A study investigating the use of CT at evaluating locoregional disease, stages I to III, adding CT to mammogram, ultrasound (US) and physical examination correctly changed the surgical approach in 13.1% of patients, based on final pathology. However, CT failed to show any disease (false-negative) in 10.8% and had a low sensitivity for detecting multicentric and multifocal tumors [20]. CT Chest, Abdomen, and Pelvis Without IV Contrast There is no evidence to support the use of CT chest, abdomen, and pelvis without IV contrast to evaluate for locoregional disease. Digital Breast Tomosynthesis Diagnostic Diagnostic mammography and US together can assess for extent of disease and tumor size. These imaging tests are usually already completed as part of the diagnostic workup (prior to pathological diagnosis). However, mammography is limited by breast density. In a prospective study of 111 consecutive women with newly diagnosed breast cancer, sensitivity of 2-D mammography for malignancy decreased from 100% in breasts that are almost entirely fatty to 45% in extremely dense breasts [22]. In addition, 2-D mammography was more sensitive than US in detecting ductal carcinoma in situ (DCIS) and less sensitive in detecting ILC. Digital breast tomosynthesis (DBT) shows a higher overall sensitivity, compared with 2-D mammography, with a similar specificity. Overall sensitivity for DBT was 88.2% compared with 78.3% for 2-D mammography [23]. DBT also has a higher sensitivity for detecting multifocal, multicentric, and contralateral breast cancer [24,25]. The improved diagnostic performance of DBT over 2-D mammography in breast cancer staging was limited to women with nondense breasts in 1 study [24], but not others [25]. Due to patient positioning constraints, 2-D mammography and DBT have limited value for evaluating the axilla.
Imaging of Invasive Breast Cancer. A study investigating the use of CT at evaluating locoregional disease, stages I to III, adding CT to mammogram, ultrasound (US) and physical examination correctly changed the surgical approach in 13.1% of patients, based on final pathology. However, CT failed to show any disease (false-negative) in 10.8% and had a low sensitivity for detecting multicentric and multifocal tumors [20]. CT Chest, Abdomen, and Pelvis Without IV Contrast There is no evidence to support the use of CT chest, abdomen, and pelvis without IV contrast to evaluate for locoregional disease. Digital Breast Tomosynthesis Diagnostic Diagnostic mammography and US together can assess for extent of disease and tumor size. These imaging tests are usually already completed as part of the diagnostic workup (prior to pathological diagnosis). However, mammography is limited by breast density. In a prospective study of 111 consecutive women with newly diagnosed breast cancer, sensitivity of 2-D mammography for malignancy decreased from 100% in breasts that are almost entirely fatty to 45% in extremely dense breasts [22]. In addition, 2-D mammography was more sensitive than US in detecting ductal carcinoma in situ (DCIS) and less sensitive in detecting ILC. Digital breast tomosynthesis (DBT) shows a higher overall sensitivity, compared with 2-D mammography, with a similar specificity. Overall sensitivity for DBT was 88.2% compared with 78.3% for 2-D mammography [23]. DBT also has a higher sensitivity for detecting multifocal, multicentric, and contralateral breast cancer [24,25]. The improved diagnostic performance of DBT over 2-D mammography in breast cancer staging was limited to women with nondense breasts in 1 study [24], but not others [25]. Due to patient positioning constraints, 2-D mammography and DBT have limited value for evaluating the axilla.