Staging of breast cancer: new recommended standard procedure.
BACKGROUND
Staging procedures used to detect metastatic breast cancer at the time of diagnosis are bone scan (BS), chest X-ray (CXR), liver ultrasonography (LUS) and laboratory parameters (LP). These procedures are expensive and not all patients need them. We aimed to identify groups of patients with different risks for metastatic disease.


METHODS
We reviewed data from 1,218 consecutive cases of breast cancer. Pathological and biological parameters and instrumental procedures performed at the time of diagnosis and during 6 months of follow-up were recorded. True positive and negative, false positive and negative cases were evaluated. All cases were grouped on the basis of tumour size, nodal involvement, biological characteristics, menopausal status and age.


RESULTS
We observed 46 (3.8%) true positive cases with metastatic disease at the time of diagnosis. Documentation relating to BS, CXR and LUS was available for 1,193, 1,206 and 1,206 patients, respectively, with 37 (3.1%), 8 (0.7%) and 10 (0.8%) true positive tests. Logistic regression analysis showed significant odds ratio estimates for pT status and nodal status, thus highlighting the role of these morphological data. These findings suggest that breast cancer patients can be divided into two subgroups: first group pT1-3N0-1. with < or = 3 involved nodes, and second group pT1-3N1 with > or = 4 involved nodes, pT4 and pN2 (metastases detection rate 1.46 and 10.68%, respectively). In the former group the appropriate procedures of staging would only be laboratory parameters, whereas in the latter group BS, CXR, LUS, LP and tumour markers CEA and CA 15.3 would.be necessary.


CONCLUSIONS
The standard staging procedures to detect metastatic disease at breast cancer diagnosis require modification. On the basis of the literature data and our findings, the full staging procedure is appropriate in the second group of patients.
Ravaioli
Alberto
A
Department of Medical Oncology and Oncohematology, City Hospital, Rimini, Italy. aravaiol@auslrn.net
Pasini
Giuseppe
G
Polselli
Antonio
A
Papi
Maximilian
M
Tassinari
Davide
D
Arcangeli
Valentina
V
Milandri
Carlo
C
Amadori
Dino
D
Bravi
Matteo
M
Rossi
Daniela
D
Fattori
Pier Paolo
PP
Pasquini
Enzo
E
Panzini
Ilaria
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000556:secondary; D001943:Breast Neoplasms / Q000191:economics / Q000453:epidemiology / Q000473:pathology*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008113:Liver Neoplasms / Q000556:secondary; D008175:Lung Neoplasms / Q000556:secondary; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging / Q000379:methods / Q000592:standards*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity