肿瘤分期的目的是确定恶性肿瘤的程度，调整辅助治疗方案。但早期患者发现转移的几率很小（3%）。
对于早期、无法确定病灶的患者进行分期检查后发现，仅有11%发展为转移性癌。


Staging in early breast cancer: Help or hindrance?

Subcategory:
Cost
Category:
Health Services Research
Meeting:
2014 ASCO Annual Meeting
Session Type and Session Title:
General Poster Session, Health Services Research
Abstract Number:
6564

Citation:
J Clin Oncol 32:5s, 2014 (suppl; abstr 6564)

Author(s):
Naera Waters, David James Porter; Medical Oncology Department, Auckland City Hospital, Auckland, New Zealand; Department of Oncology, Auckland City Hospital, Auckland, New Zealand


Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy are designated with a caret symbol (^).

Abstract Disclosures

2014 ASCO Annual Meeting Proceedings Errata
Abstract:

Background: In 2012, ASCO identified staging CT, radionuclide or PET scans for asymptomatic, low risk breast cancer pts as one of the 5 big money wasters in oncology, due to a lack of demonstrated benefit and the potential harm of a false positive diagnosis. We assessed the frequency of staging CT and bone scans in asymptomatic pts with early breast cancer, whether metastases were conclusively detected, and the impact of inconclusive results.


Methods: 664 consecutive pts with breast cancer referred to the Auckland Regional Cancer and Blood Service between 1 Nov 2010 and 25 Oct 2013 were identified from a prospectively collated referral database. 273 pts were excluded for locally recurrent or metastatic disease, symptoms requiring investigation, or neoadjuvant therapy. Age, LN status, tumour type and grade, receptor and HER2 status and results of staging and follow up scans were recorded in 391 women.

Results: 81/330 (25%) pts with <4 nodes involved (N0/1) had staging CT, bone scan or both. Metastatic breast cancer (MBC) was found in 2/81(2%) and staging was negative in 51%. 38(47%) pts had radiological abnormalities of uncertain importance. Follow up scans showed 2/38 of these abnormalities were MBC, and 2 lung cancer (1 early stage, 1 metastatic), (total metastatic 3/38=8%). 59/61(97%) pts with >4 nodes (N2+) had staging. MBC was identified in 2 pts (3%), 1 of whom also had early stage lung cancer. 33 (56%) pts had indeterminate radiological findings, of which 5 (15%) were later confirmed to be MBC. Staging was negative in 41%. Up to 5 follow up scans per pt and 1-24 mo were required to clarify indeterminate findings

Conclusions: Staging investigations modified adjuvant treatment plans in only 4/140 (3%) pts who were found to have MBC. 11% of women with indeterminate lesions on staging were later shown to have either metastatic breast (n=7) or metastatic lung cancer (n=1) underscoring the importance of continuing adjuvant therapy where uncertainty exists. Indeterminate results were frequent, imply the possibility of incurable cancer, and required up to 24 mo and 5 extra scans before pts could be reassured. This causes great uncertainty and distress for pts and consumes limited healthcare resources. The harms and benefits of staging in early breast cancer should be carefully weighed.