Adherence to NCCN Guidelines for Chest CT in Early Stage Breast Cancer Lacking

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NCCN Guidelines recommend patients with stage I-II breast cancer undergo chest CT only when symptomatic.
NCCN Guidelines recommend patients with stage I-II breast cancer undergo chest CT only when symptomatic.

A large percentage of patients with stage I and II breast cancer underwent unneeded chest CT as part of the initial workup, according to results from a recent study in the Journal of the National Comprehensive Cancer Network.

Almost one-third of patients with early-stage breast cancer had pulmonary nodules, though pulmonary metastases were subsequently diagnosed in only 1.3% of these patients. This rate of CT scans at this disease stage does not align with NCCN Guidelines; adherence to the guidelines would reduce unnecessary chest CT scans.

NCCN Guidelines recommend patients with stage I and II breast cancer undergo chest CT only when symptomatic, yet many asymptomatic patients undergo chest CT.

This study identified from a prospectively maintained database patients with breast cancer diagnosed between 1998 and 2012. Researchers included patients with stage I/II disease who did not undergo neoadjuvant chemotherapy.

In total, 3321 patients had early-stage breast cancer; 62.1% (n=2062) had stage I disease, and 37.9% (n=1259) had stage II disease. More than 10% of patients with stage I disease (n=227) and 36.2% of patients with stage II disease (n=456) underwent chest CT.

Of the patients who underwent CT, 26.9% (n=184) had pulmonary nodules that were 5 mm or smaller (69.6% of patients), 5-10 mm (25.0%), 11-20 mm (3.2%), and 20 mm or larger (2.2% of patients).

Only 9 patients (1.3%) who underwent CT for staging eventually received a diagnosis of pulmonary metastases, at an average of 25 months after initial CT.

Reference

1. Dull B, Linkugel A, Margenthaler JA, Cyr AE. Overuse of chest CT in patients with stage I and II breast cancer: an opportunity to increase guidelines compliance at an NCCN member institution. J Natl Compr Canc Netw. 2017;15(6):783-789.

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