Radiographic patterns of intrathoracic disease in breast carcinoma: prognostic implications

The chest radiographic appearances of patients with intrathoracic metastases from breast cancer are variable and their relationship to patient outcome is unknown. This study aimed to classify and determine the frequency of various radiographic patterns and, in addition, to establish whether these patterns can be used to predict patient prognosis. A retrospective study was made of the patients of a major breast unit who over a 3 year period were found to have developed intrathoracic metastases. In each case, the earliest plain chest X-ray showing signs of metastasis was reviewed and the frequency of the different radiographic 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. Pulmonary nodules were found in 66%, pleural effusions in 41% (bilateral in 18%), lymphadenopathy in 25%, lymphangitis in 18% and pleurally-based nodules in 11%. Median survival of the whole group was 13.5 months. Patients with bilateral, but not unilateral, effusions had a significantly poorer prognosis (median survival 3 months). Although the median survival of patients with lymphangitis seemed poor (5.5 months), this difference was not statistically significant. Multivariate analysis showed bilateral effusions to be the only independent predictor of worse outcome. We have found that of the plain radiographic patterns seen in intrathoracic metastasis from breast cancer, only bilateral pleural effusions can be used to predict a worse prognosis than that associated with intrathoracic metastasis as a whole.