RADIOGRAPHIC PATTERNS OF INTRATHORACIC DISEASE IN BREAST-CARCINOMA - PROGNOSTIC IMPLICATIONS

The chest radiographic appearances of patients with intrathoracic meta stases from breast cancer are variable and their relationship to patie nt outcome is unknown. This study aimed to classify and determine the frequency of various radiographic patterns and, in addition, to establ ish whether these patterns can be used to predict patient prognosis. A retrospective study was made of the patients of a major breast unit w ho over a 3 year period were found to have developed intrathoracic met astases. In each case, the earliest plain chest X-ray showing signs of metastasis was reviewed and the frequency of the different radiograph ic patterns determined. Comparison was made between these patterns and patient mortality. The chest radiographs of 92 patients who developed intrathoracic metastases during a 3 year period were analysed. Pulmon ary nodules were found in 66%, pleural effusions in 41 (bilateral in 1 8%), lymphadenopathy in 25%, lymphangitis in 18% and pleurally-based n odules in 11%. Median survival of the whole group was 13.5 months. Pat ients with bilateral, but not unilateral, effusions had a significantl y poorer prognosis (median survival 3 months). Although the median sur vival of patients with lymphangitis seemed poor (5.5 months), this dif ference was not statistically significant. Multivariate analysis showe d bilateral effusions to be the only independent predictor of worse ou tcome. We have found that of the plain radiographic patterns seen in i ntrathoracic metastasis from breast cancer, only bilateral pleural eff usions can be used to predict a worse prognosis than that associated w ith intrathoracic metastasis as a whole.