The Role of Chest X-Ray in the Follow-Up of Primary Breast Cancer

Ciatto, Stefano; Herd-Smith, Andrea

doi:10.1177/030089168306900211

Cited by 25 publications

(9 citation statements)

References 5 publications

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“…The high accuracy of the tumour marker panel in our study, particularly diagnostic sensitivity in the detection of distant metastases, may partly be due to the high frequency of test repetition compared to that of CXR and LE. However previous studies evaluating the accuracy of intensive follow-up with instrumental examinations for the same purpose including CXR and/or LE did not show accuracy values comparable to those obtained by the tumour marker panel we used (Ciatto and Herd-Smith, 1983;Logager et al, 1990;Schapira and Urban, 1991;The GIVIO Investigators, 1994). The accuracy and negative predictive value of the CEA-TPA-CA15.3 tumour marker panel which we previously reported for diagnosis of bone metastases in patients with equivocal BS (Nicolini et al, 1999) were similar to those we found in this study for diagnosis of chest or liver metastases in patients with equivocal CXR or equivocal LE.…”

Section: Discussionmentioning

confidence: 73%

The role of tumour markers in improving the accuracy of conventional chest X-ray and liver echography in the post-operative detection of thoracic and liver metastases from breast cancer

et al. 2000

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The aim of this retrospective study was to assess the value of a serum tumour marker panel in selecting from among the patients with equivocal chest X-ray (CXR) or liver echography (LE) those with thoracic or liver metastases respectively. Between January 1984 and December 1999, 467 (341 non-relapsed and 126 metastatic) breast cancer patients were followed-up postoperatively. Among the 126 metastatic patients 36 showed thoracic (19 patients) or liver (17 patients) metastases, alone or in conjunction with other organs as the first evidence of distant spread. We focused on this series of 377 patients including 341 non-relapsed plus 36 with liver or thoracic metastases. The patients were followed-up after mastectomy with serial determinations of a panel of CEA-TPA-CA15.3 tumour markers, bone scintigraphy, CXR and LE. Up to December 1999, equivocal CXR occurred in 23 (6.1%) patients of whom 11 (47.8%) developed thoracic metastases; 14 (3.7%) patients showed an equivocal LE of whom 5 developed liver metastases. In the 37 patients with equivocal CXR or equivocal LE prolonged clinical and imaging follow-up over 41 ± 36 months (mean ± SD, range 3–163) was used to ascertain the presence or absence of thoracic or liver metastases. In the 23 patients with equivocal CXR the negative and positive predictive values of the tumour marker panel to predict thoracic metastases were 92% and 100% respectively. In the 14 patients with equivocal LE the negative and positive predictive values of the tumour marker panel for prediction of liver metastases were 90% and 100% respectively. This study shows that in breast cancer patients the CEA-TPA-CA15.3 tumour marker panel has a high value for selecting those patients at high risk of developing clinically evident pulmonary or liver metastases from amongst those subjects with equivocal CXR or equivocal LE. © 2000 Cancer Research Campaign http://www.bjcancer.com

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Section: Discussionmentioning

confidence: 73%

The role of tumour markers in improving the accuracy of conventional chest X-ray and liver echography in the post-operative detection of thoracic and liver metastases from breast cancer

et al. 2000

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“…Of 523 relapses, only 39 were identified solely by chest x-ray. 50 Radionucleide bone scans also have not been found to be of value in asymptomatic patients with normal serum chemistry values. 51 Two randomized, controlled studies indicate that bone scans are of no utility in asymptomatic patients regardless of serum chemistry values.…”

Section: Breast Cancermentioning

confidence: 99%

The Utility of Follow-up Testing After Curative Cancer Therapy: A Critical Review and Economic Analysis

