Detection of bone metastasis from breast cancer

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IN a patient suspected of having mammary carcinoma, the presence of skeletal or pulmonary metastases may dissuade the surgeon from planning a radical operation on the breast itself. The preoperative roentgenograms (posteroanterior and lateral) of the chest will reveal evidence of pulmonary metastasis and also display a number of bones that may be the site of skeletal metastasis. The addition of a plain film of the abdomen in the preoperative evaluation makes available more bony areas for scrutinizing. A so-called “bone survey,” including radiographic examination of the skull, spine, chest, pelvis, and long bones, is often conducted in an effort on the part of the physician to determine the presence or absence of skeletal metastases not otherwise identified.

One of us (S.O.H.) wondered how often a complete bone survey actually discloses metastases not shown by chest films and a plain film of the abdomen. Bones that usually can be seen on 14 inch by 17 inch chest roentgenograms include ribs, some thoracic and cervical vertebrae, clavicles, scapulae, and humeral heads. Bones that ordinarily can be seen on a 14 inch by 17 inch roentgenogram of the abdomen include lumbar and sacral vertebrae, lower ribs, most of the pelvic girdle, and the heads and necks of the femurs. If the more complete examination of bones rarely yields more pertinent information, the patient could be spared unnecessary irradiation, inconvenience, and expense. To investigate this problem, a retrospective study of patients with carcinoma of the breast was undertaken, and the results are herewith . . .



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