## Staging Breast Cancer: Role of PET-CT **Key Point:** For stage III breast cancer (T2N1M0), PET-CT is the investigation of choice to detect occult distant metastases and guide treatment planning. ### Staging Algorithm for Breast Cancer: | Stage | T | N | M | Investigation Priority | |---|---|---|---|---| | **I–II** | T1–T2 | N0–N1 | M0 | Clinical exam + imaging for M0 confirmation | | **III (locally advanced)** | Any T | N2–N3 or T4 | M0 | **PET-CT for M staging** | | **IV** | Any T | Any N | M1 | PET-CT + organ-specific imaging | ### Why PET-CT for This Patient: - **T staging:** Already done (mastectomy specimen) - **N staging:** Already done (3 positive nodes = N1) - **M staging:** PET-CT detects bone, lung, liver, brain metastases with high sensitivity - Sensitivity 85–95% for distant metastases - Changes treatment from curative to palliative in 10–15% of stage III patients **Clinical Pearl:** PET-CT is more sensitive than bone scan + CT for detecting metastases in stage III breast cancer and is cost-effective as a single investigation. **High-Yield:** Bone scan alone is outdated; PET-CT has replaced it for staging.
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