Accuracy of multidetector computed tomography with a dedicated protocol in the locoregional staging of breast cancer

Abstract

Objective: To evaluate the accuracy of multidetector computed tomography (MDCT) with a dedicated protocol for locoregional breast cancer staging. Methods: This was a retrospective, single-center study that included female patients diagnosed with breast cancer who underwent contrast-enhanced MDCT for staging purposes. Patients who underwent neoadjuvant chemotherapy were excluded. Some scans were performed using a conventional protocol, with patients in the
supine position. In contrast, others were performed using a dedicated protocol in the prone position. MDCT results were
compared to surgical pathology findings (gold standard). Results: A total of 95 patients were included, with a mean age
of 54 years (32–85). Most tumors were of no special type (66.3%) and luminal (86.3%). The majority of patients underwent
breast-conserving surgery (58.9%) and sentinel lymph node biopsy (84.2%). Of the CT scans, 47 (49.5%) were performed
in the supine position and 48 (50.5%) in the prone position, using the dedicated breast evaluation protocol. The primary
tumor was detected on CT in 85 patients (89.5%), occurring more frequently in prone-position scans (93.8%) than in supineposition scans (85.1%). Tumors most commonly appeared as masses on CT (68.4%) or masses associated with non-mass
enhancement areas (11.6%). Tumor size assessed on prone-position CT showed a stronger correlation with the tumor size
in the surgical specimen (r=0.662; p<0.001) compared to the supine position (r=0.176; p=0.298). Prone-position CT showed
a significant association with pathological analysis for the detection of multifocality/multicentricity (accuracy of 73%;
p=0.032) and the presence of metastatic axillary lymph nodes (accuracy of 75%; p=0.003), while supine-position CT did not
show a significant association. Conclusion: MDCT with a dedicated protocol is a feasible method for evaluating breast
lesions and axillary lymph nodes and can provide additional information for locoregional staging, especially in settings
where breast magnetic resonance imaging is not routinely performed.