[A perioperative screening for metastatic disease is not indicated in patients with primary breast cancer and no clinical signs of tumor spread].
OBJECTIVE
Is a perioperative metastatic screening programme indicated in patients presenting with primary operable breast cancer and no signs of distant metastases?


METHODS
The impact of staging results (chest X-ray, bone scanning, liver ultrasound) for prognosis, treatment, quality of life and costs was retrospectively analysed in 1 076 patients with an operable breast cancer and no clinical signs of metastases.


RESULTS
Staging examinations revealed 30 (2.8 %) distant metastases, 130 (12.1 %) suspect findings and excluded metastases in 916 (85.1 %) patients. Further diagnostic procedures confirmed distant metastases in 7 (5.4 %) and excluded them in 123 (94.6 %) out of 130 patients with suspect findings. Distant metastases were detected more frequently with increasing tumor size (pT < or = 2.0 cm: 1.6 %, pT 2.1-5.0 cm: 3.0 %, respectively pT > 5.0 cm: 15.1 %; p < 0.001) and increasing number of involved axillary lymph nodes (pN0: 1.4 %, pN1-3 +: 1.8 %, pN4-9 +: 4.0 %, pN > 10 +: 12.5 %; p < 0.001). Due to false positive findings 123 (11.4 %) patients had to live for a significant period of time with the psychological distress of suspected metastatic disease. The abandonment of a perioperative screening in 1 076 patients saves costs of at least euro 259,366.68.


CONCLUSIONS
In breast cancer patients without clinical signs of tumor spread perioperative screening for metastases is not warranted because of low frequency of metastases, false positive findings, missing therapeutic consequences and high costs.
Gerber
B
B
I. Frauenklinik der Ludwig-Maximilians-Universität München, München. bernd.gerber@med.uni-muenchen.de
Seitz
E
E
Müller
H
H
Krause
A
A
Reimer
T
T
Janni
W
W
Kundt
G
G
Friese
K
K
D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D006801:Humans; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis / Q000473:pathology*; D009367:Neoplasm Staging; D018579:Patient Selection; D011300:Preoperative Care; D015203:Reproducibility of Results; D016019:Survival Analysis; D013997:Time Factors
Ein perioperatives Screening auf Metastasen ist bei Patientinnen mit einem primär operablem Mammakarzinom und fehlender klinischer Symptomatik einer Metastasierung nicht indiziert.