Frequency and distribution pattern of distant metastases in breast cancer patients at the time of primary presentation.
BACKGROUND
For routine staging of patients with primary breast cancer, clinical practice guidelines of many medical societies recommend chest X-ray, liver ultrasound and bone scan. With respect to expanding health care costs and patients' psychological distress it has been supposed, that there might be a group of breast cancer patients, who do not need these imaging studies.


METHODS
Four hundred and eighty-eight consecutive patients with primary breast cancer who had primary surgery at our institution and complete work-up for distant metastases including chest X-ray, liver ultrasound, and bone scan were studied.


RESULTS
We found distant metastases at the time of primary diagnosis in 19 patients (3.9%). Bone metastases were found in 2.7%, liver metastases in 1.0%, and pulmonary metastases in 0.4%. However, in breast tumors smaller than 1 cm, no metastatic lesions were found, whereas 18.2% of the patients with pT4 tumors had metastases. In 2.4% of screening imaging studies, metastases were ruled out by additional imaging.


CONCLUSIONS
Based on our data and a review of the literature, we suggest that chest X-ray, liver ultrasound and bone scan can be omitted in the staging of asymptomatic patients with pT1a or pT1b disease.
Schneider
Christoph
C
Department of Obstetrics and Gynecology, Division of Gynecology, University Hospital of Zurich, 8091 Zurich, Switzerland.
Fehr
Mathias K
MK
Steiner
Rolf A
RA
Hagen
Daniela
D
Haller
Urs
U
Fink
Daniel
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000175:diagnosis / Q000378:metabolism*; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary*; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary*; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D013902:Radiography, Thoracic; D014463:Ultrasonography