Clinicopathological characteristics, treatment patterns, and contrast-enhanced computed tomography surveillance in post-treated breast cancer patients: A single-center study from Nepal.

Abstract

e13626 Background: Breast cancer is a leading malignancy in Nepal. While mammography is the surveillance standard, its sensitivity is limited by dense tissue or post-treatment changes. Evidence on the role of contrast-enhanced computed tomography (CECT) for post-treatment follow-up in resource-constrained settings is sparse. This study evaluates clinical characteristics, treatment patterns, and the utility of CECT-based surveillance in identifying recurrence at a tertiary center. Methods: A retrospective study included 258 post-treated patients undergoing CECT follow-up at BP Koirala Memorial Cancer Hospital (July 2023–January 2024). Data analyzed included histopathology, AJCC 8th edition staging, and IHC (ER, PR, HER2). Variables included chemotherapy, surgery type, and radiotherapy. CECT was used to identify locoregional and distant metastasis patterns. Survival was calculated from the date of surgery. Statistical analysis (SPSS v25.0) utilized descriptive measures and Fisher’s exact test to compare recurrence rates between major chemotherapy regimens. Results: Mean age was 48.3±11.1 years; 60.5% were aged 41–60. Invasive carcinoma NST (82.1%) and triple-negative disease (32.8%) predominated. Most patients presented at stage IIA (34%) or IIIA (25%). Modified radical mastectomy was the primary surgery (91.9%), with a 20% recurrence rate. CECT identified recurrence or metastasis in 21.8% (n = 54). Primary metastatic sites were lymph nodes (59.3%), bone (29.6%), lung (20.4%), and liver (18.5%). Median survival (MS) for the overall cohort was 594 days (IQR 847). Stage-specific MS: IA 660d (IQR 979.75), IIA 662d (IQR 1167.25), IIIA 641d (IQR 714), and IIIC 668.5d (IQR 941.5). Anthracycline/taxane-based (AC-T) regimens (51.4%) and FEC (28.0%) were most frequent. No significant difference in recurrence was observed between AC-T (17.6%) and FEC (13.2%) (p = 0.54). Imaging also identified pulmonary fibrosis (10.5%) and non-neoplastic skin thickening (8.1%). Conclusions: CECT detected significant locoregional and distant recurrence in asymptomatic patients, supporting its role as a complementary tool where locally advanced disease and triple-negative subtypes prevail. Risk-adapted surveillance with CECT may improve recurrence detection in resource-constrained settings. Future studies should evaluate the survival benefits and cost-effectiveness of routine CECT surveillance in the Nepalese context.