Patients receiving neoadjuvant chemotherapy for breast cancer do not require routine staging investigations
Association of Breast Surgery ePoster Library. McLean R. 05/13/19; 257117; P073
Mr. Ross McLean
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P073
Topic: Diagnosis/ Referral
Introduction: North East Cancer Network guidelines recommend pre-operative staging for ≥T3 disease (clinically or on imaging), if ≥4 proven malignant axillary nodes or symptoms of distant disease. However there has been a tendency to stage all patients receiving neoadjuvant chemotherapy (NACT). We assessed the validity of this. Methods :Single centre retrospective review of cases receiving NACT from 2016-17. Indication and respective tumour biology was recorded. Computed Tomography of chest, abdomen and pelvis was used for staging. Results:58 patients underwent NACT, 51 of whom had staging investigations. Of the 7 patients not staged only one met the criteria.IndicationNumber stagedMet criteria (%)Normal staging (%)Indeterminate(%)Metastatic(%)Inflammatory Ca(13)1313 (100)463Triple negative(11)95 (56)621For dual anti Her2(28)2318 (78)1274ER+, Her2- downstage(6)66 (100)411Total5142 (82)26 (51)16 (31.4)9 (17.6)26 CTs were normal (51%). 18 were indeterminate, 12 of whom required follow up imaging, 2 of which were confirmed to have metastatic disease. 7 patients had metastatic disease on initial CT.Overall 9 patients had metastatic disease (17.6%), 8 of whom met our staging criteria. In total, 93 staging CT scans were performed.Conclusion:88% of patients with metastatic disease met the staging criteria. These results show that patients receiving NACT for breast cancer do not require routine staging investigations. A selective policy should be adopted, particularly for triple negative and for dual anti-HER2 therapy.
Topic: Diagnosis/ Referral
Introduction: North East Cancer Network guidelines recommend pre-operative staging for ≥T3 disease (clinically or on imaging), if ≥4 proven malignant axillary nodes or symptoms of distant disease. However there has been a tendency to stage all patients receiving neoadjuvant chemotherapy (NACT). We assessed the validity of this. Methods :Single centre retrospective review of cases receiving NACT from 2016-17. Indication and respective tumour biology was recorded. Computed Tomography of chest, abdomen and pelvis was used for staging. Results:58 patients underwent NACT, 51 of whom had staging investigations. Of the 7 patients not staged only one met the criteria.IndicationNumber stagedMet criteria (%)Normal staging (%)Indeterminate(%)Metastatic(%)Inflammatory Ca(13)1313 (100)463Triple negative(11)95 (56)621For dual anti Her2(28)2318 (78)1274ER+, Her2- downstage(6)66 (100)411Total5142 (82)26 (51)16 (31.4)9 (17.6)26 CTs were normal (51%). 18 were indeterminate, 12 of whom required follow up imaging, 2 of which were confirmed to have metastatic disease. 7 patients had metastatic disease on initial CT.Overall 9 patients had metastatic disease (17.6%), 8 of whom met our staging criteria. In total, 93 staging CT scans were performed.Conclusion:88% of patients with metastatic disease met the staging criteria. These results show that patients receiving NACT for breast cancer do not require routine staging investigations. A selective policy should be adopted, particularly for triple negative and for dual anti-HER2 therapy.
P073
Topic: Diagnosis/ Referral
Introduction: North East Cancer Network guidelines recommend pre-operative staging for ≥T3 disease (clinically or on imaging), if ≥4 proven malignant axillary nodes or symptoms of distant disease. However there has been a tendency to stage all patients receiving neoadjuvant chemotherapy (NACT). We assessed the validity of this. Methods :Single centre retrospective review of cases receiving NACT from 2016-17. Indication and respective tumour biology was recorded. Computed Tomography of chest, abdomen and pelvis was used for staging. Results:58 patients underwent NACT, 51 of whom had staging investigations. Of the 7 patients not staged only one met the criteria.IndicationNumber stagedMet criteria (%)Normal staging (%)Indeterminate(%)Metastatic(%)Inflammatory Ca(13)1313 (100)463Triple negative(11)95 (56)621For dual anti Her2(28)2318 (78)1274ER+, Her2- downstage(6)66 (100)411Total5142 (82)26 (51)16 (31.4)9 (17.6)26 CTs were normal (51%). 18 were indeterminate, 12 of whom required follow up imaging, 2 of which were confirmed to have metastatic disease. 7 patients had metastatic disease on initial CT.Overall 9 patients had metastatic disease (17.6%), 8 of whom met our staging criteria. In total, 93 staging CT scans were performed.Conclusion:88% of patients with metastatic disease met the staging criteria. These results show that patients receiving NACT for breast cancer do not require routine staging investigations. A selective policy should be adopted, particularly for triple negative and for dual anti-HER2 therapy.
Topic: Diagnosis/ Referral
Introduction: North East Cancer Network guidelines recommend pre-operative staging for ≥T3 disease (clinically or on imaging), if ≥4 proven malignant axillary nodes or symptoms of distant disease. However there has been a tendency to stage all patients receiving neoadjuvant chemotherapy (NACT). We assessed the validity of this. Methods :Single centre retrospective review of cases receiving NACT from 2016-17. Indication and respective tumour biology was recorded. Computed Tomography of chest, abdomen and pelvis was used for staging. Results:58 patients underwent NACT, 51 of whom had staging investigations. Of the 7 patients not staged only one met the criteria.IndicationNumber stagedMet criteria (%)Normal staging (%)Indeterminate(%)Metastatic(%)Inflammatory Ca(13)1313 (100)463Triple negative(11)95 (56)621For dual anti Her2(28)2318 (78)1274ER+, Her2- downstage(6)66 (100)411Total5142 (82)26 (51)16 (31.4)9 (17.6)26 CTs were normal (51%). 18 were indeterminate, 12 of whom required follow up imaging, 2 of which were confirmed to have metastatic disease. 7 patients had metastatic disease on initial CT.Overall 9 patients had metastatic disease (17.6%), 8 of whom met our staging criteria. In total, 93 staging CT scans were performed.Conclusion:88% of patients with metastatic disease met the staging criteria. These results show that patients receiving NACT for breast cancer do not require routine staging investigations. A selective policy should be adopted, particularly for triple negative and for dual anti-HER2 therapy.
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