The bone marrow of 307 patients with primary breast cancer was examined for tumour cells by immunocytochemistry using an antiserum to epithelial membrane antigen. Micrometastases were found in 81 cases (26.4%) and their presence was related to various poor prognostic factors: spread to lymph nodes, vascular invasion, T stage, and pathological size. The median duration of follow up was 28 months. Seventy five patients relapsed, 60 at distant sites. Of these 60 patients, 26 had micrometastases detected at presentation and 34 were free of micrometastases initially. The relapse free interval was significantly shorter for patients with micrometastases, and these patients had a shorter survival. Analysis of the sites of relapse showed that the test

Xeromammography did not enhance the diagnostic accuracy of clinical examination and aspiration cytology in patients presenting with a breast lump and, as a procedure with potential hazard, the benefit of routine xeromammography is qtuestionable when an efficient cytological service is available.

Summary. Detailed necropsies were performed on 26 individuals who had died of disseminated breast carcinoma, to assess the frequency of spread to the lungs, pleura and pericardium, and to determine the likely routes of spread to these sites. Tumour was present in the lung parenchyma in 67% of the lungs examined, in the visceral pleura in 75%o and the parietal pleura in 5Oo0. Although even small deposits of pleural tumour were invariably visible to naked-eye examination, lung parenchymal involvement was almost invariably microscopic, despite its frequently extensive distribution. This finding draws attention to the difficulties of clinical staging with respect to lung metastases. Tumour in lymphatics predominated over that in blood vessels in both lung and pleura and this, together with the widespread mediastinal lymphnode infiltration found, suggests that the lymphatic system forms the dominant route of spread of breast carcinoma to the thorax. The possible role of mediastinal lymphatics in the dissemination of breast cancer to bone and liver is also discussed. Our findings suggest that the fields of adjuvant irradiation after primary surgery should include the mediastinal lymphatic network.IT IS COMMONLY BELIEVED that the spread of breast cancer beyond the regional lymph nodes is haematogenous. However, the distinct clinical pattern of laterality of pleural effusions in breast cancer suggests a non-haematogenous mechanism of dissemination. When a pleural effusion develops for the first time in patients with unilateral breast cancer, it is usually on the same side as the primary breast lesion (Stoll & Ellis, 1953; Porter, 1965). This pattern of spread would be better explained by a regional mechanism of dissemination, because haematogenous tumour spread should involve both sides of the thorax synchronously and with equal frequency.Our previous necropsy experience had shown that disease within lymphatics was common at sites remote from the breast, especially in lung and pleura. We were also aware that visceral pleural disease was invariably macroscopic, whilst lung parenchymal disease was almost invariably microscopic. These observations prompted us to investigate the incidence of pulmonary and pleural metastases in breast cancer, to determine the extent of involvement of various mediastinal lymphnode groups, and to compare the frequency of intralymphatic and intravascular (blood) tumour. In this way further information on the mechanism of spread of breast cancer to the thorax might be obtained.

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