Mammography Diagnostic There is no evidence to support the use of diagnostic mammography to evaluate for distant disease. Imaging of Invasive Breast Cancer Mammography With IV Contrast There is no evidence to support the use of mammography with IV contrast to evaluate distant disease. MRI Breast Without and With IV Contrast There is no evidence to support the use of MRI breast without and with IV contrast to evaluate for distant disease. MRI Breast Without IV Contrast There is no evidence to support the use of noncontrast breast MRI in evaluating extent of disease. US Axilla There is no evidence to support the use of US axilla to evaluate for distant disease. US Breast There is no evidence to support the use of US breast to evaluate for distant disease. Variant 5: Newly diagnosed. Clinical stage IIB-III (late stage) breast cancer at presentation. Evaluation for distant disease. IDC or ILC that is HER2+ or triple negative (ER, PR, and HER2-). It has long been recognized that steroid receptor expression reflects intrinsic biologic diversity in breast cancer with treatment and survival implications, also determining patterns of metastatic spread. The specific response patterns and outcomes associated with ER/PR/HER2 status occur despite the known limitation of pathologic sampling and receptor expression heterogeneity [142]. Historically, bone is the most likely site of breast cancer metastases (51%), followed by liver/soft tissue (19%), pleura (16%), lung (14%), and brain (4%) [115]. The higher percentage of bone metastases from breast cancer appears to be driven primarily by the majority of primary tumors expressing ER and/or PR. In 1 large multidecade study, 82% of patients with breast cancer who developed bone metastases had either ER and PR or ER positivity in the primary tumor [115].
Imaging of Invasive Breast Cancer. Mammography Diagnostic There is no evidence to support the use of diagnostic mammography to evaluate for distant disease. Imaging of Invasive Breast Cancer Mammography With IV Contrast There is no evidence to support the use of mammography with IV contrast to evaluate distant disease. MRI Breast Without and With IV Contrast There is no evidence to support the use of MRI breast without and with IV contrast to evaluate for distant disease. MRI Breast Without IV Contrast There is no evidence to support the use of noncontrast breast MRI in evaluating extent of disease. US Axilla There is no evidence to support the use of US axilla to evaluate for distant disease. US Breast There is no evidence to support the use of US breast to evaluate for distant disease. Variant 5: Newly diagnosed. Clinical stage IIB-III (late stage) breast cancer at presentation. Evaluation for distant disease. IDC or ILC that is HER2+ or triple negative (ER, PR, and HER2-). It has long been recognized that steroid receptor expression reflects intrinsic biologic diversity in breast cancer with treatment and survival implications, also determining patterns of metastatic spread. The specific response patterns and outcomes associated with ER/PR/HER2 status occur despite the known limitation of pathologic sampling and receptor expression heterogeneity [142]. Historically, bone is the most likely site of breast cancer metastases (51%), followed by liver/soft tissue (19%), pleura (16%), lung (14%), and brain (4%) [115]. The higher percentage of bone metastases from breast cancer appears to be driven primarily by the majority of primary tumors expressing ER and/or PR. In 1 large multidecade study, 82% of patients with breast cancer who developed bone metastases had either ER and PR or ER positivity in the primary tumor [115].