Staging computerized tomography before delayed breast reconstruction could alter the management plan

Area of Science:

• Oncology
• Radiology
• Plastic Surgery

Background:

• Delayed breast reconstruction (DBR) is a common procedure following breast cancer treatment.
• Current guidelines lack specific protocols for assessing oncological status before DBR in asymptomatic patients, especially those at higher risk of recurrence.
• Tumor biology, staging, treatment timelines, and patient/surgeon preferences influence DBR decisions.

Purpose of the Study:

• To identify patients who may benefit from a staging CT scan prior to DBR, irrespective of reconstruction method.
• To evaluate the impact of staging CT scans on the overall management of patients undergoing DBR.

Main Methods:

• Retrospective review of 207 patients who underwent staging CT scans before DBR between 2009 and 2019.
• Correlation of CT scan findings with the Nottingham Prognostic Index (NPI) to assess prognostic value.

Main Results:

• Incidental findings (incidentaloma) were noted in 34% of CT scans.
• No significant difference in NPI scores was observed between patients with and without incidental findings.
• DBR procedures were cancelled or surgical plans altered in 5.7% of patients based on CT findings.

Conclusions:

• Patients with moderate to poor prognosis (NPI score ≥3.4) may benefit from pre-DBR CT staging.
• CT staging can detect adverse prognostic features that might preclude major surgery, thus avoiding unnecessary risks and guiding appropriate management pathways.