Staging investigations in patients with breast cancer: the role of bone scans and liver imaging.
OBJECTIVE
Metastatic workup for patients newly diagnosed as having breast cancer is variable, especially for early disease (T1-2 N0-1). Routine bone scans and liver imaging are often performed without any evidence to support their usefulness.


METHODS
A retrospective review of patients with breast cancer referred to our center during a 2-year period was performed to determine the value of staging investigations in detecting metastases.


RESULTS
Of the total 250 patients referred to our center after initial diagnosis, 25 (10.0%) were diagnosed as having metastases, 23 of whom had either clinical symptoms or signs suggestive of metastatic disease or abnormalities on routine blood work or chest x-ray examinations. Only 2 patients with metastatic disease were diagnosed solely on bone scan results; none were diagnosed solely on liver imaging (either with an ultrasound or radionuclide isotope liver scan). Overall, 3% (5/161) of patients with pathologic T1-2 N0-1 disease had metastases diagnosed compared with 30% (18/61) of patients with pathologic stage T3-4 or N2 disease.


CONCLUSIONS
Our results confirm the low yield of routine bone scans and liver imaging among patients with asymptomatic, pathologically confirmed, early stage (T1-2 N0-1) breast cancer. Therefore, we do not recommend these tests for such patients, although intensive investigations are appropriate for more advanced (stage T3-4 or N2) tumors.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011877:Radionuclide Imaging; D012189:Retrospective Studies