Systemic staging in locoregional breast cancer recurrence: Do Contrast-Enhanced CT and Bone Scintigraphy Still Add Value?

Abstract: Objectives Recent guidelines recommend computed tomography (CT) thorax, abdomen and pelvis (TAP) alone for systemic staging of primary breast cancer. However, evidence on imaging in breast cancer recurrence (BCR) is limited and CT TAP with bone scintigraphy is often performed. This study aims to determine the benefit of combination CT TAP and bone scintigraphy in BCR. Methods Patients presenting with BCR during the 15-year study period were identified from a prospectively maintained database. Definitive treatment of the primary breast cancer was required for inclusion. The institutional picture archiving and communication system was searched to identify patients who underwent CT TAP and bone scintigraphy for BCR. Sites of distant metastasis (DM) were recorded. Results 227 patients with BCR were identified during the study period;155(68.28%) patients underwent contrast-enhanced CT TAP with metastatic disease identified in 55(35.48%). Patients with grade 3 or triple negative breast cancer were more likely to have DM at time of BCR (p < 0.005). 95(41.85%) patients underwent bone scintigraphy and CT TAP. Bone scintigraphy did not identify bone metastasis in any patients without concurrent evidence of bone metastasis on CT. Conclusion CT TAP identified DM in over a third of patients with BCR who underwent restaging, a higher yield than seen in primary breast cancer staging. Bone scintigraphy did not identify osseous metastases in those without concurrent CT evidence of metastatic bone disease, suggesting limited additive value of bone scintigraphy when CT TAP is performed for BCR. Advances in knowledge This study provides evidence that CT TAP alone may be sufficient for systemic staging in BCR.