Title

Prevalence of metastatic disease in newly diagnosed breast cancer patients as seen on contrast enhanced computed tomography of the chest, abdomen and pelvis at the Aga Khan University Hospital, Nairobi.

Date of Award

5-31-2018

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Prof. Sudhir Vinayak

Second Supervisor/Advisor

Prof. Ronald Wasike

Third Supervisor/Advisor

Dr. Rose Ndumia

Department

Imaging and Diagnostic Radiology (East Africa)

Abstract

Introduction: Breast cancer patients have traditionally been screened for occult metastases with abdominal ultrasound, chest radiography and bone scan although the use of modern tests with greateraccuracy such as computed tomography (CT), 2-[fluorine-18] fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) and Magnetic resonance (MR) imaging is on the increase. The use of contrast enhanced CT (CECT) in the staging of patients with newly diagnosed breast cancer has increased greatly in clinical practice in view of it being widely available and relatively cheapwhen compared to other modalities such as MRI and PET imaging. The clinical utility of routine staging CECT is yet to be fully defined as there is no agreement between protocols on what clinical stage, size of tumour or extent of lymph node involvement that should trigger the use of advanced imaging such as staging CECT or even MRI/PET at time of breast cancer diagnosis.

Objective: This study was done to determine the prevalence of distant metastasis as seen on staging CECT done at time of diagnosis in patients with new diagnosis breast cancer.

Study design: Cross sectional study with data gathered retrospectively.

Methods: Results of CECT examinations done for staging of patients with new diagnosis breast cancer were reviewed retrospectively to determine the prevalence of metastatic disease at time of diagnosis. CECT examinations done between January 2014 andJanuary 2017 at Aga Khan University Hospital in Nairobi (AKUH, N) were used in this study. Additional data were gathered from patient files and pathology records.

Results: The overall prevalence of distant metastasis was 14.8 % in the 183 patients recruited in this study. Using tumour size and nodal status staging (AJCC 7thEdition), 38 patients were classified as stage I (21%), 89 patients were classified as stage II (49%) and 56 patients (30%) were classified as stage III. Following the results of CECT,noneof the 38 patients at stage I were upstaged while6 of the 89 patients (7%) and 21 of the 56 (37.5%) at stage II andIII respectively were upstaged to stage IV breast cancer.

Conclusions: The overall prevalence of distant metastasis was 14.8 % in the 183 patients recruited in this study. The general practice of using staging CECT to screen for metastasis in patients with newly diagnosed breast cancer was useful in patients with locally advanced breast cancer (stage III) and not useful in those with stage I disease. 7% of patients were upstaged from stage II breast cancer to stage IV disease following staging CECT therefore staging CECT may be considered in these patients. In view of this, larger studies are recommended to establish which patients in stage II breast cancer may benefit from staging CECT examinations.

This document is available in the relevant AKU library

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