“Superstaging” in breast cancer—A correlation of lymph node histology and investigations designed to detect occult metastatic disease

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Abstract
In an effort to detect occult metastases in women with “early” breast cancer and no evidence of metastatic disease by conventional criteria, 50 women with “early” breast cancer were subjected to a battery of tests that included skeletal scintiscanning, liver scintiscanning, and measurements of urinary hydroxyproline, serum alkaline phosphatase of bone origin, serum alkaline phosphatase of liver origin and serum gamma glutamyl transpeptidase. One or more abnormalities suggestive of occult metastatic disease in the skeleton and/or the liver were found in 44% of patients. There was no correlation between positive test results and the finding of positive pectoral lymph nodes (found in 42% of patients). Short‐term follow‐up suggests a correlation between positive test results and development of recurrent disease. It appears that the performance of these tests preoperatively and the histological evaluation of pectoral and axillary lymph nodes are complementary approaches to the staging of breast cancer.