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Looking for Metastasis in Early Breast Cancer: Does Bone Scan Help? A Retrospective Review

      Abstract

      Background

      Routine staging investigations are not recommended for early breast cancer (EBC). Staging scans and further confirmatory tests add to the cost of breast cancer treatment. Despite recommendations from international guidelines, whole body bone scan (BS) is commonly used for staging EBC. We examined our experience with BS as a staging investigation when selectively used in EBC.

      Patients and Methods

      All EBC patients who underwent treatment through the Eastern Health breast unit during a 50-month period from January 2012 were included in this study. All staging BS results were reviewed to evaluate yield and false-positive rate. The causes of false-positive results were analyzed. The role of BS when performed along with computed tomographic scans of chest, abdomen, and pelvis (CTCAP) was evaluated.

      Results

      Even with the selective use of BS, we could only achieve a yield of 1% (95% confidence interval, −0.6, 2.7) in EBC. When combined with CTCAP, only one additional metastasis was detected in 194 BSs.

      Conclusion

      BS plays only a limited role in staging EBC. Patients who have undergone CTCAP will experience minimal benefit by undergoing additional BS.

      Keywords

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      References

        • Australian Institute of Health and Welfare (AIHW)
        Breast cancer in Australia: an overview, 2009.
        (Available at:)
        • Berry D.A.
        • Cronin K.A.
        • Plevritis S.K.
        • et al.
        Effect of screening and adjuvant therapy on mortality from breast cancer.
        N Engl J Med. 2005; 353: 1784-1792
        • Saadatmand S.
        • Bretveld R.
        • Siesling S.
        • Tilanus-Linthorst M.M.
        Influence of tumour stage at breast cancer detection on survival in modern times: population based study in 173,797 patients.
        BMJ. 2015; 351: h4901
        • Mailliez A.
        • Turpin A.
        • Vennin P.
        • Bonneterre J.
        Results and consequence of the systematic staging imaging at the time of the breast cancer diagnosis.
        Breast. 2013; 22: 555
        • Gerber B.
        • Seitz E.
        • Müller H.
        • et al.
        Perioperative screening for metastatic disease is not indicated in patients with primary breast cancer and no clinical signs of tumor spread.
        Breast Cancer Res Treat. 2003; 82: 29-37
        • Australian Institute of Health and Welfare (AIHW)
        Health system expenditure on cancer and other neoplasms in Australia, 2008-09.
        (Available at:)
        • Schnipper L.E.
        • Smith T.J.
        • Raghavan D.
        • et al.
        American Society of Clinical Oncology identifies five key opportunities to improve care and reduce costs: the top five list for oncology.
        J Clin Oncol. 2012; 30: 1715-1724
        • Patanaphan V.
        • Salazar O.
        • Risco R.
        Breast cancer: metastatic patterns and their prognosis.
        South Med J. 1988; 81: 1109-1112
        • Arvelo F.
        • Sojo F.
        • Cotte C.
        Cancer and the metastatic substrate.
        Ecancermedicalscience. 2016; 10: 701
        • Galasko C.
        The significance of occult skeletal metastases, detected by skeletal scintigraphy, in patients with otherwise apparently “early” mammary carcinoma.
        Br J Surg. 1975; 62: 694-696
        • Myers R.E.
        • Johnston M.
        • Pritchard K.
        • Levine M.
        • Oliver T.
        Breast Cancer Disease Site Group of the Cancer Care Ontario Practice Guidelines Initiative. Baseline staging tests in primary breast cancer: a practice guideline.
        CMAJ. 2001; 164: 1439-1444
        • Curigliano G.
        • Ferretti G.
        • Colleoni M.
        • et al.
        Bone scan had no role in the staging of 765 consecutive operable T(1-2)N(0-1) breast cancer patients without skeletal symptoms.
        Ann Oncol. 2001; 12: 724-725
        • Morris P.
        • O’Connor M.
        • O’Rafferty C.
        • et al.
        The excessive cost of baseline diagnostic imaging in early breast cancer.
        Ir Med J. 2009; 102: 149-152
        • McCartan D.
        • Prichard R.
        • MacDermott R.
        • et al.
        Role of bone scan in addition to CT in patients with breast cancer selected for systemic staging.
        Br J Surg. 2016; 103: 839-844
        • National Comprehensive Cancer Network
        NCCN clinical practice guidelines in oncology: breast cancer, version 4.2020.
        (Available at:)
        • Cardoso F.
        • Kyriakides S.
        • Ohno S.
        • et al.
        Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.
        Ann Oncol. 2019; 30: 1194-1220
        • Chagpar A.
        • Babiera G.
        • Aguirre J.
        • Caropreso P.
        • Hughes T.
        American College of Surgeons Communities. Variation in metastatic workup for patients with invasive breast cancer.
        Am J Surg. 2015; 210: 1147-1154
        • Brennan M.E.
        • Houssami N.
        Evaluation of the evidence on staging imaging for detection of asymptomatic distant metastases in newly diagnosed breast cancer.
        Breast. 2011; 21: 112-123
        • Norum J.
        • Andreassen T.
        Screening for metastatic disease in newly diagnosed breast cancer patients. What is cost-effective?.
        Anticancer Res. 2000; 20: 2193-2196
        • Barrett T.
        • Bowden D.
        • Greenberg D.
        • Brown C.
        • Wishart G.
        • Britton P.
        Radiological staging in breast cancer: which asymptomatic patients to image and how.
        Br J Cancer. 2009; 101: 1522
        • Cox M.R.
        • Giluland R.
        • Odling-Smee G.W.
        • Spence R.A.J.
        An evaluation of radionuclide bone scanning and liver ultrasonography for staging breast cancer.
        Aust N Z J Surg. 1992; 62: 550-555