A154: CT staging in patients with sentinel or axillary lymph node sampling positive early breast cancer. Is there any impact on clinical outcomes?
1Beatson West of Scotland Cancer Centre, Glasgow, UK
Royal College of Radiologists recommends radiological staging for clinical N2 or T4 disease. In this audit we specifically look at the practice of staging patients with early stage breast cancer (clinical stage N0) who have a histologically positive lymph node on sentinel lymph node biopsy or axillary sampling.
One hundred and seven patients with positive sentinel lymph node biopsy (SLNB) or axillary lymph node sampling between 11th January 2010 to 26th May 2013 were assessed retrospectively via case note and electronic health record review. All patients had no axillary spread on clinical examination and ultrasonography (N0) and had no signs or symptoms to suggest metastatic cancer.
Fifty (46.7%) patients had staging CT scan. Two patients had metastatses on radiological appearance. Fourteen (13%) patients had indeterminate lesions on baseline CT scan as reported by radiologist. Median number of follow-up CT scans in such patients was 0.5 (range 0 - 4) for lesions that did not progress to definitive metastatic disease. Significant incidental findings detected were a lung cancer leading to curative resection, benign hydronephrosis and pulmonary embolism. By 30th Jan 2014 nine (8.4%) of the patients had died and one patient was alive with recurrent cancer. The staging CT scan affected the treatment plan by diagnosing asymptomatic metastatic cancer or diagnosed a serious non oncological condition in 5 out of 107 (4.7%) patients. However in 7 (6.5%) patients indeterminate lesions were followed up by at least one repeat CT scan.
CT staging in early stage breast cancer patients with positive SLNB / axillary sampling is not an effective investigation in diagnosing asymptomatic metastatic disease. The number of patients harbouring metastases thus detected is small (<2%) and can result in identification of indeterminate lesions in greater than one-tenth of the individuals causing radiation exposure and patient anxiety.