Staging investigations in patients with breast cancer - The role of bone scans and liver imaging

Hypothesis: 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 suppor t their usefulness. Design: A retrospective review of patients with breast cancer referred to o ur center during a 2-year period was performed to determine the value of st aging investigations in detecting metastases. Results: Of the total 250 patients referred to our center after initial dia gnosis, 25 (10.0%) were diagnosed as having metastases, 23 of whom had eith er clinical symptoms or signs suggestive of metastatic disease or abnormali ties on routine blood work or chest x-ray examinations. Only 2 patients wit h metastatic disease were diagnosed solely an bone scan results; none were diagnosed solely on liver imaging (either with an ultrasound or radionuclid e 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 patient s with pathologic stage T3-4 or N2 disease. Conclusions: Our results confirm the low yield of routine bone scans and li ver imaging among patients with asymptomatic, pathologically confirmed, ear ly stage (T1-2 N0-1) breast cancer. Therefore, we do not recommend these te sts for such patients, although intensive investigations are appropriate fo r more advanced (stage T3-4 or NZ) tumors.