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Radiological Staging for Distant Metastases in Breast Cancer Patients with Confirmed Local and/or Locoregional Recurrence: How Useful are Current Guideline Recommendations?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Breast cancer patients with local and/or locoregional recurrence (LR) are at higher risk of developing distant metastases (DM) at a later time. Once LR has been confirmed, some international interdisciplinary guidelines recommend performing radiological examinations for DM to determine the course of further therapy (curative or palliative approach). This study analyzed the metastatic patterns of patients with LR with particular regard to the frequency of concurrent diagnosis of LR and DM; in other words: are radiological staging procedures actually justified for DM at the time of diagnosis of LR?

Methods

This study included all patients (n = 1368) who were diagnosed and treated for nonmetastatic breast cancer (Stage I–III) at the University Women’s Hospital Basel, Switzerland between 1990 and 2009.

Results

In 137 patients, LR was diagnosed without a history of DM: in-breast/thoracic wall only, n = 90 (65.7%); involvement of axillary/supra-/infraclavicular lymph nodes, n = 47 (34.3%). DM was found at the time of diagnosis of LR in 44 patients (32.1%). Concurrent diagnosis of LR and DM occurred significantly more often in patients with lymph node recurrence compared with those with in-breast/chest wall recurrence (48.9% vs. 23.3%; p = 0.004).

Conclusions

Approximately one-third of patients with a LR had synchronous DM at the time of their local/locoregional event. For this reason, routine systemic staging imaging at the time of LR should be an absolute requirement for planning further therapy. Confirmation of DM may spare the patients radical surgical interventions with questionable impact on survival in the face of an incurable disease.

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Acknowledgment

The authors thank Serenella Eppenberger-Castori from the Institute for Pathology of the University Hospital of Basel for statistical analyses.

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Authors and Affiliations

  1. Department of Breast Surgery, Brust-Zentrum Zürich, Zurich, Switzerland

    Constanze Elfgen MD, Christoph Johannes Tausch MD & Uwe Güth MD

  2. Breast Center St. Gallen, Location Spital Grabs, Grabs, Switzerland

    Seraina Margaretha Schmid MD

  3. Department of Gynecology and Obstetrics, University Hospital Basel (UHB), Basel, Switzerland

    Seraina Margaretha Schmid MD & Uwe Güth MD

  4. Breast Center, UHB, Basel, Switzerland

    Giacomo Montagna MD

Authors
  1. Constanze Elfgen MD
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  2. Seraina Margaretha Schmid MD
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  3. Christoph Johannes Tausch MD
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  4. Giacomo Montagna MD
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  5. Uwe Güth MD
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Correspondence to Uwe Güth MD.

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Elfgen, C., Schmid, S.M., Tausch, C.J. et al. Radiological Staging for Distant Metastases in Breast Cancer Patients with Confirmed Local and/or Locoregional Recurrence: How Useful are Current Guideline Recommendations?. Ann Surg Oncol 26, 3455–3461 (2019). https://doi.org/10.1245/s10434-019-07629-9

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  • DOI: https://doi.org/10.1245/s10434-019-07629-9

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