Linkugel Andrew, Margenthaler Julie, Dull Barbara, Cyr Amy
Endocrine and Oncologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Endocrine and Oncologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
J Surg Res. 2015 Jun 1;196(1):33-8. doi: 10.1016/j.jss.2015.02.065. Epub 2015 Mar 5.
For stage I-II breast cancer, routine radiologic staging in the absence of symptoms suggesting distant metastasis is not recommended. This study aims to determine the yield of these studies at a National Comprehensive Cancer Network member institution.
Patients presenting with clinical stage I-II breast cancer between 1998 and 2012 were identified in a prospective database. Charts were reviewed to document staging studies (computed tomography, bone scan, and positron emission tomography) performed within 6 mo of diagnosis. Results and additional diagnostic procedures were recorded. Appropriate statistical tests were used for the analysis.
A total of 3291 patients were included (2044 stage I and 1247 stage II). Eight hundred eighty-two patients (27%) received computed tomography, bone scan, or positron emission tomography within 6 mo of diagnosis. Three hundred twelve patients were stage I (15% of the stage I cohort) and 570 patients were stage II (46% of the stage II cohort). Patients receiving staging studies were more often younger and had estrogen receptor/progesterone receptor-negative or HER2/neu-positive tumors. Of the 882 patients, 194 (22%) required additional imaging and/or biopsies to further evaluate abnormalities. Only 11 of those (5%) were confirmed to have metastasis (1.2% of the imaged patients, 0.3% of the total cohort). Of these, 1 was stage I at presentation and 10 were stage II.
Identification of distant metastasis among stage I-II patients was rare. Even among patients judged appropriate for staging, only 1.2% were diagnosed with metastatic disease. These findings suggest that even at a National Comprehensive Cancer Network member institution staging studies are overused and lead to additional testing in over 20% of patients.
对于Ⅰ-Ⅱ期乳腺癌，不建议在没有提示远处转移症状的情况下进行常规放射学分期。本研究旨在确定在一家美国国立综合癌症网络成员机构中这些检查的阳性率。
在一个前瞻性数据库中识别出1998年至2012年间表现为临床Ⅰ-Ⅱ期乳腺癌的患者。查阅病历以记录在诊断后6个月内进行的分期检查（计算机断层扫描、骨扫描和正电子发射断层扫描）。记录结果和其他诊断程序。使用适当的统计检验进行分析。
共纳入3291例患者（2044例Ⅰ期和1247例Ⅱ期）。882例患者（27%）在诊断后6个月内接受了计算机断层扫描、骨扫描或正电子发射断层扫描。312例患者为Ⅰ期（占Ⅰ期队列的15%），570例患者为Ⅱ期（占Ⅱ期队列的46%）。接受分期检查的患者更年轻，且肿瘤雌激素受体/孕激素受体阴性或人表皮生长因子受体2/神经氨酸酶阳性。在这882例患者中，194例（22%）需要额外的影像学检查和/或活检以进一步评估异常情况。其中只有11例（5%）被确诊有转移（占接受影像检查患者的1.2%，占整个队列的0.3%）。其中，1例初诊时为Ⅰ期，10例为Ⅱ期。
在Ⅰ-Ⅱ期患者中发现远处转移的情况很少见。即使在被认为适合进行分期检查的患者中，也只有1.2%被诊断为转移性疾病。这些发现表明，即使在一家美国国立综合癌症网络成员机构，分期检查也被过度使用，并导致超过20%的患者接受额外检查。
