Use of contrast-enhanced computed tomography in clinical staging of asymptomatic breast cancer patients to detect asymptomatic distant metastases
Use of contrast-enhanced computed tomography in clinical staging of asymptomatic breast cancer patients to detect asymptomatic distant metastases
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DOI：
10.3892/ol.2012.594
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发表时间：
2012-04-01
期刊：
影响因子：
2.9
通讯作者：
Uchiyama, Kazuhisa
中科院分区：
文献类型：
--
作者：
Tanaka, Satoru;Sato, Nayuko;Uchiyama, Kazuhisa
临床实践中越来越多地使用计算机断层扫描 (CT) 对无症状乳腺癌患者进行临床分期。然而，常规CT的好处尚未完全阐明。本研究调查了采用对比增强 CT (CECT) 筛查无症状乳腺癌患者远处转移的价值。回顾性分析了 2006 年 4 月至 2011 年 1 月期间在同一机构接受 CECT 的 483 例无症状乳腺癌患者的临床记录。 CECT 结果分为正常、真阳性（转移）或假阳性结果。在 65 名患者 (13.5%) 中检测到异常 CECT 结果，包括真阳性和假阳性结果。其中，26名患者（5.4%）显示出确诊的真正转移性疾病，包括18名肺转移、11名肝转移和13名骨转移。根据 CECT 扫描结果，I 期 155 名患者中有 0 名升级至 IV 期，II 期 261 名患者中有 5 名 (1.9%) 升级至 IV 期，III 期 67 名患者中有 21 名 (31.3%) 升级至 IV 期。 I、II、III期的假阳性率分别为7.7%、9.0%和8.7%。肺或肝转移灶的大小明显大于假阳性病灶。常规 CECT 似乎无法用于检测完全无症状患者的远处转移。相反，少数患者从早期阶段升级到 IV 期，并且似乎需要单独 T 和 N 阶段之外的预测因素来预测哪些无症状患者有远处转移。
The use of computed tomography (CT) with regards to the clinical staging of patients with asymptomatic breast cancer has been on the increase in clinical practice. However, the benefits of routine CT have yet to be fully clarified. This study investigated the value of employing contrast-enhanced CT (CECT) to screen for distant metastases in patients with asymptomatic breast cancer. The clinical records of 483 patients with asymptomatic breast cancer who underwent CECT at a single institution between April 2006 and January 2011 were reviewed retrospectively. The CECT results were classified into normal, true-positive (metastases) or false-positive findings. Abnormal CECT findings, including true- and false-positive results, were detected in 65 patients (13.5%). Of these, 26 patients (5.4%) showed confirmed true metastatic disease, including 18 lung metastases, 11 liver metastases and 13 bone metastases. Upstaging to stage IV due to the results of the CECT scan occurred in 0 of 155 patients at stage I, 5 of 261 patients (1.9%) at stage II and 21 of 67 patients (31.3%) at stage III. The false-positive rates were 7.7, 9.0 and 8.7% in stages I, II and III, respectively. The size of the lung or liver metastasis was significantly larger than the false-positive lesion. Routine CECT did not appear to be useful for detecting distant metastases in completely asymptomatic patients. Conversely, a small number of patients were upstaged from early to stage IV and a predictive factor beyond T and N stage alone appears to be needed in order to predict which asymptomatic patients have distant metastases.