Zusammenfassung
Fragestellung
Eine Skelettszintigraphie, eine Lebersonographie und ein Thoraxröntgen gehören an
der Universitäts-Frauenklinik Bern routinemäßig zum initialen Fernmetastasen-„Staging“
beim Mammakarzinom. Diese Untersuchungen sind aber aufwändig und teuer und wurden
in den letzten Jahren infrage gestellt. Ziel dieser Studie war es die Resultate dieser
Untersuchungen an unserer Klinik zu analysieren. Außerdem hat es uns interessiert,
wie dieses „Staging“ in den anderen gynäkologischen öffentlichen Spitälern der Schweiz
durchgeführt wird.
Material und Methodik
Zwischen Januar 1992 und Dezember 1996 wurden 266 konsekutive Patientinnen mit einem
kompletten initialen „Staging“ retrospektiv analysiert. Das Vorhandensein einer Metastase
wurde mit folgenden Tumorcharakteristiken korreliert: Stadium (T), Lymphknoten-Status
(N), Grading (G), Östrogenrezeptoren (ER) und Progesteronrezeptoren (PR). Alle Mitglieder
der Schweizerischen Gynäkologischen Chefärztekonferenz wurden mittels Rundschreiben
befragt, wie sie das „Staging“ in ihren Kliniken durchführen.
Ergebnisse
Zum Zeitpunkt der Diagnosestellung hatten 23 Patientinnen (8,6 %) Fernmetastasen.
Bei nur 3 asymptomatischen Patientinnen (1,1 %) wurden Metastasen aufgrund des initialen
„Stagings“ diagnostiziert. Mit dem Vorhandensein von Metastasen korrelierten ein fortgeschrittenes
Stadium (T2 - T4) und axillärer Lymphknotenbefall (N1) (beide p < 0,0001). Wir erhielten
66 (83,5 %) Antworten von 79 angefragten Chefärzten: Die meisten Kliniken (85 %) führen
das gleiche „Staging“ durch wie unsere Klinik.
Schlussfolgerungen
Auf der Basis dieser Resultate und in Übereinstimmung mit mehreren Autoren verzichten
wir bei asymptomatischen Patientinnen ohne axillären Lymphknotenbefall künftig auf
das initiale Fernmetastasen-„Staging“. Gesamtschweizerisch könnte man so viel Geld
sparen, ohne die Prognose dieser Patientinnen negativ zu beeinflussen.
Abstract
Objective
Bone scintigraphy, ultrasonography of the liver, and chest radiography are used as
routine staging procedures in patients with breast cancer at our department. The value
of these studies has been questioned because of their cost and low yield of metastases.
We aimed to analyze the results of staging tests at our department and to survey staging
procedures at other departments in Switzerland.
Methods
We reviewed 266 consecutive patients with breast cancer and complete staging between
1992 and 1996. The presence of metastases was analyzed according to tumor stage, regional
lymph node status, tumor grade, estrogen and progesterone receptor status. We also
surveyed all 79 public hospital gynecology departments in Switzerland with a written
questionnaire about their practice of staging breast cancer.
Results
23 patients (8.6 %) had metastases at the time of diagnosis but only three (1.1 %)
were asymptomatic and detected by the routine staging tests. The presence of metastases
was strongly correlated with advanced stage (T2 - T4) and positive axillary lymph
nodes (p < 0.0001). The response rate to the survey questionnaire was 84 %. Most (85
%) of the responding departments performed the same routine staging tests as we did.
Discussion
These data confirm that the diagnostic yield of routine bone scintigraphy, ultrasonography
of the liver, and chest radiography in asymptomatic patients with negative axillary
nodes is low. We no longer perform these tests in such patients. This procedure would
appear to save time and money without adversely affecting the prognosis.
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Dr. med. Gilles Berclaz
Frauenklinik Inselspital
Schanzeneckstraße 1
3012 Bern
Schweiz
Email: E-mail: gilles.berclaz@insel.ch
