Two studies were performed to assess the accuracy of non-invasive methods in detecting intra-abdominal
metastases from
breast cancer. Firstly, the sites of spread detected at the time of first presentation with
metastases were compared with the sites of spread shown at necropsy in the same patients. Although about two-thirds of the patients with bone and lung
metastases at necropsy had had
metastases detected at these sites when they first presented with
metastases, only a third of the patients with liver
metastases and none of those with other intra-abdominal
metastases had had evidence of disease at first presentation with
metastases. The second study confirmed a poor detection rate of liver and other intra-abdominal
metastases in patients with
breast cancer undergoing
laparotomy and
oophorectomy who were staged immediately before operation.Pre-
mastectomy staging
laparotomy should be considered in those patients with primary
breast cancer who are most likely to have disseminated disease beyond the regional nodes. In the presence of occult gross
metastases detected by staging
laparotomy,
mastectomy will not provide additional protection against loca recurrence of disease. Patients with occult gross
metastases should also be excluded from studies on
adjuvant chemotherapy (designed to treat
micrometastases). Aggressive methods of staging are justified to protect the patient as far as possible against unnecessary
mastectomy and to identify those patients who should be treated by therapeutic
chemotherapy rather than
adjuvant chemotherapy.