Skip to main content

Advertisement

SpringerLink
Log in

Incidental radiologic findings at breast cancer diagnosis and likelihood of disease recurrence

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Despite guidelines recommending against its routine use, perioperative imaging for distant metastases is frequently performed in newly diagnosed breast cancer patients, uncovering incidental findings of uncertain significance. We assessed the clinical significance of incidental findings by determining if their presence is associated with disease recurrence. A retrospective review of staging imaging was performed in patients with stage II or III invasive breast cancer diagnosed during 2008–2009 at a large academic medical center. Data related to perioperative imaging and disease recurrence were abstracted from the medical record. Kaplan–Meier curves and Cox proportional hazards models were used to assess the association between incidental findings and time to disease recurrence. A total of 169 of 340 patients (49.7 %) underwent staging evaluation for distant metastases (CT chest, abdomen, pelvis, bone scan, and/or PET-CT). Of these, 146 (86.4 %) had at least one suspicious or indeterminate finding. Follow-up studies were performed in 73 (43.2 %) patients. Nineteen patients were diagnosed with metastatic disease at diagnosis, 18 of whom had stage III disease. In patients without metastatic disease at diagnosis, 32 later developed recurrence. Non-calcified pulmonary nodules were associated with shorter time to disease recurrence (hazard ratio 2.51, 95 % CI 1.13–5.57, p = 0.02). Imaging for distant metastases frequently reveals indeterminate findings, most of which are not associated with disease recurrence. The association between pulmonary nodules and recurrence warrants validation in an independent cohort. Overall, these findings support current guidelines recommending against routine extent of disease evaluation in patients with newly diagnosed stage II breast cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Puglisi F, Follador A, Minisini AM et al (2005) Baseline staging tests after a new diagnosis of breast cancer: further evidence of their limited indications. Ann Oncol 16(2):263–266

    Article  CAS  PubMed  Google Scholar 

  2. Kasem AR, Desai A, Daniell S, Sinha P (2006) Bone scan and liver ultrasound scan in the preoperative staging for primary breast cancer. Breast J 12(6):544–548

    Article  PubMed  Google Scholar 

  3. Kim H, Han W, Moon HG et al (2011) The value of preoperative staging chest computed tomography to detect asymptomatic lung and liver metastasis in patients with primary breast carcinoma. Breast Cancer Res Treat 126(3):637–641

    Article  CAS  PubMed  Google Scholar 

  4. Gerber B, Seitz E, Muller H et al (2003) 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 82(1):29–37

    Article  PubMed  Google Scholar 

  5. Schnipper LE, Smith TJ, Raghavan D et al (2012) American Society of Clinical Oncology identifies five key opportunities to improve care and reduce costs: the top five list for oncology. J Clin Oncol 30(14):1715–1724

    Article  PubMed  Google Scholar 

  6. NCCN Clinical Practice Guidelines in Oncology: Breast Cancer (version 2.2015). National Comprehensive Cancer Network website. http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed Mar 9 2015

  7. Simos D, Hutton B, Clemons M (2015) Are physicians choosing wisely when imaging for distant metastases in women with operable breast cancer? J Oncol Pract 11(1):62–68

    Article  Google Scholar 

  8. Crivello ML, Ruth K, Sigurdson ER et al (2013) Advanced imaging modalities in early stage breast cancer: preoperative use in the United States Medicare population. Ann Surg Oncol 20(1):102–110

    Article  PubMed Central  PubMed  Google Scholar 

  9. Han D, Hogeveen S, Sweet Goldstein M et al (2012) Is knowledge translation adequate? A quality assurance study of staging investigations in early stage breast cancer patients. Breast Cancer Res Treat 132(1):1–7

    Article  CAS  PubMed  Google Scholar 

  10. James JJ, McMahon MA, Tennant SL, Cornford EJ (2012) CT staging for breast cancer patients with poor prognostic tumours. Breast 21(6):735–738

    Article  CAS  PubMed  Google Scholar 

  11. Morris PG, O’Connor M, O’Rafferty C et al (2009) The excessive cost of baseline diagnostic imaging in early breast cancer. Ir Med J 102(5):149–152

