1124 Staging CT in the Work Up for Primary Breast Cancer – Indications, Incidentalomas, Metastases and the Impact on Patient Management

Abstract Aim There is considerable variation amongst units in the use of staging CT in breast cancer. The current ABS guidelines advise staging in those with >/ = N2, T3/4 or those with symptoms suspicious for metastatic disease. The aim of this study was to assess the indications for primary breast cancer patients undergoing staging CT scan, and the subsequent detection rate of incidentalomas and metastatic disease. Method This was a retrospective cohort study conducted in a high-volume tertiary referral centre of patients diagnosed with a primary breast cancer between January 2018 and December 2018 who underwent staging CT. Data was assessed for patient demographics, tumour characteristics and findings on CT. Results 714 patients were diagnosed with breast cancer in this 12-month period, of which 120 had a staging CT. Twelve had recurrent disease and were excluded. There was an overall incidentaloma rate of 66.6% and metastases rate of 11.1%. The group was subdivided into those who fulfilled the guidelines and those who did not. 46 patients met the staging criteria, with metastatic and incidentaloma rates of 21.7% and 65.2% respectively. 62 patients did not meet the staging criteria, with metastatic and incidentalomas rates of 3.2% and 67.7% respectively. Conclusions This study demonstrates that the detection of metastatic disease in patients who do not meet the criteria is low with a rate of 3.2%. CT staging in primary breast cancer should be reserved for patients who meet the guidelines in order to better direct resource, avoid over investigation and mitigate patient anxiety.