Preoperative assessment of the patient with breast cancer

The clinical assessment of patients with stage I and II breast cancer is limited to a history and physical examination supplemented by a chest radiograph and serum alkaline phosphatase determination. In the absence of positive clinical findings or elevation of the alkaline phosphatase, routine scintigraphy of the skeletal system and liver is not indicated. In contrast, routine scintigraphy of the skeletal system and liver is indicated in patients with stage III disease, even in the absence of clinical evidence of systemic metastasis.