title: Multidetector CT improving surgical outcomes in breast cancer (MISO-BC): A randomised controlled trial.
abstract: BACKGROUND
  Early diagnosis of malignant axillary nodes in breast cancer guides the extent of axillary surgery: patients with known axillary malignancy receive a more extensive single operation at the same time as surgery to their breast. A multicentre randomised controlled trial assessed whether a Computed Tomography (CT) scan of the axilla could more accurately diagnose malignant axillary lymph node involvement in patients with newly diagnosed breast cancer when compared to usual care.
  
  
  METHODS
  Patients with newly diagnosed breast cancer (identified via screening and symptomatic pathways) at two NHS Trusts in the North East of England were recruited and randomised in equal numbers. Both groups received routine diagnostic and surgical care. In addition, one group received a CT scan of their axilla on the same side as the breast cancer. The primary endpoint was the need to undergo a second axillary surgical procedure.
  
  
  RESULTS
  The trial recruited 297 patients of whom 291 contributed to findings. The proportion of patients undergoing a second operation was similar (CT vs UC: 19.4% vs. 19.7%; CT-UC: -0.3%, 95%CI: = -9.5% to 8.9%, χ2[1]: p = 1.00). Patients in the two groups were similar before treatment, had similar types and grade of cancer, experienced similar patterns of post-operative complications and reported similar experiences of care.
  
  
  CONCLUSIONS
  CT scan-guided care did not result in a change in the number of patients requiring a second operation; similar numbers of patients needed further axillary surgery in both groups. New diagnostic imaging technologies regularly enter NHS centres. It is important these are evaluated rigorously before becoming routine care.
authors.affiliation: Department of Radiology, City Hospitals Sunderland Foundation Trust, Kayll Rd, Sunderland, SR4 7PT, UK. Electronic address: julie.cox@chsft.nhs.uk.
authors.forename: Julie
authors.initials: J
authors.lastname: Cox
authors.affiliation: Durham University, Queen's Campus, University Boulevard, Thornaby, Stockton-on-Tees, TS17 6BH, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Hancock
authors.affiliation: Durham University, Queen's Campus, University Boulevard, Thornaby, Stockton-on-Tees, TS17 6BH, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Maier
authors.affiliation: Department of Radiology, City Hospitals Sunderland Foundation Trust, Kayll Rd, Sunderland, SR4 7PT, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Spratt
authors.affiliation: Perth Radiological Clinic, Perth, Australia.
authors.forename: Chooi May
authors.initials: CM
authors.lastname: Lee
authors.affiliation: Department of Surgery, University Hospital North Durham, North Rd, Durham, DH1 5TW, UK.
authors.forename: Amir
authors.initials: A
authors.lastname: Bhatti
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
authors.forename: James
authors.initials: J
authors.lastname: Mason
mesh_terms: D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods / Q000706:statistics & numerical data*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008408:Mastectomy; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D012086:Reoperation / Q000706:statistics & numerical data*; D006113:United Kingdom
keywords: Axilla; Breast cancer; CT scan; Sentinel lymph node biopsy