In women with newly diagnosed breast cancer, locoregional restaging with mammography and ultrasonography of the whole breast and regional nodes led to incremental cancer detection (i.e., discovery of additional lesions in the breasts) and improved the accuracy of clinical staging, according to a retrospective study conducted at The University of Texas MD Anderson Cancer Center. The value of repeating breast imaging studies in women who are referred to tertiary care centers for breast cancer treatment previously had not been validated.
A group led by Rosalind Candelaria, M.D., Monica Huang, M.D., and Beatriz Adrada, M.D., of the Section of Breast Imaging in the Department of Diagnostic Radiology reviewed the records of 1,000 women referred to MD Anderson’s breast imaging center in 2010. Four hundred one women with primary breast cancer were included in the final analysis. At the breast imaging center, all 401 women underwent bilateral full-field digital mammography followed by ultrasonography of the entire affected breast and regional lymph nodes.
The restaging at MD Anderson changed the known extent of the disease in 68 of the 401 women, which represented an incremental cancer detection rate of 15.5% (62 women) in the ipsilateral breast and 3.9% (six women) in the contralateral breast. Furthermore, locoregional restaging at MD Anderson resulted in a higher disease stage in 100 (25%) of the 401 women, including a higher N stage in 94 (23%) and a higher T stage in 86 (21%).
The changes in known disease extent also led to changes in surgical management. Fifty women in whom restaging revealed extensive multifocal or multicentric disease underwent mastectomy rather than breast-conserving surgery. Radiation strategies and consideration for neoadjuvant chemotherapy were also affected by restaging.
“Our findings confirmed that in women with newly diagnosed breast cancer, locoregional restaging with bilateral full-field digital mammography and whole-breast and regional nodal ultrasonography led to incremental cancer detection, reduced underestimation of disease, and influenced treatment strategies,” said Dr. Candelaria, the lead author of the study’s report, which was published in Academic Radiology.
OncoLog, February 2017, Volume 62, Issue 2