46:2344–2356.
Harris LN, Ismaila N, McShane LM, et al. Use of biomarkers to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2016; 34:1134–1150.
Houssami N, Ciatto S, Turner RM, et al. Preoperative ultrasound-guided needle biopsy of axillary nodes in invasive breast cancer: meta- analysis of its accuracy and utility in staging the axilla. Ann Surg 2011; 254:243–251.
Houssami N, Turner R, Morrow M. Preoperative magnetic resonance imaging in breast cancer: meta-analysis of surgical outcomes. Ann Surg 2013; 257:249–255.
Kesson EM, Allardice GM, George WD, et al. Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. BMJ 2012; 344:e2718.
Krag D, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol 2010; 11:927–933.
Lieske B, Ravichandran D, Wright D. Role of fine-needle aspiration cytology and core biopsy in the preoperative diagnosis of screen- detected breast carcinoma. Br J Cancer 2006; 95:62–66.
Perry N, Broeders M, de Wolf C, et al. European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis, fourth edition. European Commission, 2006, 2013.
Robertson F, Bondy M, Yang W, et al. Inflammatory breast cancer: the disease, the biology, the treatment. CA Cancer J Clin 2010; 60:351–375.
Senkus E, Kyriakides S, Ohno S, et al. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26(Suppl 5):v8–v30.
Wilson AR, Marotti L, Bianchi S, et al; EUSOMA (European Society of Breast Cancer Specialists). The requirements of a specialist Breast Centre. Eur J Cancer 2013; 49:3579–3587.
