BASELINE STAGING TESTS FOR LOCALLY ADVANCED BREAST CANCER

Abstract

Goals: To evaluate the impact of different radiological exams in the clinical staging of locally advanced breast cancer (LABC) and the possibility to evaluate bone metastasis with computed tomography (CT) in substitution of scintigraphy. Methods: A prospective clinical trial (www.clinicaltrials.gov; NCT00820690) performed in breast cancer women during 06/2008 to 05/2011. Patients with invasive carcinoma, clinical stage III, absence of systemic symptoms and absence of previous treatment were included. Exclusion criteria were the absence of invasive disease, staging exams and follow-up. The patients were submitted to a clinical examination, mammography, breast ultrasound and biopsy. To evaluate the presence of metastatic disease the patients were submitted to chest X-Ray, abdominal ultrasound, bone scintigraphy (conventional exams) and CT (abdominal and thoracic). In the presence of suspicion exams, complementary exams were performed. If the CT needs control, new exams were performed. All patients were submitted to neoadjuvant or palliative chemotherapy. At the end of study one radiologist reviewed all exams and medical reports. We evaluated the frequency of metastasis in the conventional exams and when the patients were evaluated with CT. Results: 148 patients were enrolled, but 10 patients were excluded. From the 138 patients, the median tumor size was 6.6cm (3–15cm). Evaluating the clinical stage (TNM) there were 60.9% cT3, 38.4% cT4, 67.4% cN1, 25.4% cN2 and 2.2% cN3. After all exams performed 38 (28.3%) had metastatic disease. When we use conventional exams8.7%hadmetastaticdisease,but17.4%neededcomplementary exams, leading to 13.8% [IC=8.08–19.55] of metastatic disease. When we use CT (abdominal and thoracic) and scintigraphy for staging, 28.3% [IC=20.8–34.9] had metastatic disease, with an increase of 14.5% of diagnosis of metastatic disease. The CT showed 6 patients (4.3%) with bone metastasis and normal scintigraphy, but it did not increased the frequency of metastatic disease. Conclusion: Patients with LABC must be evaluated with a minimum of CT (abdominal and thoracic) added to the bone scintigraphy. The conventional exams decreased 14.5% of the metastatic disease diagnosis and the CT increased 4.3% of diagnosis of bone metastasis. Disclosure of Interest: No significant relationships.