Ein perioperatives Screening auf Metastasen ist bei Patientinnen mit einem primär operablem Mammakarzinom und fehlender klinischer Symptomatik einer Metastasierung nicht indiziert

Zusammenfassung

Fragestellung: Ist ein perioperatives Screening auf Fernmetastasen bei Patientinnen mit einem primär operablen Mammakarzinom und fehlender klinischer Symptomatik indiziert?
Patientinnen und Methoden: Bei 1 076 Mammakarzinompatientinnen ohne klinischen Metastasenverdacht wurden die Befunde der perioperativen Screeninguntersuchungen (Röntgen-Thorax, Lebersonographie, Skelettszintigraphie) auf die Prognose, adjuvante Therapie, Lebensqualität und Kosten analysiert.
Ergebnisse: Die perioperativen Staginguntersuchungen ergaben bei 30 (2,8 %) Patientinnen Fernmetastasen, 130 (12,1 %) suspekte Befunde und 916 (85,1 %) normale Befunde. Die weiterführenden Untersuchungen bei den 130 Patientinnen mit suspekten Befunden ergaben Fernmetastasen in 7 (5,4 %) und schlossen diese in 123 (94,6 %) Fällen aus. Fernmetastasen wurden häufiger mit steigender Tumorgröße (pT ≤ 2,0 cm: 1,6 %, pT 2,1-5,0 cm: 3,0 %, pT > 5,0 cm: 15,1 %; p < 0,001) und Anzahl befallener Lymphknoten (pN0: 1,4 %, pN1-3 +: 1,8 %, pN4-9 +: 4,0 %, pN > 10 +: 12,5 %; p < 0,001) nachgewiesen. Falsch positive Befunde mit der Ungewissheit über die Erkrankungssituation führten bei 123 (11,4 %) aller Patientinnen zu einer verminderten Lebensqualität. Der Verzicht auf perioperative Screeninguntersuchungen wäre ohne therapeutische Nachteile und würde Kosten von minimal € 259 366,68 sparen.
Schlussfolgerung: Bei Brustkrebspatientinnen ohne klinische Hinweise auf eine Fernmetastasierung ist ein perioperatives Metastasenscreening wegen fehlender therapeutischer Konsequenzen, häufig falsch positiver Befunde mit Verminderung der Lebensqualität und hoher Kosten nicht indiziert.

Abstract

Objective: Is a perioperative metastatic screening programme indicated in patients presenting with primary operable breast cancer and no signs of distant metastases?
Patients and methods: The impact of staging results (chest X-ray, bone scanning, liver ultrasound) for prognosis, treatment, quality of life and costs was retrospectively analysed in 1 076 patients with an operable breast cancer and no clinical signs of metastases.
Results: Staging examinations revealed 30 (2.8 %) distant metastases, 130 (12.1 %) suspect findings and excluded metastases in 916 (85.1 %) patients. Further diagnostic procedures confirmed distant metastases in 7 (5.4 %) and excluded them in 123 (94.6 %) out of 130 patients with suspect findings. Distant metastases were detected more frequently with increasing tumor size (pT ≤ 2.0 cm: 1.6 %, pT 2.1-5.0 cm: 3.0 %, respectively pT > 5.0 cm: 15.1 %; p < 0.001) and increasing number of involved axillary lymph nodes (pN0: 1.4 %, pN1-3 +: 1.8 %, pN4-9 +: 4.0 %, pN > 10 +: 12.5 %; p < 0.001). Due to false positive findings 123 (11.4 %) patients had to live for a significant period of time with the psychological distress of suspected metastatic disease. The abandonment of a perioperative screening in 1 076 patients saves costs of at least € 259 366.68.
Conclusions: In breast cancer patients without clinical signs of tumor spread perioperative screening for metastases is not warranted because of low frequency of metastases, false positive findings, missing therapeutic consequences and high costs.

Schlüsselwörter

Brustkrebs - Staging - Fernmetastasierung - Kosten - Behandlung

Key words

Breast cancer - staging - metastatic disease - costs - treatment

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