Overuse of Preoperative Staging of Patients Undergoing Neoadjuvant Chemotherapy for Breast Cancer
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Guidelines of the American Society of Clinical Oncology (ASCO), the National Comprehensive Cancer Network (NCCN), and the European Society for Medical Oncology (ESMO) discourage the use of imaging to stage newly diagnosed early breast cancer (stages 1 and 2). This study aimed to evaluate preoperative staging imaging rates among patients with stage 1 or 2 breast cancer treated with neoadjuvant chemotherapy (NAC).
From a prospectively maintained database, 303 patients with stage 1 or 2 breast cancer who had NAC from 2008 to 2016 were identified. The main outcome measures were the rate and outcomes of staging imaging performed.
The mean age of the 303 patients with stage 1 or 2 breast cancer was 51 years (range, 26–87 years). Of these 303 patients, 278 (92.4%) had invasive ductal cancer. 90 (30.2%) had estrogen receptor (ER)-positive disease, 79 (26.5%) had triple-negative disease, and 127 (42.6%) had human epidermal growth factor receptor 2 (HER2)-positive disease. Staging positron emission tomography (PET) or computed tomography (CT) scan was performed for 258 patients (85.2%), brain imaging for 94 patients (31%), bone scans for 117 patients (38.6%), and all three for 48 patients (15.8%). As a result, 15 patients (4.9%) with a positive PET/CT scan were upstaged to stage 4 breast cancer. No difference was observed among the ER-positive (p = 1.000), HER2-positive (p = 0.259), or triple-negative (p = 0.369) receptor profiles of the patients upstaged to stage 4 disease. One patient (1.1%) had positive brain imaging. Five patients (4.3%) had a positive bone scan, and three of these patients (60%) had bone metastasis also shown on the PET/CT scan.
Despite guideline recommendations, a high rate of preoperative staging imaging is completed for patients with clinical stage 1 or 2 breast cancer who receive NAC, with few positive results.
The authors thank The Fashion Footwear Charitable Foundation of New York, Inc.; The Margie and Robert E. Petersen Foundation; Associates for Breast and Prostate Cancer Studies; and Linda and Jim Lippman for their contributions to this study.
There are no conflicts of interest.
- 1.ASCO/ABIM choosing wisely. Cancer tests and treatments. 2012. Retrieved 1 March 2019 at http://www.choosingwisely.org/patient-resoruces/cancer-tests-and-treatments.
- 2.NCCN Clinical Practice Guidelines in Oncology. Breast Cancer. Version 3. 2015. Retrieved 1 March 2019 at www.nccn.org.
- 4.Lin NU, Thomssen C, Cardoso F, Cameron D, Cufer T, Fallowfield L, et al. International guidelines for management of metastatic breast cancer (MBC) from the European School of Oncology (ESO)–MBC task force: surveillance, staging, and evaluation of patients with early-stage and metastatic breast cancer. Breast. 2013;22(3):203–10.CrossRefGoogle Scholar