Anuj Sharma Singh1 , Ashish Gupta2 , Sibashish Saha3 , Kanakeshwar Bhuyan4 , Bibhash Chandra Gowami5
BACKGROUND In developing countries, majority of breast cancer patients present in advanced stage with poor outcomes. In rural parts of India, 50% to 60% of all breast cancer patients have locally advanced disease or distant metastasis at presentation. It is recommended to include CECT abdomen and CECT thorax for metastatic work up of locally advanced breast cancer (LABC). This study was done to compare CECT abdomen versus USG abdomen and CECT thorax versus Chest X-Ray respectively in LABC patients for detecting visceral metastasis. METHODS Medical records of patients referred to State Cancer Institute, GMC, from July 2017 to March 2019 were retrieved for analysis. From this data investigations performed for metastatic work up, results, and costs were recorded. Sensitivity and specificity of CECT thorax and abdomen were calculated and compared to those of Chest XRay (CXR) and Ultrasound abdomen (USG) respectively. Fischer’s exact test and Pearson chi square test were used for univariate analysis. McNemar test was used to compare the sensitivities. RESULTS CECT abdomen and USG abdomen had sensitivity rates of 80% and 85.7% respectively. The sensitivity of CECT thorax and CXR was found to be 88.9% and 66.6% respectively, however specificity of both the modalities was comparable at 91.6% and 95.6% respectively. Patients having tumour size ≥8 cm, oral tobacco chewers and having N2, N3 disease were at significantly high risk for developing visceral mets. On comparing the sensitivities, it was found there is no significant difference between USG and CECT abdomen, CXR and CECT thorax. CONCLUSIONS More than 80% of patients with visceral mets could be diagnosed combining CECT thorax and USG abdomen. Hence, it is recommended to further subgroup LABC patients into low and high risk, based on presence of any one of the features which are significantly associated with visceral mets (≥8 cm tumour size, N2, N3 disease and tobacco chewer). We can consider using CECT thorax and CECT abdomen for high risk patients. KEYWORDS Contrast Enhanced Computed Tomography (CECT), Chest X-Ray (CXR), Ultrasonography (USG), Visceral Metastasis (Mets), Locally Advanced Breast Cancer (LABC)
