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Advanced Breast Cancer Advanced Breast Cancer Imaging AssessmentNICE Breast Cancer Assessment
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Advanced breast cancer: imaging assessmentAdvanced breast cancer: imaging assessment
NICE Pathways bring together all NICE guidance, quality standards and other NICEinformation on a specific topic.
NICE Pathways are interactive and designed to be used online. They are updatedregularly as new NICE guidance is published. To view the latest version of this pathwaysee:
http://pathways.nice.org.uk/pathways/advanced-breast-cancerPathway last updated: 15 December 2015
This document contains a single pathway diagram and uses numbering to link theboxes to the associated recommendations.
Copyright © NICE 2015. All rights reserved
Advanced breast cancer: imaging assessmentAdvanced breast cancer: imaging assessment NICE Pathways
Advanced breast cancer pathAdvanced breast cancer pathwawayyCopyright © NICE 2015.
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1 Patient presents with suspected advanced breast cancer
No additional information
2 Assess for visceral metastases: plain radiography, ultrasound, CTscan and MRI
No additional information
3 SonoVue for contrast-enhanced ultrasound imaging of the liver
Contrast-enhanced ultrasound with SonoVue is recommended for investigating potential liver
metastases in adults:
if contrast-enhanced computed tomography (CT) is not clinically appropriate, is notaccessible or is not acceptable to the person, and
in whom an unenhanced ultrasound scan is unsatisfactory and contrast is needed forfurther diagnosis.
This recommendation is from SonoVue (sulphur hexafluoride microbubbles) – contrast agent for
contrast-enhanced ultrasound imaging of the liver NICE diagnostics guidance 5.
Resources
The following implementation tools are relevant to this part of the pathway.
SonoVue (sulphur hexafluoride microbubbles) – contrast agent for contrast-enhanced
ultrasound imaging of the liver: electronic audit tool
SonoVue (sulphur hexafluoride microbubbles) – contrast agent for contrast-enhanced
ultrasound imaging of the liver: costing template
SonoVue (sulphur hexafluoride microbubbles) – contrast agent for contrast-enhanced
ultrasound imaging of the liver: implementation advice
Advanced breast cancer: imaging assessmentAdvanced breast cancer: imaging assessment NICE Pathways
Advanced breast cancer pathAdvanced breast cancer pathwawayyCopyright © NICE 2015.
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4 Imaging suspicious but not diagnosis of metastases?
No additional information
5 PET-CT
Monitoring: PET-CT is not recommended to monitor patients with advanced breast cancer.
Resources
The following implementation tools are relevant to this part of the pathway.
Advanced breast cancer: audit support
Early and locally advanced breast cancer and Advanced breast cancer: costing report
Early and locally advanced breast cancer and Advanced breast cancer: costing template
Advanced breast cancer: slide set
6 Assess for bone metastases
No additional information
7 Axial skeleton: CT scan or MRI or bone scintigraphy
Monitoring: Bone scintigraphy is not recommended to monitor the response of bone
metastases to treatment.
8 Proximal limb bones: bone scintigraphy and/or plain radiography
Monitoring: Bone scintigraphy is not recommended to monitor the response of bone
metastases to treatment.
Advanced breast cancer: imaging assessmentAdvanced breast cancer: imaging assessment NICE Pathways
Advanced breast cancer pathAdvanced breast cancer pathwawayyCopyright © NICE 2015.
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9 Imaging is equivocal or more information is needed?
No additional information
10 MRI
No additional information
11 Imaging results
No additional information
12 Back to the overview
See Advanced breast cancer
Advanced breast cancer: imaging assessmentAdvanced breast cancer: imaging assessment NICE Pathways
Advanced breast cancer pathAdvanced breast cancer pathwawayyCopyright © NICE 2015.
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Glossary
ER
Oestrogen receptor
HER2
Human epidermal growth factor receptor 2
PET-CT
Positron emission tomography fused with computed tomography
DCIS
Ductal carcinoma in situ
MDT
Multidisciplinary team
Sources
Advanced breast cancer (2009 updated 2014) NICE guideline CG81
SonoVue (sulphur hexafluoride microbubbles) – contrast agent for contrast-enhanced
ultrasound imaging of the liver (2012) NICE diagnostics guidance 5
Your responsibility
The guidance in this pathway represents the view of NICE, which was arrived at after careful
consideration of the evidence available. Those working in the NHS, local authorities, the wider
public, voluntary and community sectors and the private sector should take it into account when
carrying out their professional, managerial or voluntary duties. Implementation of this guidance
is the responsibility of local commissioners and/or providers. Commissioners and providers are
reminded that it is their responsibility to implement the guidance, in their local context, in light of
their duties to avoid unlawful discrimination and to have regard to promoting equality of
Advanced breast cancer: imaging assessmentAdvanced breast cancer: imaging assessment NICE Pathways
Advanced breast cancer pathAdvanced breast cancer pathwawayyCopyright © NICE 2015.
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opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent
with compliance with those duties.
Copyright
Copyright © National Institute for Health and Care Excellence 2015. All rights reserved. NICE
copyright material can be downloaded for private research and study, and may be reproduced
for educational and not-for-profit purposes. No reproduction by or for commercial organisations,
or for commercial purposes, is allowed without the written permission of NICE.
Contact NICE
National Institute for Health and Care Excellence
Level 1A, City Tower
Piccadilly Plaza
Manchester
M1 4BT
www.nice.org.uk
0845 003 7781
Advanced breast cancer: imaging assessmentAdvanced breast cancer: imaging assessment NICE Pathways
Advanced breast cancer pathAdvanced breast cancer pathwawayyCopyright © NICE 2015.
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