A survey of NCCN member institutions found that 11% of patients with stage I and 36.2% of patients with stage II received a staging CT of the chest. This resulted in 27% of patients diagnosed with pulmonary nodules requiring a mean 2.34 additional CTs (range 0-16) for follow-up. Of pulmonary nodules detected in asymptomatic women with early stage breast cancer, only 2% of these patients were ultimately diagnosed with pulmonary metastasis [131,132]. Imaging of Invasive Breast Cancer 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 in identifying distant disease. Digital Breast Tomosynthesis Diagnostic There is no evidence to support the use of DBT to evaluate distant disease. FDG-PET/CT Skull Base to Mid-Thigh According to the ABIM/ASCO, ESMO, and SEOM guidelines, there is insufficient evidence to routinely use FDG- PET/CT to evaluate for distant disease in asymptomatic women with early stage breast cancer [128-130]. 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]. Although not definitive, and not currently recommended in the guidelines above, there is evidence that PET/CT may be useful in early stage breast cancer [133].
Imaging of Invasive Breast Cancer. A survey of NCCN member institutions found that 11% of patients with stage I and 36.2% of patients with stage II received a staging CT of the chest. This resulted in 27% of patients diagnosed with pulmonary nodules requiring a mean 2.34 additional CTs (range 0-16) for follow-up. Of pulmonary nodules detected in asymptomatic women with early stage breast cancer, only 2% of these patients were ultimately diagnosed with pulmonary metastasis [131,132]. Imaging of Invasive Breast Cancer 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 in identifying distant disease. Digital Breast Tomosynthesis Diagnostic There is no evidence to support the use of DBT to evaluate distant disease. FDG-PET/CT Skull Base to Mid-Thigh According to the ABIM/ASCO, ESMO, and SEOM guidelines, there is insufficient evidence to routinely use FDG- PET/CT to evaluate for distant disease in asymptomatic women with early stage breast cancer [128-130]. 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]. Although not definitive, and not currently recommended in the guidelines above, there is evidence that PET/CT may be useful in early stage breast cancer [133].