Staging for breast carcinoma

Pretreatment staging and posttreatment follow-up of the breast cancer patient consists of physical examination of the breasts and regional node-bearing areas, routine laboratory studies, chest radiography, and bilateral mammography. For palpable tumors, mammography is used to determine tumor size and to identify nonpalpable multifocal or contralateral lesions. Mammography is an important adjunct to physical examination when monitoring for local recurrence in the irradiated breast or when searching for second primary cancers in the contralateral breast. Axillary nodes are evaluated by direct palpation, but some investigators recommend lymphoscintigraphy to examine the internal mammary chain. The most common sites for distant metastases are the skeleton, lung, brain, and liver. Although radionuclide scanning is currently the most effective method to evaluate metastases to bone, plain radiography, and sometimes computed tomography and magnetic resonance imaging, are required to corroborate radionuclide findings. However, due to cost constraints and anticipated low yield, routine imaging for metastases should be limited to chest radiography.