    CAS  PubMed  Google Scholar 

  12. Yeh KA, Fortunato L, Ridge JA, Hoffman JP, Eisenberg BL, Sigurdson ER (1995) Routine bone scanning in patients with T1 and T2 breast cancer: a waste of money. Ann Surg Oncol 2(4):319–324

    Article  CAS  PubMed  Google Scholar 

  13. Truong MT, Ko JP, Rossi SE et al (2014) Update in the evaluation of the solitary pulmonary nodule. Radiographics 34(6):1658–1679

    Article  PubMed  Google Scholar 

  14. MacMahon H, Austin JH, Gamsu G et al (2005) Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans: a Statement from the Fleischner Society. Radiology 237(2):395–400

    Article  PubMed  Google Scholar 

  15. Lee B, Lim A, Lalvani A et al (2008) The clinical significance of radiologically detected silent pulmonary nodules in early breast cancer. Ann Oncol 19(12):2001–2006

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Hahn EE, Tang T, Lee JS et al (2015) Use of imaging for staging of early-stage breast cancer in two integrated health care systems: adherence with a choosing wisely recommendation. J Oncol Pract. 11(3):e320–e328

    Article  PubMed  Google Scholar 

  17. Ramsey SD, Henry NL, Gralow JR et al (2015) Tumor marker usage and medical care costs among older early-stage breast cancer survivors. J Clin Oncol 33(2):149–155

    Article  PubMed Central  PubMed  Google Scholar 

  18. Brennan ME, Houssami N (2012) Evaluation of the evidence on staging imaging for detection of asymptomatic distant metastases in newly diagnosed breast cancer. Breast 21(2):112–123

    Article  CAS  PubMed  Google Scholar 

  19. Brennan M, Houssami N (2012) Newly diagnosed early breast cancer—an update on pre-operative assessment and staging. Aust Fam Physician 41(11):871–874

    PubMed  Google Scholar 

  20. Daglar G, Yuksek YN, Gozalan U, Tutuncu T, Kama NA (2010) The significance of pulmonary nodule in breast cancer patients. Bratisl Lek Listy 111(5):280–283

    PubMed  Google Scholar 

  21. Khatcheressian JL, Wolff AC, Smith TJ et al (2006) American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting. J Clin Oncol 24(31):5091–5097

    Article  PubMed  Google Scholar 

  22. Al-Mutairi A, Meyer AN, Chang P, Singh H (2015) Lack of timely follow-up of abnormal imaging results and radiologists’ recommendations. J Am College Radiol 12(4):385–389

    Article  Google Scholar 

  23. Blagev DP, Lloyd JF, Conner K et al (2014) Follow-up of incidental pulmonary nodules and the radiology report. J Am College Radiol 11(4):378–383

    Article  Google Scholar 

  24. Dutta S, Long WJ, Brown DF, Reisner AT (2013) Automated detection using natural language processing of radiologists recommendations for additional imaging of incidental findings. Ann Emerg Med 62(2):162–169

    Article  PubMed  Google Scholar 

Download references

Funding

Dr. Henry was supported in part by an NCI Clinical Cancer Investigator Team Leadership Award (supplement to 3-P30-CA046592, PI M Wicha).

Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Med Inn Bldg C450, Ann Arbor, MI, 48109-5843, USA

    Joel M. Brothers & N. Lynn Henry

  2. Department of Biostatistics, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, USA

    Kelley M. Kidwell

  3. Department of Radiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, USA

    Richard K. J. Brown

Authors
  1. Joel M. Brothers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kelley M. Kidwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard K. J. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Lynn Henry
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. Lynn Henry.

Ethics declarations

Conflicts of interest

Dr. Henry has previously received research funding from BioMarin, Celldex, and Sanofi. No other authors have conflicts of interest to report.

Informed consent

Institutional Review Board approval was granted for this study and a waiver of informed consent was obtained.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 194 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brothers, J.M., Kidwell, K.M., Brown, R.K.J. et al. Incidental radiologic findings at breast cancer diagnosis and likelihood of disease recurrence. Breast Cancer Res Treat 155, 395–403 (2016). https://doi.org/10.1007/s10549-016-3687-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-016-3687-1

Keywords

Search

Navigation