Systemic Imaging Not Effective in Detecting Metastatic Disease in Early-Stage Breast Cancer

Systemic imaging — CT scan, non-breast MRI, bone scan, or PET scan — is not effective in detecting metastasis in early-stage breast cancer according to a study presented at the 2018 San Antonio Breast Cancer Symposium. The finding is consistent with the National Comprehensive Cancer Network (NCCN) guidelines recommending against routine systemic imaging in early stage breast cancer patients without abnormal laboratory test results or distant metastasis. 

The study is the first to assess the relationship between appropriateness of ordered imaging and its ability to detect changes in stage among patients with early-stage breast cancer. The study authors retrospectively identified 882 patients with breast cancer, 544 with stage I and 338 with stage II disease, between 2011 and 2015 from the tumor registry. Patients charts, provider notes, and laboratory data were evaluated to determine if routine scans were ordered and to assess the appropriateness of ordering such scans. 

A total of 101 patients with stage I and 172 patients with stage II breast cancer underwent imagining studies within the first 6 months after diagnosis. Only 12.68% of scans in stage I patients and 18.24% of scans in stage II patients were deemed appropriate based on the patient’s risk of metastasis. There were no significant changes in breast cancer stage between the appropriately and inappropriately scanned groups.

Higher-grade patients were more likely to undergo systemic imaging, as well as patients with triple negative status and those were 50 or younger. These findings suggest using more stringent criteria when deciding whether to obtain systemic imaging studies of patients with stage I and II breast cancer. 

Reference

Gaba AG, Kraft R, Stjern BK, et al.Systemic imaging fails to detect metastasis in early stage breast cancer. Poster presentation at: San Antonio Breast Cancer Symposium; December 4-8, 2018; San Antonio, TX. Abstract P-01-01.