Need for Staging Investigations in Newly Diagnosed Breast Cancer: Establishing Local Guidelines for Radiological...

Area of Science:

• Oncology
• Radiology
• Pathology

Background:

• Staging workup for distant metastases is crucial for breast cancer treatment decisions and prognosis.
• Current recommendations for breast cancer staging investigations vary widely.
• Routine staging is common in Bahrain due to a lack of consistent guidelines, leading to potential overuse.

Purpose of the Study:

• To evaluate factors associated with distant metastases in newly diagnosed breast cancer patients.
• To establish local guidelines for selecting patients who require systemic staging investigations.
• To optimize staging criteria, identifying metastases while minimizing harm and costs.

Main Methods:

• Retrospective analysis of clinical, radiological, and pathological data from 593 newly diagnosed breast cancer patients.
• Patients were treated at Salmaniya Medical Complex in Bahrain between January 2016 and December 2022.
• Exclusion criteria included prior cancer history, synchronous tumors, bilateral breast cancer, and ductal carcinoma in situ.

Main Results:

• Distant metastases (M1 disease) were identified in 20.7% of patients.
• M1 disease was significantly associated with multifocality/multicentricity, high tumor grade, hormone receptor-negative status, high Ki67, advanced tumor stage, node-positive disease, triple-negative breast cancer, PET scan use, and neoadjuvant chemotherapy.
• Age was not found to be associated with the identification of distant metastases.

Conclusions:

• The prevalence of distant metastases in this Bahraini cohort was higher than previously reported.
• Routine staging for all newly diagnosed breast cancer patients, especially asymptomatic early-stage cases, is not indicated.
• Identifying high-risk patient groups can guide the development of local guidelines for appropriate metastatic workup.