Borowiec Tomasz, Matkowski Rafał, Cybulska-Stopa Bożena, Kuniej Tomasz, Kołodziejczyk Andrzej, Dupla Dorota, Maciejczyk Adam
Lower Silesian Oncology, Pulmonology and Hematology Center, Wroclaw, Poland.
Department of Oncology, Wroclaw Medical University, Wroclaw, Poland.
Front Oncol. 2025 Feb 27;15:1556122. doi: 10.3389/fonc.2025.1556122. eCollection 2025.
Routine medical imaging used for preliminary breast cancer workup, such as mammography (MMG) and ultrasound (US), has limited utility for radiation oncologists. We hypothesized that the inclusion of cross-sectional imaging (CT scan or PET-CT) prior to primary systemic therapy (PST) would improve clinical staging accuracy and facilitate customized postoperative radiation therapy planning. Therefore, this study aimed to compare the standard baseline imaging with extended radiological staging.
To assess our hypothesis, we performed a prospective, single-center study that included 132 participants who were recruited from October 2015 to March 2020. We quantified the value of cross-sectional imaging compared to those of MMG and US. Descriptive statistics, the Friedman and chi-square tests were performed, and p < 0.05 was considered significant.
Patients were grouped into two cohorts: the CT scan cohort (n = 87) and the PET-CT cohort (n = 43). A comparison of the value of cross-sectional imaging with those of MMG and US revealed that staging and radiation planning were altered by this additional procedure. The originally determined disease stage changed in 36.8% and 51.2% of cases in the first and second groups, respectively. The consistency between the assessment of involved axillary lymph nodes using imaging (cN) and the postoperative pathology report (pN) were evaluated. In most cases, clinical and pathological evaluation were consistent, with χ2(1) = 18.98; p < 0.001 for CT scan, and χ2(1) = 6.41; p = 0.03 for PET-CT.
Cross-sectional imaging is recommended for patients with locally advanced high-risk breast cancer. A highly customized radiation therapy, including a dose boost, was administered in nine patients with affected lymph nodes that were surgically inaccessible. This procedure was facilitated by extended radiological staging.
用于乳腺癌初步检查的常规医学成像，如乳腺钼靶摄影（MMG）和超声（US），对放射肿瘤学家的作用有限。我们假设在原发性全身治疗（PST）之前进行横断面成像（CT扫描或PET-CT）将提高临床分期的准确性，并有助于定制术后放射治疗计划。因此，本研究旨在比较标准基线成像与扩展放射学分期。
为了评估我们的假设，我们进行了一项前瞻性单中心研究，纳入了2015年10月至2020年3月招募的132名参与者。我们量化了横断面成像相对于MMG和US的价值。进行了描述性统计、Friedman检验和卡方检验，p < 0.05被认为具有统计学意义。
患者被分为两个队列：CT扫描队列（n = 87）和PET-CT队列（n = 43）。将横断面成像的价值与MMG和US的价值进行比较，结果显示，这一额外检查改变了分期和放射治疗计划。在第一组和第二组中，最初确定的疾病分期分别在36.8%和51.2%的病例中发生了变化。评估了使用成像（cN）评估腋窝淋巴结受累情况与术后病理报告（pN）之间的一致性。在大多数情况下，临床和病理评估是一致的，CT扫描的χ2(1) = 18.98；p < 0.001，PET-CT的χ2(1) = 6.41；p = 0.03。
对于局部晚期高危乳腺癌患者，建议进行横断面成像。对9例手术无法触及的受累淋巴结患者实施了高度定制的放射治疗，包括剂量增强。扩展放射学分期有助于这一过程。
