ABSTRACT: Staging of Breast Cancer: New Recommended Standard Procedure
Background: Staging procedures used to detect metastatic breast
cancer at the time of diagnosis are bone scan (BS), chest X-ray
(CXR), liver ultrasonography (LUS) and laboratory parameters (LP).
These procedures are expensive and not all patients need them.
We aimed to identify groups of patients with different risks for
Methods: We reviewed data from 1,218 consecutive cases of breast
cancer. Pathological and biological parameters and instrumental
procedures performed at the time of diagnosis and during 6 months
of follow-up were recorded. True positive and negative, false
positive and negative cases were evaluated.
All cases were
grouped on the basis of tumour size, nodal involvement, biological
characteristics, menopausal status and age.
Results: We observed 46 (3.8%) true positive cases with metastatic
disease at the time of diagnosis. Documentation relating to BS,
CXR and LUS was available for 1,193, 1,206 and 1,206 patients,
respectively, with 37 (3.1%), 8 (0.7%) and 10 (0.8%) true positive
tests. Logistic regression analysis showed significant odds ratio
estimates for pT status and nodal status, thus highlighting the role
of these morphological data.
These findings suggest that breast
cancer patients can be divided into two subgroups: first group
pT1-3N0-1, with <=3 involved nodes, and second group pT1-3N1
with >=4 involved nodes, pT4 and pN2 (metastases detection rate
1.46 and 10.68%, respectively).
In the former group the appropriate
procedures of staging would only be laboratory parameters, whereas
in the latter group BS, CXR, LUS, LP and tumour markers CEA and
CA15.3 would be necessary.
Conclusions: The standard staging procedures to detect metastatic
disease at breast cancer diagnosis require modification.
basis of the literature data and our findings, the full staging
procedure is appropriate in the second group of patients.
[04/04/2002; Breast Cancer Research and Treatment]
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