What methods are used to detect breast cancer metastasis?

From the Guidelines

Detecting breast cancer metastasis should be guided by symptoms and clinical suspicion, with imaging studies and tissue sampling used to confirm the presence of metastatic disease, as routine systemic imaging is not recommended for asymptomatic patients with early-stage breast cancer 1.

Diagnosis and Detection

The primary methods for detecting breast cancer metastasis include:

• CT scans of the chest, abdomen, and pelvis to identify spread to organs
• Bone scans to detect bone metastases
• PET scans to reveal metabolically active cancer cells throughout the body
• MRI for detailed imaging of the brain and other soft tissues Blood tests, such as complete blood counts and liver function tests, may indicate metastatic disease, but are not definitive on their own 1.

Imaging and Staging

A minimal staging work-up should include a complete history and physical examination, hematology and biochemistry tests, and imaging of the chest, abdomen, and bone 1.

• CT scans are indicated for patients with symptoms such as cough or hemoptysis
• Abdominal imaging using diagnostic CT or MRI is indicated for patients with elevated alkaline phosphatase levels, abnormal liver function tests, abdominal symptoms, or abnormal physical examination of the abdomen or pelvis
• Bone scans are indicated for patients with localized bone pain or elevated alkaline phosphatase levels

Tissue Sampling and Biopsy

Biopsy of suspicious areas remains the gold standard for confirming metastasis, as it allows pathologists to examine tissue samples microscopically for cancer cells 1.

Screening and Follow-up

Regular follow-up imaging and examinations are essential for breast cancer survivors, with frequency determined by cancer stage, biology, and individual risk factors 1. Early detection of metastasis is crucial, as it guides treatment decisions, and a combination of imaging studies, blood tests, and tissue sampling should be used to detect breast cancer metastasis in a timely and effective manner 1.

From the Research

Detection of Breast Cancer Metastasis

• Breast cancer metastasis can be detected using various imaging techniques, including CT, PET/CT, MRI, WB-DWI, and CCA 2.
• The choice of imaging modality depends on the individual patient's needs and the specific characteristics of the tumor 2.
• PET/CT, particularly 2-[18F]FDG-PET/CT, has been shown to be highly sensitive and specific for detecting bone metastases in breast cancer patients 3, 4, 5.
• MRI is also a highly sensitive and specific modality for detecting bone metastases, and its performance is comparable to that of PET/CT 3.
• Bone scintigraphy, on the other hand, has been shown to be less sensitive than PET/CT and MRI for detecting bone metastases, particularly osteolytic lesions 3, 4, 5.
• The use of dual-time-point FDG-PET/CT has been shown to improve the detection of bone metastases, particularly in patients with recurrent breast cancer 5.
• Routine screening tests such as complete blood counts, liver function tests, and chest x-rays have been shown to have limited value in detecting occult metastatic disease in asymptomatic women with early-stage breast cancer 6.

Imaging Modalities for Detecting Breast Cancer Metastasis

• CT: widely available, relatively cheap, and sufficient in many cases, but may not be as sensitive as other modalities 2.
• PET/CT: highly sensitive and specific for detecting bone metastases, particularly 2-[18F]FDG-PET/CT 3, 4, 5.
• MRI: highly sensitive and specific for detecting bone metastases, comparable to PET/CT 3.
• WB-DWI: emerging modality, may be useful in certain cases 2.
• CCA: emerging modality, may be useful in certain cases 2.
• Bone scintigraphy: less sensitive than PET/CT and MRI, particularly for osteolytic lesions 3, 4, 5.