The routine use of bone scans, liver ultrasound, and chest radiography in the staging evaluation of primary breast cancer patients is of little value in detecting metastatic disease in women with clinical stage I and II cancers, according to an abstract to be presented at the upcoming American Society of Clinical Oncology (ASCO) Breast Cancer Symposium in San Francisco.
Researchers at the University of North Carolina at Chapel Hill conducted a literature review to assess whether routine screening such as bone scans, chest x-rays, and liver ultrasound could help clinicians determine the extent of metastatic disease.
Medical student Stuart-Allison Moffat Staley and colleagues included eight articles out of 232 reviewed in their final analysis. The team calculated the following pooled detection rates for bone scan according to stage:
- Stage I: Seven of 544 (1%)
- Stage II: 29 of 938 (3%)
- Stage I and II: 36 of 1,482 (2%)
- Stage III: 39 of 312 (12%)
For liver ultrasound, Staley's group found detection rates of 0.47% for stage I (one of 213), 1% for stage II (four of 400), 0.82% for stage I and II (five of 613), and 4% for stage III (six of 143). For chest radiograph, the study found detection rates of 0 for stage I (zero of 223), 0.42% for stage II (two of 473), 0.51% for stage I and II (nine of 1,782), and 4% for stage III (eight of 175).
"Our literature analysis suggests that these three tests are of little use in screening women for metastases, and likely to result in a lot of false negatives in early-stage disease," Staley said. "A full picture would require a head-to-head comparison of these radiological tests with more sensitive imaging, such as CT or PET. While metastases detection rates were higher in women with stage III cancer, performing radiological tests may still be unnecessary if patients are also assessed with more sensitive imaging."
