10. Staging
Overview
For breast cancer patients without symptoms suggestive of metastases at clinical stage 1, the ECIBC's Guidelines Development Group (GDG):
- suggest against using conventional staging exams (conditional recommendation, low certainty of the evidence)
- recommends against using positron emission tomography-computed tomography (PET-CT) (strong recommendation, very low certainty of the evidence)
Stage 1: PET-CT exams
Issued on: September 2018
Healthcare question
Healthcare question
Should fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) staging exams vs. no PET staging exams be used for patients with clinical stage I breast cancer without symptoms suggestive of metastases?
Recommendation
Recommendation
For patients with clinical stage I breast cancer without symptoms suggestive of metastases, the ECIBC's Guidelines Development Group (GDG) recommends not using positron emission tomography-computed tomography (PET-CT) staging exams.
Recommendation strength
| Strong recommendation |
| Very low certainty of the evidence |
Subgroup considerations
Subgroup considerations
For triple negative tumours and HER2-positive, evidence suggests that there is no additional benefit because of no increased risks from metastases.
Research priorities
Research priorities
The GDG suggests research to clarify the clinical significance of true positives (for all stages).
Supporting material
yes
- Organised vs. non-organised screening
- Double vs. single reading in mammograpy screening
- Communication skills training
- Communication with care providers
- Optimal number of mammography readings
- Specialised training
- Risk stratification
- Women aged 40-44: screening vs. no screening
- Women aged 45-49: screening vs. no screening
- Women aged 45-49: annual vs. biennial screening
- Women aged 45-49: annual vs. triennial screening
- Women aged 45-49: triennial vs. biennial screening
- Women aged 50-69: screening vs. no screening
- Women aged 50-69: annual vs. biennial screening
- Women aged 50-69: annual vs. triennial screening
- Women aged 50-69: triennial vs. biennial screening
- Women aged 70-74: screening vs. no screening
- Women aged 70-74: annual vs. biennial screening
- Women aged 70-74: annual vs. triennial screening
- Women aged 70-74: triennial vs. biennial screening
- Single reading with AI support
- Double reading with AI support
- Screening with tomosynthesis vs. mammography
- Screening with tomosynthesis plus mammography vs. mammography alone
- Tailored screening with tomosynthesis
- Screening with tomosynthesis vs. mammography
- Tailored screening with MRI
- Tailored screening with ABUS
- Tailored screening with HHUS
- Informing about benefits and harms: use of decision aids
- Informing about benefits and harms: Numbers in addition to plain language
- Informing about benefits and harms: Infographics in addition to plain language
- Informing about benefits and harms: Story telling in addition to plain language
- Inviting women to screening: letter vs. no invitation
- Inviting socially disadvantaged women to screening: Targeted vs. general communication strategy
- Inviting women with an intellectual disability to screening
- Inviting non-native speakers to screening
- Inviting socially disadvantaged women to screening: Tailored vs. targeted communication strategy
- Inviting socially disadvantaged women to screening: Tailored vs. general communication strategy
- Inviting women to subsequent screening rounds: letter vs. no invitation
- Inviting women to screening: letter with fixed appointment vs. letter
- Inviting women to subsequent screening rounds: letter with fixed appointment vs. lett
- Inviting women to screening: letter with GP signature vs. letter
- Inviting women to subsequent screening rounds: letter with GP signature vs. letter
- Inviting women to screening: letter followed by phone call vs. letter
- Inviting women to subsequent screening rounds: letter followed by phone call vs. letter
- Inviting women to screening: letter followed by phone call vs. no invitation
- Inviting women to screening: letter followed by written reminder vs. letter
- Inviting women to subsequent screening rounds: letter followed by written reminder vs. letter
- Inviting women to screening: letter followed by face to face intervention vs. letter
- Inviting women to subsequent screening rounds: letter followed by face to face intervention vs. letter
- Inviting women to screening: e-mail vs. letter
- Inviting women to screening: automated telephone call vs. letter
- Inviting women to screening: letter followed by automated telephone call vs. letter
- Inviting women to screening: letter followed by SMS notification vs. letter
- Inviting women to screening: letter followed by personalised phone call vs. automated phone call
- Negative result: letter vs. nothing
- Further assessment: letter followed by a phone call
- Further assessment: timing of results
- Negative result: phone call vs. letter
- Negative result: face to face interview vs. letter
- Negative result: timing of results
- Tomosynthesis vs. assessment mammography
- Obtaining a sample from a suspicious breast lesion
- Type of guidance for needle core biopsy
- Stage 1: conventional exams
- Stage 1: PET-CT exams
- Stage 2: conventional exams
- Stage 2: PET-CT exams
- Stage 3: conventional exams
- Stage 3: PET-CT exams
- Stage 3: conventional exams plus PET-CT
- Use of clip-marking
- Additional magnetic resonance imaging
- Contrast-enhanced mammography
- Threshold of oestrogen for endocrine therapy
- Threshold of progesterone for endocrine therapy
- Multigene testing: 70 gene signature at low clinical risk
- Multigene testing: 70 gene signature at high clinical risk
- Multigene testing: 21 gene recurrence score
- Organising screening programmes
- Risk stratification
- Women 40-44
- Women 45-49
- Women 50-69
- Women 70-74
- Women with high breast density
- General Population
- Vulnerable Population
- Informing women about their results
- Women recalled due to suspicious lesions
- Obtaining a sample from a suspicious lesion
- Type of guidance for needle core biopsy
- Stage 1
- Stage 2
- Stage 3
- Planning surgical treatment
- Hormone receptor to guide use of endocrine therapy
- Multigene testing to guide use of chemotherapy