INCIDENCE OF NODAL AND DISTANT METASTASIS AND THEIR CORRELATION WITH PRIMARY BREAST TUMOR SIZE ON PRE-THERAPY FDG PET/CT IMAGING

Nosheen Ftima; Sidra Zaman; Areeba Zaman; Naeem Pasha; Unaiza UZ Zaman; Rabia Tahseen; Anamta UZ Zaman; Maseeh Uz Zaman

INCIDENCE OF NODAL AND DISTANT METASTASIS AND THEIR CORRELATION WITH PRIMARY BREAST TUMOR SIZE ON PRE-THERAPY FDG PET/CT IMAGING

Nosheen Ftima, Sidra Zaman, Areeba Zaman, Naeem Pasha, Unaiza UZ Zaman, Rabia Tahseen, Anamta UZ Zaman, Maseeh Uz Zaman

Abstract

Background: In patients with breast cancer, it is thought that the risk of developing metastases increases monotonically with tumor size, because the larger the cancer at diagnosis, the more cells are available to metastasize with increase disease specific mortality. Purpose of this study was to evaluate relation between primary tumor size and metastases (nodal and non-nodal) using baseline FDG PET/CT. Material and Methods: We recruited 214 consecutive breast cancer patients who were referred for FDG PET/CT imaging for initial staging. Patients were categorized in to four groups based on primary tumor size (T1: ≤ 2 cm; T2: >2 cm and ≤ 5 cm; T3: > 5 cm; T4: any size involving chest wall or skin). For each group we determined ipsilateral axillary nodal, extra-axillary (including contralateral axillary) nodal, visceral and skeletal metastases seen on FDG PET/CT imaging. Results: 37/214 patients had T1 tumor and found to have 15% axillary, 47% extra-axillary, 11% visceral and 04% skeletal metastases. 104/214 patients had T2 tumor and found to have 21% axillary, 45% extra-axillary, 19% visceral and 11% skeletal metastases. 34/214 patients had T3 tumor and found to have 26% axillary, 47% extra-axillary, 53% visceral and 08% skeletal metastases. 29/214 patients had T4 tumor and found to have 45% axillary, 69% extra-axillary, 55% visceral and 06% skeletal metastases. On regression analysis, highest positive linear correlation was found for ipsilateral nodal metastasis (r = 0.945; significant p-value) followed by visceral (r = 0.941) and extra-axillary nodal (r = 0.772), metastases. No significant correlation was found between primary tumor size and skeletal metastasis (r= 0.129). Conclusions: We found a linear correlation between primary tumor size and presence of metastases to nodes (highest for ipsilateral nodes) and viscera and favoring the conventional linear model. However, no linear correlation was found between presence of skeletal metastases and primary breast tumor size.

Key Words: Breast cancer; tumor size; nodal metastasis; distant metastasis; linear model

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