Optimización del diagnóstico y estadificación TNM del cáncer de mama en acto único desde el servicio de radiología: protocolo TEMA

Abstract

Introduction

After histological confirmation, mammography, ultrasound (including nodal territory), and MRI are used for locoregional staging. Tests such as computed tomography (CT) are used for the study of distant metastases.

Methods

Prospective randomized controlled study with 44 patients (September 2022 to March 2023), studied by initial directed ultrasound with: breast nodules suspicious for malignancy (BNSM) > 5 cm or associated breast inflammation, BNSM with lymphadenopathy (axillary/internal mammary region), or lymphadenopathy in axillary/internal mammary region without nodule. Half followed the usual protocol and the other half the TEMA protocol (thoraco-abdominal-pelvic CT and mammography with contrast with the same bolus of intravenous contrast, 2 phases, tomosynthesis and ultrasound with biopsies; all in a single act).

Results

There were no significant differences in age, stage, tumor type, or immunophenotype between the two groups. With the usual protocol, the mean time from biopsy of lesions with suspected malignancy to staging CT scan, or Total Delay Time (TDT) was 40 days, and all had started neoadjuvant chemotherapy. The median time required for diagnóstico and staging with the TEMA protocol was 27 min.

Conclusions

Initial targeted ultrasound identifies patients who will benefit from initial locoregional and distant staging, candidates for the TEMA protocol. This allows immediate complete staging, which is more accurate (without modifications due to chemotherapy), and eliminating TDT.