title: Frequency and distribution pattern of distant metastases in breast cancer patients at the time of primary presentation.
abstract: 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.
authors: Department of Obstetrics and Gynecology, Division of Gynecology, University Hospital of Zurich, 8091 Zurich, Switzerland.
authors: Christoph
authors: C
authors: Schneider
authors: Mathias K
authors: MK
authors: Fehr
authors: Rolf A
authors: RA
authors: Steiner
authors: Daniela
authors: D
authors: Hagen
authors: Urs
authors: U
authors: Haller
authors: Daniel
authors: D
authors: Fink
mesh_terms: 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