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Overuse of Preoperative Staging of Patients Undergoing Neoadjuvant Chemotherapy for Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Guidelines of the American Society of Clinical Oncology (ASCO), the National Comprehensive Cancer Network (NCCN), and the European Society for Medical Oncology (ESMO) discourage the use of imaging to stage newly diagnosed early breast cancer (stages 1 and 2). This study aimed to evaluate preoperative staging imaging rates among patients with stage 1 or 2 breast cancer treated with neoadjuvant chemotherapy (NAC).

Methods

From a prospectively maintained database, 303 patients with stage 1 or 2 breast cancer who had NAC from 2008 to 2016 were identified. The main outcome measures were the rate and outcomes of staging imaging performed.

Results

The mean age of the 303 patients with stage 1 or 2 breast cancer was 51 years (range, 26–87 years). Of these 303 patients, 278 (92.4%) had invasive ductal cancer. 90 (30.2%) had estrogen receptor (ER)-positive disease, 79 (26.5%) had triple-negative disease, and 127 (42.6%) had human epidermal growth factor receptor 2 (HER2)-positive disease. Staging positron emission tomography (PET) or computed tomography (CT) scan was performed for 258 patients (85.2%), brain imaging for 94 patients (31%), bone scans for 117 patients (38.6%), and all three for 48 patients (15.8%). As a result, 15 patients (4.9%) with a positive PET/CT scan were upstaged to stage 4 breast cancer. No difference was observed among the ER-positive (p = 1.000), HER2-positive (p = 0.259), or triple-negative (p = 0.369) receptor profiles of the patients upstaged to stage 4 disease. One patient (1.1%) had positive brain imaging. Five patients (4.3%) had a positive bone scan, and three of these patients (60%) had bone metastasis also shown on the PET/CT scan.

Conclusion

Despite guideline recommendations, a high rate of preoperative staging imaging is completed for patients with clinical stage 1 or 2 breast cancer who receive NAC, with few positive results.

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Acknowledgment

The authors thank The Fashion Footwear Charitable Foundation of New York, Inc.; The Margie and Robert E. Petersen Foundation; Associates for Breast and Prostate Cancer Studies; and Linda and Jim Lippman for their contributions to this study.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Marissa K. Srour MD, Minna Lee MD, Sarah Walcott-Sapp MD, Alice Chung MD, Armando E. Giuliano MD & Farin Amersi MD

  2. Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Michael Luu MPH

Authors
  1. Marissa K. Srour MD
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  2. Minna Lee MD
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  3. Sarah Walcott-Sapp MD
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  4. Michael Luu MPH
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  5. Alice Chung MD
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  6. Armando E. Giuliano MD
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  7. Farin Amersi MD
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Correspondence to Farin Amersi MD.

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Srour, M.K., Lee, M., Walcott-Sapp, S. et al. Overuse of Preoperative Staging of Patients Undergoing Neoadjuvant Chemotherapy for Breast Cancer. Ann Surg Oncol 26, 3289–3294 (2019). https://doi.org/10.1245/s10434-019-07543-0

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  • DOI: https://doi.org/10.1245/s10434-019-07543-0

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