title: How far investigations for occult metastases in breast cancer aid the clinician.
abstract: This retrospective study aimed to assess the usefulness and clinical importance of current, commonly used, diagnostic staging procedures in breast cancer. The analysis comprises all 398 women clinically staged I-III (UICC criteria), and irradiated with radical intent in the Professorial Unit of Radiotherapy at the Middlesex Hospital over a ten-year period (1978-1987). The routine initial screening in this institution included the following staging investigations within 4 weeks of referral: 99mTc MDP bone scan; chest X-ray; liver function tests (including serum alkaline phosphatase) and liver ultrasound scan. Further enquiry and examination of the patient, clear progression of disease, additional radiographs or a recommended repeat interval scan provided sufficient additional information to confirm metastatic disease. The overall rate of detection of metastatic disease at three months was 29/389 (7.4%) for skeletal scintigraphy, 10/386 (2.6%) for chest radiographs, 8/271 (2.9%) for liver ultrasound and 3/347 (0.8%) for serum alkaline phosphatase. In total 37/398 (9.3%) of patients were confirmed to have metastatic disease by three months. Skeletal scintigraphy alone appears to identify 78% (29/37) of those with detectable metastatic disease at 3 months. Skeletal scintigraphy and liver ultrasound will identify 95% (35/37).
authors.affiliation: Meyerstein Institute of Clinical Oncology, University College and Middlesex School of Medicine, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Glynne-Jones
authors.forename: T
authors.initials: T
authors.lastname: Young
authors.forename: A
authors.initials: A
authors.lastname: Ahmed
authors.forename: P J
authors.initials: PJ
authors.lastname: Ell
authors.forename: R J
authors.initials: RJ
authors.lastname: Berry
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000556:secondary; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis*; D011859:Radiography; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D015996:Survival Rate; D013899:Thoracic Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D014463:Ultrasonography