The use of chest X-rays as a routine staging investigation for patients with invasive breast cancer – An audit of current practice

Abstract

Introduction Chest x-ray (CXR) has traditionally been performed as a staging tool searching for pulmonary metastases in patients with invasive breast cancer. Aims To investigate whether patients diagnosed with invasive breast cancer in NHS Highland received a pre-operative CXR in line with local preoperative assessment guidelines. M et hod s Data from all patients with invasive breast cancer diagnosed over a 6 month period were retrieved from a prospectively maintained database. Hospital notes and computer records identified if patients received a pre-operative CXR. Performing CXRs in 95% was deemed an acceptable audit standard. Abnormal CXRs were identified and investigated in more detail. (Ethical approval not required for local audit) Results Only 89% of patients undergoing surgery for invasive breast cancer received a pre-operative CXR. Metastatic disease was subsequently identified in a small proportion of patients. Conclusions Routine preoperative CXRs were not being performed in accordance with local guidelines. SIGN (1) Guidelines (84) suggest CXRs are not indicated in asymptomatic patients with invasive breast cancer and clearly are not an effective tool in our population . Completing the audit loop was thought unhelpful as this local data has changed practice and helped suggest a more effective, CT-based, staging strategy. References (1) SIGN 84 Management of Breast Cancer in Women: A National Clinical Guideline December 2005