312P - Early detection of metastatic disease in asymptomatic early-stage breast cancer patients using imaging: A cross-sectional analytic study at a tertiary hospital

Background

Current guidelines recommend against imaging for early-stage breast cancer patients in the absence of signs and symptoms of metastatic disease. However, incidental detection of metastases through asymptomatic imaging evaluations has been documented. It is challenging to avoid overdiagnosis and unnecessary treatment and ensure detection of true metastases. This study aims to determine the utility of imaging modalities among asymptomatic early-stage breast cancer patients.

Methods

Medical records of 200 asymptomatic early-stage breast cancer patients who underwent any imaging modality from January 2020 to December 2023 at St. Luke’s Medical Center were reviewed. The presence of metastatic disease based on imaging results was determined per patient, as well as breast cancer stages, high-risk features, and subtypes. Data correlations were analyzed through Pearson’s Chi-squared test.

Results

Imaging modalities detected metastasis in 65% (130/200) of cases with either suspicious or definite lesions. 11.5% (23/200) have definite metastases with biopsy confirmation yielding 100% accuracy. It is important to note that biopsy confirmation was limited in this study, with majority of diagnoses relying solely on imaging. Among the imaging modalities, Chest CT Scan (71.43%) and PET CT Scan (69.23%) detected most metastases. Analysis revealed statistically significant (P < 0.001) correlation between cancer stage and metastasis detection. Higher cancer stages exhibited a progressively increased metastasis detection rate: 44.8% in Stage 1, 58.5% in Stage 2, and 80.5% in Stage 3. No significant association was found between metastasis and breast cancer subtype or presence of high-risk feature.

Conclusions

Imaging modalities exhibited substantial efficacy in identifying metastasis among asymptomatic early-stage breast cancer patients with high detection rate and accuracy. The incorporation of imaging modalities at the time of breast cancer diagnosis is highly recommended. However, in cases of uncertainty, decision to pursue metastatic workup via imaging should primarily be guided by disease stage rather than breast subtype or high-risk feature presence.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.