Evaluation for locoregional disease (includes IDC, or ILC, or NOS). Bone Scan Whole Body There is no evidence to support the use of bone scan whole body for determining locoregional disease. CT Chest, Abdomen, and Pelvis With IV Contrast Few studies have evaluated the use of CT to determine locoregional disease in breast cancer and so there is limited supporting evidence for this indication. In a study using CT to determine the size of the in-breast malignancy, surgical treatment was changed in 42 of 297 (14.1%) patients. The same study showed that CT failed to show the extent of disease in 10.8% of patients and overestimated the extent of disease in 1% of tumors. Notably, MRI was not included as a comparator [20]. An additional study looking at later stage (at least 2 cm) or higher risk (triple Imaging of Invasive Breast Cancer negative or other biomarkers of risk such as high Ki67 or HER2+) found that CT predicted the N stage correctly in 64 of 80 patients (80%, 95% CI,70.0%-87.3%), with a sensitivity of 61.5% (CI,45.9%-75.1%) and a specificity of 97.6% (CI, 87.4%-99.6%). Despite the higher specificity of CT, MRI has better performance to detect multicentric/multifocal disease and estimate final pathologic size. CT Chest, Abdomen, and Pelvis Without and With IV Contrast The majority of clinical questions for abdominal and/or pelvic CT can be appropriately answered with a single- phase study as detailed in the ACR-SABI-SPR practice parameter for the performance of CT of the abdomen and CT of the pelvis [21]. 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 for determining locoregional disease and guiding surgical management in late-stage disease. Digital Breast Tomosynthesis Diagnostic Diagnostic mammography and US together can assess for extent of disease and tumor size.
Imaging of Invasive Breast Cancer. Evaluation for locoregional disease (includes IDC, or ILC, or NOS). Bone Scan Whole Body There is no evidence to support the use of bone scan whole body for determining locoregional disease. CT Chest, Abdomen, and Pelvis With IV Contrast Few studies have evaluated the use of CT to determine locoregional disease in breast cancer and so there is limited supporting evidence for this indication. In a study using CT to determine the size of the in-breast malignancy, surgical treatment was changed in 42 of 297 (14.1%) patients. The same study showed that CT failed to show the extent of disease in 10.8% of patients and overestimated the extent of disease in 1% of tumors. Notably, MRI was not included as a comparator [20]. An additional study looking at later stage (at least 2 cm) or higher risk (triple Imaging of Invasive Breast Cancer negative or other biomarkers of risk such as high Ki67 or HER2+) found that CT predicted the N stage correctly in 64 of 80 patients (80%, 95% CI,70.0%-87.3%), with a sensitivity of 61.5% (CI,45.9%-75.1%) and a specificity of 97.6% (CI, 87.4%-99.6%). Despite the higher specificity of CT, MRI has better performance to detect multicentric/multifocal disease and estimate final pathologic size. CT Chest, Abdomen, and Pelvis Without and With IV Contrast The majority of clinical questions for abdominal and/or pelvic CT can be appropriately answered with a single- phase study as detailed in the ACR-SABI-SPR practice parameter for the performance of CT of the abdomen and CT of the pelvis [21]. 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 for determining locoregional disease and guiding surgical management in late-stage disease. Digital Breast Tomosynthesis Diagnostic Diagnostic mammography and US together can assess for extent of disease and tumor size.