Thorax 1983;38:175-179 Breast cancer and thoracic metastases: review of 119

ABSTRACT Review of the case notes of 660 patients with a diagnosis of breast cancer during a five-year period showed that in 119 cases there had been thoracic metastases. These were recorded as pleural or extrapleural metastases (79 patients), mediastinal tumour (46 patients), lymphangitic carcinoma (41 patients), pulmonary nodules (34 patients), and solitary pulmonary nodule (nine patients). Endobronchial metastases were present in seven patients and multiple pulmonary tumour emboli in two. The thorax was often the initial site of tumour recurrence. Most of these recurrences were present in several locations (intrathoracic or both intrathoracic and extrathoracic) simultaneously, facilitating the clinical diagnosis of metastatic breast cancer. Histopathological confirmation of metastasis was mandatory for the 10 patients who had a solitary intrathoracic abnormality without evidence of disease elsewhere. The median survival after diagnosis and treatment of a solitary thoracic metastasis was 42+ months and three of 10 patients are currently in remission (at 44, 87, and 121 months). The small tumour burden and early diagnosis giving lead time may explain the long survival in this group of patients. Breast cancer is the most common malignancy in women; 60-74 % of patients dying of breast cancer have pulmonary metastases and the lung is the only site of metastasis in 21 %. ' 2 As many as 28 % of lung metastases may be undetected before necropsy.2 These data from necropsy series, however, do not provide information about the clinical manifesta-tions of breast cancer. This study was designed to find out the range of pulmonary metastases from breast cancer, the disease-free interval before their detection, and the prognosis after their discovery. Methods We reviewed the case records of all patients with a diagnosis of breast cancer (current or remote) at th