The sensitivity of whole body bone scans for detecting bone metastases in patients with late-stage breast cancer ranges from 62% to 100%, regardless of tumor subtype [143]. Studies using bone scans to stage women with late- stage disease have shown the prevalence of osseous metastases ranging from 4.7% to 45% [144]. A study by Chu et al [145] on 256 women with N2/N3 disease showed a metastatic workup for asymptomatic patients was only indicated with T3 or T4 primary lesions. For patients with T0, T1, and T2 diseases, the incidence of stage IV disease was 0%, 0%, and 6%, respectively. The incidence increased with higher T stage; 22% for T3 and 36% for T4 tumors. Several studies comparing bone scan performance with CT and PET have been performed in women presenting with late-stage disease [144]. Some studies have shown up to 17.1% of women with extraosseous metastasis on CT had negative or inconclusive bone scans [144]. One of the benefits of whole body bone scans is the detection of metastasis in the peripheral skeleton, areas not included by CT chest, abdomen, and pelvis with IV contrast. Imaging of Invasive Breast Cancer However, the presence of peripheral metastasis almost always (>99%) occurs in the context of extraosseous or central osseous metastasis, and detection of additional peripheral metastases does not typically result in a change in management [144,146]. CT Chest, Abdomen, and Pelvis With IV Contrast Correctly identifying the stage of breast cancer prior to surgery has important prognostic implications, because survival decreases as stage increases [145]. In a study of 1,329 patents with breast cancer, metastatic disease of any type was identified by imaging between 15% to 16% and 22% to 36% based on N2/3 and T3/4 status, respectively [145].
Imaging of Invasive Breast Cancer. The sensitivity of whole body bone scans for detecting bone metastases in patients with late-stage breast cancer ranges from 62% to 100%, regardless of tumor subtype [143]. Studies using bone scans to stage women with late- stage disease have shown the prevalence of osseous metastases ranging from 4.7% to 45% [144]. A study by Chu et al [145] on 256 women with N2/N3 disease showed a metastatic workup for asymptomatic patients was only indicated with T3 or T4 primary lesions. For patients with T0, T1, and T2 diseases, the incidence of stage IV disease was 0%, 0%, and 6%, respectively. The incidence increased with higher T stage; 22% for T3 and 36% for T4 tumors. Several studies comparing bone scan performance with CT and PET have been performed in women presenting with late-stage disease [144]. Some studies have shown up to 17.1% of women with extraosseous metastasis on CT had negative or inconclusive bone scans [144]. One of the benefits of whole body bone scans is the detection of metastasis in the peripheral skeleton, areas not included by CT chest, abdomen, and pelvis with IV contrast. Imaging of Invasive Breast Cancer However, the presence of peripheral metastasis almost always (>99%) occurs in the context of extraosseous or central osseous metastasis, and detection of additional peripheral metastases does not typically result in a change in management [144,146]. CT Chest, Abdomen, and Pelvis With IV Contrast Correctly identifying the stage of breast cancer prior to surgery has important prognostic implications, because survival decreases as stage increases [145]. In a study of 1,329 patents with breast cancer, metastatic disease of any type was identified by imaging between 15% to 16% and 22% to 36% based on N2/3 and T3/4 status, respectively [145].