Abstract P6-11-05: Chest imaging in patients with breast cancer treated with curative intent
Authors: Dawar R , Palacio S , Monge J , Torres A , Salzberg M , Malpica Castillo LE , Saravia D , Amarapurkar P , Hurley J 
Published: May 2016

Background:

With progressive advances in contemporary medicine, care of cancer patients has become increasingly complex and costly. Nationwide demands to regulate health care expenditure have escalated, urging healthcare providers (HCP) to reassess their investigative strategies in patient care for optimal resource utilization. An abnormal chest x ray (CXR), done routinely as preoperative work up for breast cancer patients, commonly prompts further imaging if found to be abnormal. Data regarding whether this additional imaging is useful is scant.

Method:

This IRB approved retrospective analysis identified all patients diagnosed with breast cancer from 2004 through 2014. Data collected included age at diagnosis, ethnicity, smoking history, insurance status, respiratory symptoms, tumor histology and stage, hormonal receptor status, HER-2 receptor status and radiographic imaging.

Results:

Data from 2400 patients were analyzed. 194 patients were excluded: 117 stage IV disease and 77 incomplete data. 2206 had clinical stages I, II and III. 14% stage 0; 27% stage I; 35% stage II; 23% stage III. Demographics: 99.5% female and 0.5% males. Mean age 54.4 (range 18-92); 4% White, 23% African descent, 1% Asian, 72% Hispanic, 39% uninsured. Smoking history: 79% never smoked, 10% former smokers, 11% current smokers. 2017 (91%) had a preoperative CXR; 83% were normal and 17% abnormal. Abnormalities: nodules(41%), granulomas(18%), atelectasis(11%), infiltrates(4%), masses(4%), other findings(21%). 70% of patients with abnormal CXR had a chest computed tomography (CT) scan; abnormal/normal 88%/12%.

Chest imaging in patients with breast cancer treated with curative intent Clinical Stage 0123Total number of patients (n = 2206)14%27%35%23%CXR (Abnormal / Total, n = 2017)11%17%17%20%Chest CT (Abnormal / Total, n = 241)92%92%86%86%Finding on abnormal chest CT (n = 211)    Nodule55%70%67%62%Granuloma27%15%15%8%Metastasis0%9%15%15%Other18%15%10%14%Patients with follow-up chest CT (n = 111)55%43%47%63%Mean number of follow-up chest CTs per patient21.811.851.96Table 1

Abnormalities: pulmonary nodules (65%), granulomas (13%) and metastases (9%), other findings (13%). Pulmonary nodules measured &lt;4 mm (40%), 4-6 mm (35%), 6-8 mm (13%) and &gt;8mm (13%). Of the 214 patients with abnormal chest CT, 52% had follow-up CT done, with mean follow-up of 1.89 per patient. There were more abnormal CXR in smokers than never smokers (23 vs 16%, p=0.001) but not chest CT scans (91 vs 86%, p = 0.35). There was no difference in rate of abnormal CXR based on age, race, ethnicity or insurance status. Evaluation of abnormal CXR's with chest CT scans found metastasis: stage 0(0%), stage 1(0%), stage 2(9%), stage 3(15%), p = 0.014.

Conclusions:

Later clinical stage predicts for finding metastasis on chest CT scans, done for evaluation of abnormal CXR. The use of chest CT scans for patients with non-specific pulmonary findings on CXR is not useful for women with clinical stage 0 and stage 1 disease.

Citation Format: Dawar R, Palacio S, Monge J, Torres A, Salzberg M, Malpica Castillo LE, Saravia D, Amarapurkar P, Hurley J. Chest imaging in patients with breast cancer treated with curative intent. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-11-05.