Best Of Best Poster Oral Clinical Oncology Society of Australia Annual Scientific Meeting 2017

Staging scans (SS) in pre-operative, asymptomatic, stage I/II early breast cancer (EBC) patients (pts) at Bankstown-Lidcombe Hospital (#286)

Abhijit Pal 1 , Patsy Soon 1 2 , Davendra Segara 1 , Simon Yarrow 1 , George Kourtesis 1 , Parameswar Rachumalla 1 , Gholamreza Asghari 1 , Sandra Harvey 1 , Miriam Boxer 1 2 , Clara Inkyung Lee 1 2 3
  1. Bankstown-Lidcombe Hospital, Condell Park, NSW, Australia
  2. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
  3. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia


It is well established that there is widespread variability in practice1,2  and that divergence from guidelines3,4,5,6   is common in the ordering of SS for pts with stage I/II EBC. This is influenced by multiple factors including pt preference.  We therefore investigated the incidence and yield of SS in asymptomatic women by conducting a retrospective audit of consecutive Stage I/II EBC pts seen at Bankstown Cancer Centre between January 2014 – December 2016.


Our final cohort of stage I/II EBC pts was derived by cross-checking theatre, surgical audit and clinic lists via MOSAIQ (EMR) for the above time-period.  Pts with symptoms were excluded.  Data were collected for age, demographic information, histopathologic characteristics and conduct and yield of SS.


Our audit included 175 women with pre-operative Stage I/II EBC, asymptomatic for metastases.  Median age was 64 (22 – 89).  76% (133) had invasive ductal carcinoma. 49% (86) were luminal A, 35% (61) were luminal B, 16% (28) were hormone insensitive- ie 11% (20) triple negative and 5% (8) were HER2 amplified. Pts who were both hormone sensitive and HER2 amplified comprised 9% (15). 73% (127) had staging CT chest, abdomen, pelvis while 76% (133) had technetium99m bone scans. 3% (4) had metastatic breast cancer (MBC) detected on SS. 13% (17) required further imaging +/-procedures due to incidental findings on SS.


75% of women in our audit underwent SS, of whom 3% had asymptomatic metastatic disease detected, while 13% of these women had incidental finding/s requiring further workup. Our results support the  guidelines3,4,5,6 in avoiding SS in Stage I/II EBC in asymptomatic women due to low yield. Unfavourable biology did not predict for increased yield. Our results are consistent with existing literature regarding widespread variable SS ordering practices and divergence from guidelines1,2, for reasons other than stage.

  1. Chagpar, A, Babiera, G, Aguirre, J. et al. Variation in metastatic workup for patients with invasive breast cancer, The American Journal of Surgery 2015, 210, 1147-1154
  2. Chand, N, Cutress, RI, Oeppen, RS, Staging Investigations in Breast Cancer: Collective Opinion of UK Breast Surgeons, International Journal of Breast Cancer 2013, 1-8
  3. Senkus, E, Kyriakides, S., Ohno, S. et al. on behalf of the ESMO Guidelines Committee, Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up, Annals of Oncology 2015, 26 (Supplement 5): v8-v30.
  4. National Comprehensive Cancer Network Breast Cancer Guidelines (Version 2. 2017) URL Accessed 26th July, 2017
  5. American Society of Clinical Oncology: Choosing Wisely: An Initiative of the ABIM Foundation, 2012. URL Accessed 26th July, 2017
  6. Brennan, M, Houssami, N. Newly diagnosed early breast cancer; An update on pre-operative assessment and staging, Australian Family Physician 2012 Nov;41 (11) 871 – 87