NCCN guidelines recommend chest, abdomen, and pelvic CT as an additional test prior to preoperative systemic therapy to evaluate for distant disease if the tumor size is >2 cm (T2) or there are positive lymph nodes, or >1 cm (T1c) and HER2+, or triple-negative disease [126]. In asymptomatic women with late-stage breast cancer, metastatic disease to the thorax is identified in 5% to 9% of patients [17,132,147]. The false-positive rate requiring additional imaging studies for further evaluation or follow-up ranged from 10% to 33% [17,132,148]. 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. Chest CT without IV contrast is often used to evaluate for metastatic disease to the lung. In asymptomatic women with late-stage breast cancer, metastatic disease to the thorax is identified in 5% to 9% of patients [17,132,147]. The false-positive rate requiring additional imaging studies for further evaluation or follow-up ranged from 10% to 33% [17,132,148]. Digital Breast Tomosynthesis Diagnostic There is no evidence to support the use of DBT to evaluate for distant disease. FDG-PET/CT Skull Base to Mid-Thigh NCCN guidelines recommend PET/CT as an optional additional test prior to preoperative systemic therapy if the tumor size is greater than T2, or there are positive lymph nodes, any HER2+, or triple-negative disease [126]. There is a large body of evidence that FDG-PET/CT is useful to detect metastatic disease in stage IIB to III breast cancer [136-139,149-158].
Imaging of Invasive Breast Cancer. NCCN guidelines recommend chest, abdomen, and pelvic CT as an additional test prior to preoperative systemic therapy to evaluate for distant disease if the tumor size is >2 cm (T2) or there are positive lymph nodes, or >1 cm (T1c) and HER2+, or triple-negative disease [126]. In asymptomatic women with late-stage breast cancer, metastatic disease to the thorax is identified in 5% to 9% of patients [17,132,147]. The false-positive rate requiring additional imaging studies for further evaluation or follow-up ranged from 10% to 33% [17,132,148]. 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. Chest CT without IV contrast is often used to evaluate for metastatic disease to the lung. In asymptomatic women with late-stage breast cancer, metastatic disease to the thorax is identified in 5% to 9% of patients [17,132,147]. The false-positive rate requiring additional imaging studies for further evaluation or follow-up ranged from 10% to 33% [17,132,148]. Digital Breast Tomosynthesis Diagnostic There is no evidence to support the use of DBT to evaluate for distant disease. FDG-PET/CT Skull Base to Mid-Thigh NCCN guidelines recommend PET/CT as an optional additional test prior to preoperative systemic therapy if the tumor size is greater than T2, or there are positive lymph nodes, any HER2+, or triple-negative disease [126]. There is a large body of evidence that FDG-PET/CT is useful to detect metastatic disease in stage IIB to III breast cancer [136-139,149-158].