Value of Systemic Staging in Asymptomatic Early Breast Cancer.

Objective Metastases are rare in early breast cancer (EBC), and international guidelines recommend against routine systemic staging for asymptomatic patients. However, imaging exams remain widely employed in the clinical practice. The aim of the present study is to evaluate the value of imaging for systemic staging in EBC. Methods A retrospective analysis of newly-diagnosed breast cancer (BC) patients was performed. Clinical data including BC subtype, stage, presence of symptoms at diagnosis and instrumental procedures performed for staging were recorded. Results A total of 753 patients were included, with a median age of 57 years. The majority of the patients underwent at least 1 imaging procedure (91%); had invasive ductal carcinoma (83.5%); histological grade 2 (51.4%); stage II (61.8%); and luminal subtype (67.9%). Among the 685 (91%) patients who underwent any radiologic staging, distant metastases (DMs) were detected in 32 (4.7%). In the univariate analyses, stage IIb and pathological lymph node involvement (pN1) showed a statistically significant association with the presence of DMs, versus only a trend for triple negative and human epidermal growth factor receptor 2 (Her2) positive subtype. In an exploratory analysis performed in this same subgroup, when unfavorable biology (triple negative or Her2 positive) was present, patients had a DM rate of 14.4%, one of the highest reported at this stage of the disease. Conclusion Early breast cancer has a low prevalence of DM at the initial evaluation, and systemic staging of asymptomatic, unselected patients is not warranted as a routine practice. However, we have identified subgroups of patients to whom a full staging could be indicated. Resumo Objetivo Metastases sAo de ocorrencia rara no cancer de mama precoce, e as diretrizes internacionais nAo recomendam o estadiamento sistemico de rotina para pacientes assintomaticos. Apesar disso, exames de imagem continuam sendo largamente empregados na pratica clinica. O objetivo do presente estudo e avaliar o valor do estadiamento por imagem no cancer de mama precoce. Metodos Analise retrospectiva de pacientes recem-diagnosticados com cancer de mama. Foram registrados os dados clinicos dos pacientes, incluindo subtipo da neoplasia de mama, estadiamento, presenca de sintomas no momento do diagnostico e procedimentos de estadiamento. Resultados Um total de 753 pacientes foram incluidos, com idade media de 57 anos. Grande parte deles se submeteu a pelo menos um exame de imagem (91%); tinha carcinoma ductal invasivo (83,5%); grau histologico 2 (51,4%); estadio II (61,8%); e subtipo luminal (67,9%). Entre os 685 (91%) pacientes que realizaram algum exame de imagem, metastases a distancia foram detectadas em 32 (4,7%). Na analise univariada, estadio IIb e acometimento linfonodal (pN1) tiveram uma associacAo estatisticamente significativa com a presenca de metastase, enquanto os subtipos triplo negativo e receptor tipo 2 do fator de crescimento epidermico humano (Her2) positivo demonstraram apenas uma tendencia para a identificacAo de metastases. Na analise exploratoria deste mesmo subgrupo, diante da presenca de biologia desfavoravel (triplo negativo e Her2 positivo), os pacientes apresentaram uma taxa de metastase a distancia de 14,4%, uma das mais altas relatadas nesse estadio. ConclusAo Neoplasia de mama precoce apresenta baixa baixa prevalencia de metastase a distancia no momento do diagnostico, e o estadiamento sistemico de rotina de pacientes assintomaticos e nAo selecionados nAo e justificavel. Contudo, identificamos subgrupos de pacientes para os quais o estadiamento completo poderia ser indicado.