Physical test for distant metastases in patients with breast cancer

Of 312 patients presenting with breast cancer to a single clinic, 297 were screened for metastases in skin and nodes, bone, marrow, liver and lungs, using standard clinical, radiological scanning and cytological techniques. Thirty-four patients were found to have overt metastatic disease using these tests. Metastases were demonstrable on chest X-ray in 6.1% of the entire group of patients, on the bone scan in 4.2%, liver scan in 1.5%, liver ultrasound in 1.2% and in the bone marrow in only a single patient; 3.8% had contralateral or supraclavicular lymph node metastases or skin metastases. Twenty-eight of these 34 patients (82%) with overt metastases would have been classed as metastatic had only chest X-ray and clinical examination been carried out.A survey was then carried out to determine when tests for bone and liver metastases became abnormal. Bone scan and skeletal survey results were reviewed in 58 patients, 22 of whom had developed skeletal metastases and all of whom had regular skeletal scintigraphy carried out. Sixteen of 20 (80%) scans carried out within six months of the development of skeletal deposits were abnormal compared with 4 of 19 (21%) scans at the same follow-up time in those who failed to develop metastases, but few patients showed definite evidence of bone metastases on scanning prior to radiological metastases. Fifty-one patients who were found to have liver metastases at post-mortem were reviewed and most showed progressively rising alkaline phosphatase before death but only 11 of 57 (19.2%) and 14 of 50 (28%) had positive liver scintiscans and liver ultrasound examinations respectively from 3-12 months before death.