Retrospective Analysis of Management of Phyllodes Tumours

Purpose: Breast cancer is a common disease; 50 285 women in the UK were diagnosed in 2011 [1]. For women considered to be at higher risk of metastatic disease, it is appropriate to undergo staging scans with CT and bone scintography [2]. This is to ensure women receive appropriate local and systemic treatment whilst not unduly burdening stretched radiology services. Methods: This is a retrospective analysis of patients newly diagnosed with breast cancer in North Wales. Patients identified from MDT records from September 2014 to September 2015 were randomly selected. Based on the ESMO 2015 guidelines [3], we defined three groups whereby CT staging is appropriate: patients undergoing neoadjuvant chemotherapy, patients with symptoms indicative of metastatic disease and patients with a higher chance ofmetastatic disease at presentation, i.e. any T N2 orN1with high risk features [4]. Patients with early stage breast cancer should not be routinely staged [5]. Results: We sampled 204 of 533 patients. 54 patients (26%) were staged. Of these, 30 (56%) patients were staged appropriately; 24 (44%) were overstaged. Of these, 8 (30%) could be considered high risk and require discussion. 5 patients (9%) were upstaged to M1 disease. 12 (22%) had equivocal lesions that required further scans. 35 (62%) patients were staged with CT chest/abdomen/pelvis only, 10 (18.5%) with CT chest/abdomen/pelvis and bone scintography, 8 (15%) with CT chest/abdomen and bone scintography and 1 (0.5%) with bone scintography only. Conclusions: Staging scans have an important role in the management of breast cancer. Patients with high risk features, e.g. aggressive tumour biology or high burden of nodal involvement, require clinical decision making to determine the need for CT staging. There is disparity within the trust regarding staging methods. For the future, clear, local guidelines are needed to ensure uniformity.