Choosing wisely: The utility and costs of routine staging imaging in breast cancer.

Abstract

e17800 Background: Occult metastasis in clinical stage I/II breast cancer is rare, but its presence could substantially change management. The American Society of Clinical Oncology (ASCO) recommends against routine staging imaging for asymptomatic stage I/II breast cancer patients as scans have questionable benefit beyond history, physical exam, and basic lab studies. To assist clinicians in providing high-value care we examined the utility and costs of modern CT-based staging to detect occult metastasis in stage I/II breast cancer. Methods: PET-CT and CT with bone scan performed for breast cancer staging over 2 years (10/1/2012 – 9/30/2013) at University of Vermont Medical Center (UVMMC) were identified by CPT and ICD-9 codes. Scans were categorized as indicated if patients were clinical stage III/IV, had recurrence, or had symptoms suggestive of advanced cancer; scans were non-indicated if no such factors were present. Scan results and subsequent interventions were determined by clinician chart review. ...