Staging Investigations in Patients With Breast Cancer

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Abstract
MANY PATIENTS have extensive staging investigations to complete their metastatic workup following a diagnosis of breast cancer.1-3 The goal of these tests is to identify those patients with incurable disease so that a more realistic prognosis can be given and their treatment can be tailored accordingly. Isotopic bone scans along with isotopic liver scans or liver ultrasound are still commonly used to detect subclinical metastatic disease at these sites.4 The usefulness of these tests is debatable,5-8 especially when one considers both their sensitivities and specificities. Despite improvements in imaging modalities, clinical staging is still considered by many to be the most useful and cost-effective.4,6 However, there is as yet no consensus on the most appropriate initial staging investigations. It remains to be determined whether tests apart from routine preoperative chest x-ray examination and blood work significantly improve the yield of a metastatic workup in asymptomatic patients.6