Screening for distant metastases in patients with ipsilateral breast tumor recurrence: the impact of different imaging modalities on distant recurrence-free interval

Ingrid G. M. Poodt*, Robert-Jan Schipper, Bianca T. A. de Greef, Guusje Vugts, Adriana J. G. Maaskant-Braat, Frits H. Jansen, Dirk N. J. Wyndaele, Adri C. Voogd, Grard A. P. Nieuwenhuijzen, R. M. H. Roumen, E. J. T. Luiten, E. J. T. Rutgers, M. T. F. D. Vrancken-Peeters, M. Bessems, J. M. Klaase, S. Muller, A. B. Francken, T. Van Dalen, S. A. Koopal, Y. L. J. VissersM. L. Smidt, J. W. S. Merkus, C. M. E. Contant, P. H. Veldman, E. M. H. Linthorst-Niers, J. R. van der Sijp, O. R. Guicherit, L. B. Koppert, A. M. Bosch, L. J. A. Strobbe, M. S. Schlooz-Vries, I. E. Arntz, J. A. van Essen, J. W. D. de Waard, B. C. Vrouenraets, B. van Ooijen, Sentinel Node And Recurrent Breast Cancer (SNARB) Research Group, Marjolein Smidt

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Web of Science)


PurposeIn patients with ipsilateral breast tumor recurrence (IBTR), the detection of distant disease determines whether the intention of the treatment is curative or palliative. Therefore, adequate preoperative staging is imperative for optimal treatment planning. The aim of this study is to evaluate the impact of conventional imaging techniques, including chest X-ray and/or CT thorax-(abdomen), liver ultrasonography(US), and skeletal scintigraphy, on the distant recurrence-free interval (DRFI) in patients with IBTR, and to compare conventional imaging with F-18-FDG PET-CT or no imaging at all.MethodsThis study was exclusively based on the information available at time of diagnoses of IBTR. To adjust for differences in baseline characteristics between the three imaging groups, a propensity score (PS) weighted method was used.ResultsOf the 495 patients included in the study, 229 (46.3%) were staged with conventional imaging, 89 patients (19.8%) were staged with F-18-FDG PET-CT, and in 168 of the patients (33.9%) no imaging was used (N=168). After a follow-up of approximately 5 years, 14.5% of all patients developed a distant recurrence as first event after IBTR. After adjusting for the PS weights, the Cox regression analyses showed that the different staging methods had no significant impact on the DRFI.ConclusionsThis study showed a wide variation in the use of imaging modalities for staging IBTR patients in the Netherlands. After using PS weighting, no statistically significant impact of the different imaging modalities on DRFI was shown. Based on these results, it is not possible to recommend staging for distant metastases using F-18-FDG PET-CT over conventional imaging techniques.

Original languageEnglish
Pages (from-to)419-428
Number of pages10
JournalBreast Cancer Research and Treatment
Issue number2
Publication statusPublished - Jun 2019


  • Breast cancer
  • Ipsilateral breast tumor recurrence
  • Preoperative screening
  • Conventional imaging
  • F-18-FDG PET-CT
  • Distant metastasis
  • Propensity score weight

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