From the Division of General Surgery, Section of Endocrine and Oncologic Surgery, Washington University, St. Louis, Missouri.
J Natl Compr Canc Netw. 2017 Jun;15(6):783-789. doi: 10.6004/jnccn.2017.0104.
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) recommend that patients with clinical stage I/II breast cancer undergo advanced imaging for staging only when symptomatic. Regardless, many asymptomatic patients undergo chest CT. The goal of this study was to assess the use and results of chest CT in these patients at an NCCN Member Institution. Patients with breast cancer diagnosed between 1998 and 2012 were identified in a prospectively maintained database. All patients with clinical stage I/II disease who did not receive neoadjuvant chemotherapy were included. Data collected included demographics, tumor size, node status, chest CT within 6 months of diagnosis, imaging findings, need for additional workup, and identification of metastatic disease. Appropriate statistical tests were used for analysis. From 1998 to 2012, 3,321 patients were diagnosed with early-stage breast cancer. Of these, 2,062 (62.1%) had clinical stage I breast cancer at diagnosis and 1,259 (37.9%) had stage II; 227 patients (11%) with stage I and 456 (36.2%) with stage II breast cancer received staging chest CT. Of patients undergoing CT, 184 (26.9%) were found to have pulmonary nodules, which measured ≤5 mm for 128 patients (69.6%), 5 to 10 mm for 46 patients (25.0%), 11 to 20 mm for 6 patients (3.2%), and ≥20 mm for 4 patients (2.2%). Patients undergoing chest CT for staging subsequently underwent a mean of 2.34 (range, 0-16) additional CTs in follow-up. Of all patients undergoing chest CT for staging, only 9 (1.3%) were ultimately diagnosed with pulmonary metastases at an average of 25 months (range, 0-97) after initial staging chest CT. A significant percentage of patients with stage I/II breast cancer underwent unnecessary chest CT as part of their initial workup. Nearly one-third of these patients were found to have pulmonary nodules, but only 1.3% were ever diagnosed with pulmonary metastases. Adherence to NCCN Guidelines will reduce the excessive use of CT chest imaging.
美国国家综合癌症网络（NCCN）临床实践指南（NCCN 指南）建议，仅当有症状时，临床 I/II 期乳腺癌患者才需要进行高级影像学检查进行分期。然而，许多无症状患者接受了胸部 CT 检查。本研究的目的是评估 NCCN 成员机构中这些患者进行胸部 CT 的使用情况和结果。在一个前瞻性维护的数据库中，确定了 1998 年至 2012 年间诊断为乳腺癌的患者。所有未接受新辅助化疗的临床 I/II 期疾病患者均被纳入。收集的数据包括人口统计学资料、肿瘤大小、淋巴结状态、诊断后 6 个月内的胸部 CT、影像学结果、额外检查的需要以及转移性疾病的识别。适当的统计检验用于分析。
1998 年至 2012 年间，共有 3321 名患者被诊断为早期乳腺癌。其中，2062 名（62.1%）患者在诊断时为 I 期乳腺癌，1259 名（37.9%）患者为 II 期；227 名（11%）I 期和 456 名（36.2%）II 期乳腺癌患者接受了分期胸部 CT 检查。在接受 CT 检查的患者中，184 名（26.9%）患者发现有肺结节，其中 128 名（69.6%）患者的结节直径≤5 毫米，46 名（25.0%）患者的结节直径为 5 至 10 毫米，6 名（3.2%）患者的结节直径为 11 至 20 毫米，4 名（2.2%）患者的结节直径≥20 毫米。进行分期 CT 检查的患者随后在随访中平均进行了 2.34 次（范围为 0-16 次）额外的 CT 检查。在所有进行分期 CT 检查的患者中，只有 9 名（1.3%）患者在初始分期 CT 后平均 25 个月（范围为 0-97 个月）后最终被诊断为肺转移。
相当一部分 I/II 期乳腺癌患者作为初始检查的一部分进行了不必要的胸部 CT 检查。这些患者中近三分之一发现有肺结节，但只有 1.3%的患者被诊断为肺转移。遵守 NCCN 指南将减少 CT 胸部成像的过度使用。
