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 the tumor size is >1 cm (T1c) and HER2+, or there is 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 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]. This is important because patients with locoregional breast malignancy have 5-year survival rates of 76% to 99%, but for patients with distant metastases, 5-year survival rates decreases to 20% to 28% [159].
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 the tumor size is >1 cm (T1c) and HER2+, or there is 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 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]. This is important because patients with locoregional breast malignancy have 5-year survival rates of 76% to 99%, but for patients with distant metastases, 5-year survival rates decreases to 20% to 28% [159].