Fast Five Quiz: Are You Prepared to Confront Metastatic Breast Cancer?

Winston W. Tan, MD

Disclosures

December 21, 2021

Combined PET-CT scanning can identify axillary and non-axillary (eg, internal mammary or supraclavicular) lymph node metastasis for the purposes of staging locally advanced and inflammatory breast cancer before initiation of neoadjuvant therapy and restaging high-risk patients for local or distant recurrences.

Scintimammography is not indicated as a screening procedure for the detection of breast cancer. However, it may play a role in various specific clinical indications, as in cases of non-diagnostic or difficult mammography and in the evaluation of high-risk patients, tumor response to chemotherapy, and metastatic involvement of axillary lymph nodes.

Ultrasonography can provide valuable information about the nature and extent of solid masses and other breast lesions and can often provide useful information regarding the staging of the axilla. It is also useful in the guidance of biopsies and therapeutic procedures; its role in cancer screening is currently being investigated.

The high cost and limited availability of MRI as well as the difficulties inherent in performing and interpreting the studies with high false-positive rates, necessitate that the use of this modality be carefully considered before it is recommended. American Cancer Society guidelines and NCCN guidelines recommend annual breast MRI screening for women at high risk for breast cancer, which includes BRCA mutation carriers and their untested first-degree relatives; women with Li-Fraumeni syndrome and other high-risk predisposition syndromes; women with a history of thoracic radiation therapy between age 10-30 years; and women with greater than 20% lifetime risk of breast cancer based on risk assessment models.

Other indications for MRI in breast cancer include:

  • Characterization of an indeterminate lesion after a full assessment with physical examination, mammography, and ultrasonography

  • Detection of occult breast carcinoma in a patient with carcinoma in an axillary lymph node

  • Evaluation of suspected multifocal or bilateral tumor

  • Evaluation of invasive lobular carcinoma, which has a high incidence of multifocality

  • Evaluation of suspected extensive high-grade intraductal carcinoma

  • Detection of occult primary breast carcinoma in the presence of metastatic adenocarcinoma of unknown origin

  • Monitoring of the response to neoadjuvant chemotherapy

  • Detection of recurrent breast cancer

Learn more about the workup of metastatic breast cancer.

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