Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Ann Surg Oncol. 2019 Oct;26(10):3289-3294. doi: 10.1245/s10434-019-07543-0. Epub 2019 Jul 24.
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).
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.
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.
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.
美国临床肿瘤学会（ASCO）、美国国家综合癌症网络（NCCN）和欧洲肿瘤内科学会（ESMO）的指南不鼓励对新诊断的早期乳腺癌（1 期和 2 期）进行影像学分期。本研究旨在评估接受新辅助化疗（NAC）治疗的 1 期或 2 期乳腺癌患者的术前分期成像率。
从一个前瞻性维护的数据库中，确定了 2008 年至 2016 年间接受 NAC 的 303 例 1 期或 2 期乳腺癌患者。主要观察指标是进行分期成像的比率和结果。
303 例 1 期或 2 期乳腺癌患者的平均年龄为 51 岁（26-87 岁）。这些患者中，278 例（92.4%）为浸润性导管癌。90 例（30.2%）为雌激素受体（ER）阳性疾病，79 例（26.5%）为三阴性疾病，127 例（42.6%）为人表皮生长因子受体 2（HER2）阳性疾病。258 例（85.2%）患者行正电子发射断层扫描（PET）或计算机断层扫描（CT）分期，94 例（31%）行脑部成像，117 例（38.6%）行骨扫描，48 例（15.8%）行以上三项检查。结果，15 例（4.9%）PET/CT 扫描阳性患者分期上调至 4 期乳腺癌。ER 阳性（p=1.000）、HER2 阳性（p=0.259）或三阴性（p=0.369）受体谱患者的分期上调至 4 期疾病无差异。1 例（1.1%）患者脑成像阳性。5 例（4.3%）患者骨扫描阳性，其中 3 例（60%）骨扫描阳性患者也在 PET/CT 扫描上显示骨转移。
尽管有指南建议，但接受 NAC 治疗的临床 1 期或 2 期乳腺癌患者仍进行了大量术前分期成像，结果阳性率较低。
