abstract
- In 1987/88 a prospective study was undertaken of 750 patients with postoperative carcinoma of the breast but no evidence as yet of skeletal metastases. A thorough history regarding pain was taken with pre-set questions and an exact clinical examination conducted to reveal any skeletal pain. Subsequently whole-body skeletal scanning was performed, plus additional X-ray films, determination of tumour markers CA-15-3 and CEA, and further tests as indicated. Clinical and imaging results agreed in 649 patients. In 70 patients the clinical suspicion or questionable finding of metastases was not confirmed by radiology or a scan. Bone metastases would have been missed in only 14 patients (1.9%) without a skeletal scan. Eleven of these 14 patients were in high-risk groups (negative hormone receptor status; axillary lymph node metastases). Skeletal metastases were undiscovered in only three of the 750 patients (0.4%). It is thus sufficient to limit skeletal scans to high-risk groups, as long as a careful history of pain is taken and a thorough clinical examination conducted.