Routine X-ray of the chest is not justified in staging of patients with primary breast cancer

INTRODUCTION. Chest X-rays (CXRs) are performed routinely as part of staging of primary breast cancer patients in most breast units in Denmark. However, several international studies have found exceedingly low detection rates for occult pulmonary metastatic disease among breast cancer patients. Even so, no data have previously been published on Danish patients.METHODS. A retrospective study was conducted of all breast cancer patients undergoing CXRs at the Department of Breast Surgery, Herlev Hospital, from April 2016 to December 2017. The primary outcome was detection of pulmonary metastases on CXRs at the time of the patient's breast cancer diagnosis. The follow-up period was 12 months.RESULTS. A total of 1,014 patients were included in this study. Among these, 11 (1%) had a positive CXR and 1,003 (99%) had a negative CXR. Three (0.3%) patients were diagnosed with lung metastases but had false negative CXRs. The sensitivity was 0%, the specificity was 98.9%, the positive predictive value was 0% and the negative predictive value was 99.6%.CONCLUSION. Routine preoperative CXR did not impact staging or lead to changes in the treatment of breast cancer patients. Therefore, routine CXR cannot be justified and should be omitted.