1997

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OBJECTIVE:To review (1) basic principles of follow-up in patients who are in complete remission following curative therapy for cancer; (2) evaluate the available data on followup strategies for testicular cancer, Hodgkin's disease, nonHodgkin's lymphoma, breast cancer, colorectal cancer, small cell and non-small cell lung cancer, and prostate cancer; and (3) analyze the cost of follow-up strategies METHODS: The English language literature was reviewed utilizing MEDLINE headings for the specific malignancies and the text word "follow-up." Bibliographies of relevant articles also were reviewed. Emphasis was placed on prospective, randomized trials or large retrospective studies in which all patients who potentially could have been evaluated were accounted. The costs of various testing strategies were analyzed utilizing data from the Health Care Finance Administration. DATA SYNTHESIS:Proper follow-up strategies should take into account patterns and time course of recurrence and should be obtained if detection of recurrence would allow meaningful therapeutic intervention. Testing also should be directed at early detection of malignant and nonmalignant complications known to be associated with the primary disease. Testicular cancer is a "model" malignancy in that sensitive tests for recurrence are available and early detection of recurrence allows for potentially curative therapy.CONCLUSIONS: According to the currently available literature, repetitive follow-up laboratory and radiologic testing, except for nonseminomatous germ cell tumors, does not detect the vast majority of cancer relapses, nor does it result in a greater chance of cure or prolonged survival. The majority of recurrences at all disease sites will first be recognized as symptomatic changes in the patient's condition or alterations in the physical examination. A limited panel of blood tests and radiographic studies to detect recurrences, metachronous disease, and complications of therapy (malignant and nonmalignant), will suffice for most cancers. Though data are limited, this more restrictive policy of follow-up testing does not appear to adversely impact patient quality of life and results in dramatic cost of savings to the health care system.A great deal has been written about the utility of screening for cancer with great emphasis on costeffectiveness. 1-3 Relatively little information exists on the value of follow-up testing of asymptomatic patients after potentially curative cancer therapy. This review will outline the general principles that should guide follow-up testing and then examine how these principles can be applied to testicular cancer, Hodgkin's disease and nonHodgkin's lymphoma, and breast, colon, prostate, and lung cancers given currently available data. Economic analysis will demonstrate how this evidence-driven approach to follow-up testing can result in considerable savings without compromise of patient care. Testicular cancer will serve as a model to illustrate the rational application of follow-up testing. The lymphomas will be ...

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“…Its actual impact on altering the survival rate, by the early detection of recurrences, is not yet clear. Presently, it appears that the median survival is similar in both symptomatic and asymptomatic patients having pulmonary metastases [3].…”

Section: Contralateral Breastmentioning

confidence: 84%

Evaluation of routine follow‐up after surgery for breast carcinoma

Marrazzo

Solina

Puccia

et al. 1986

Journal of Surgical Oncology

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Close postoperative follow-up of patients with breast cancer permits the early detection of possible recurrence of disease. Such follow-up allows for the detection of a tumor mass, that is small enough to permit adequate treatment leading to an increased survival time and better quality of life. Thus we studied 85 patients treated by radical mastectomy in stages I, II, and III during the period from December 1977 to June 1982. Among 82 patients, 41 had axillary node involvement and received adjuvant chemotherapy with C.M.F. All patients received a strict follow-up. Thirty-two patients showed recurrence of the disease, with 28. 1% being discovered while still asymptomatic. Seventy-five percent of the recurrences were in the first 24 months after treatment. The frequency of involved sites was different between the group of patients with involvement and the group without involvement of axillary nodes. We have concluded that in asymptomatic patients certain exams need not be repeated at frequent intervals, and we have proposed a new follow-up protocol.

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The Role of Chest X-Ray in the Follow-Up of Primary Breast Cancer

Cited by 25 publications

References 5 publications

The role of tumour markers in improving the accuracy of conventional chest X-ray and liver echography in the post-operative detection of thoracic and liver metastases from breast cancer

The role of tumour markers in improving the accuracy of conventional chest X-ray and liver echography in the post-operative detection of thoracic and liver metastases from breast cancer

The Utility of Follow-up Testing After Curative Cancer Therapy: A Critical Review and Economic Analysis

Evaluation of routine follow‐up after surgery for breast carcinoma

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