Tc-99m bone scans detect early bone metastasis because of the new bone formation occurring at these sites [124] and have a 98% sensitivity for detecting early bone metastasis in symptomatic patients. However, bone scan is not helpful for asymptomatic women with newly diagnosed early stage breast cancer due to the low prevalence of metastasis (<1%) at initial diagnosis [125]. Whole body bone scans are performed in up to 35% of women with newly diagnosed breast cancer despite National Comprehensive Cancer Network (NCCN) guidelines recommending against routine staging in asymptomatic women with early stage breast cancer [125,126]. The unnecessary use of this imaging test and the further evaluation of false-positive findings can result in treatment delay [127]. There is no evidence to use whole body bone scan in the evaluation of distant disease in stage I to IIA breast cancer. CT Chest, Abdomen, and Pelvis With IV Contrast National and international guidelines (American Board of Internal Medicine [ABIM]/ASCO, European Society for Medical Oncology [ESMO], and Spanish Society of Medical Oncology [SEOM]) discourage the use of imaging for staging in asymptomatic patients with newly diagnosed early stage breast cancer [128-130]. NCCN guidelines recommend chest, abdomen, and pelvic CT as an additional test prior to preoperative systemic therapy in clinical stage I to IIA if the tumor is >2 cm, >1 cm and immunohistochemical subtype is triple negative, or HER2+ or any size/subtype with known axillary nodal spread [126]. However, this test is often used in the staging evaluation of low-risk cancers, outside these guidelines, despite a lack of evidence suggesting that it improves detection of metastatic disease or increases survival. There is a lack of evidence demonstrating a benefit for the use of CT in asymptomatic individuals with clinical stage I or II disease outside the guidelines above.
Imaging of Invasive Breast Cancer. Tc-99m bone scans detect early bone metastasis because of the new bone formation occurring at these sites [124] and have a 98% sensitivity for detecting early bone metastasis in symptomatic patients. However, bone scan is not helpful for asymptomatic women with newly diagnosed early stage breast cancer due to the low prevalence of metastasis (<1%) at initial diagnosis [125]. Whole body bone scans are performed in up to 35% of women with newly diagnosed breast cancer despite National Comprehensive Cancer Network (NCCN) guidelines recommending against routine staging in asymptomatic women with early stage breast cancer [125,126]. The unnecessary use of this imaging test and the further evaluation of false-positive findings can result in treatment delay [127]. There is no evidence to use whole body bone scan in the evaluation of distant disease in stage I to IIA breast cancer. CT Chest, Abdomen, and Pelvis With IV Contrast National and international guidelines (American Board of Internal Medicine [ABIM]/ASCO, European Society for Medical Oncology [ESMO], and Spanish Society of Medical Oncology [SEOM]) discourage the use of imaging for staging in asymptomatic patients with newly diagnosed early stage breast cancer [128-130]. NCCN guidelines recommend chest, abdomen, and pelvic CT as an additional test prior to preoperative systemic therapy in clinical stage I to IIA if the tumor is >2 cm, >1 cm and immunohistochemical subtype is triple negative, or HER2+ or any size/subtype with known axillary nodal spread [126]. However, this test is often used in the staging evaluation of low-risk cancers, outside these guidelines, despite a lack of evidence suggesting that it improves detection of metastatic disease or increases survival. There is a lack of evidence demonstrating a benefit for the use of CT in asymptomatic individuals with clinical stage I or II disease outside the guidelines above.