Abstract 227P
Background
An accurate staging is essential to determine the optimal treatment approach for breast cancer. In resource-limited settings, breast cancer staging relies on physical examination, a frontal chest radiograph, abdominal ultrasound and blood chemistries. Our understanding of the performance of this standard clinical and radiographic staging in sub-Saharan Africa is limited.
Methods
The PELO study is a prospective observational cardiac imaging study of women with newly-diagnosed breast cancer for whom an anthracycline-based chemotherapy regimen is planned. Prior to initiation of chemotherapy, women undergo a cardiac MRI which includes incidental partial imaging of adjacent thoracic structures. For participants enrolled from September 2019 to October 2020, we abstracted clinical exam findings, radiographic results, and the provided oncologic stage from clinical records. Cardiac MRI images were reviewed by two experts in cardiac imaging.
Results
A total of 22 participants were enrolled, including 11 (50%) living with HIV. Locally advanced stage was common with 17 (77%) patients having stage III malignancy. All patients were planned to have curative-intent treatment. Thirteen (59%) participants had extracardiac findings identified on MRI. These included pulmonary masses not identified on chest X-ray (3), lesions consistent with metastatic involvement of spine (2), pleural effusion (5), axillary masses (11), pectoral muscle involvement (2), and hepatic metastasis (1). In addition, pericardial effusions were detected in 2 (9%) patients. Subsequent computed tomography (CT) imaging confirmed some lesions as metastatic: As a result of the cardiac MRI findings, treatment intent and treatment plan was modified for 3 (14%) patients.
Conclusions
Cardiac MRI revealed new extracardiac findings in pre-operative breast cancer patients, confirming the underperformance of the routine staging approach in resource-limited settings. Patients with locally advanced breast cancer could benefit from advanced staging tools. However, as delays for CT scan are long, a pragmatic approach can be to start neo-adjuvant hormonal therapy or chemotherapy, and if necessary, adapt the treatment with subsequent advanced imaging results.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Botswana Havard Partnership for Health, Botswana.
Funding
Massachusetts General Hospital, Boston, MA, USA.
Disclosure
T. Neilan: Financial Interests, Personal, Advisory Role: Intrinsic Imaging, H3-Biomedicine, Amgen, AbbVie; Financial Interests, Institutional, Research Grant: AstraZeneca. P. Vuylsteke: Financial Interests, Institutional, Invited Speaker: Novartis; Financial Interests, Personal and Institutional, Advisory Board: MSD; Financial Interests, Institutional, Advisory Board: BMS; Financial Interests, Institutional, Advisory Board: Eli Lilly; Financial Interests, Personal and Institutional, Invited Speaker: Roche; Financial Interests, Institutional, Speaker’s Bureau: Pfizer. All other authors have declared no conflicts of interest.