Staging for Breast Cancer: A Comparison Between Old and New Approaches

Abstract

Background/aim: Staging for breast cancer in advanced stages or prior to neoadjuvant chemotherapy is recommended to be performed with CT scan of the chest and abdomen and a bone scan. This recommendation is valid since 2012, when conventional staging with chest x-ray and ultrasound of the abdomen was replaced by the more sensitive CT scan. However, it remains unclear if this approach improves patient outcome and prognosis.

Patients and methods: We identified patients who were treated for breast cancer at the breast center of the St. Elisabeth Hospital, Cologne, in 2012 and 2014. Clinical information such as age at diagnosis, stage, tumor biology, grading, and the applied method for staging was abstracted from the patient chart. We also looked for local or distant recurrence and data of survival.

Results: A total of 1,122 patients were identified. Of those, 104 patients developed local or distant recurrence and 54 died. Conventional staging with chest x-ray, abdominal ultrasound and a bone scan was more often in 2012 (482 cases) than in 2014 (135), but CT-staging was more often in 2014 (180 vs. 29 cases). In general, less patients were staged in 2014 than in 2012. There were no significant survival differences between the two groups.

Conclusion: Staging habits changed in 2012 compared to 2014 according to the changes in guidelines. This change did not affect disease-free survival.

Keywords: Breast cancer; comparison; guidelines; radiologic imaging; staging.

Figure 1. Distant disease-free survival was 103.6 months in group 1 (patients diagnosed in 2012) and 108.9 months in group 2 (patients diagnosed in 2014); p=0.325.