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Liver Function Tests in the diagnostic work up of newly diagnosed Stage III breast cancer: added value or just an additional test?
*Raphael J Louie, *Jennifer E Tonneson, Richard J Barth, Jr, Kari Rosenkranz
Dartmouth-Hitchcock Medical Center, Lebanon, NH
Objective: Current National Comprehensive Cancer Network guidelines recommend patients with newly diagnosed Stage III breast cancer undergo CBCs, LFTs, Chest/Abdomen CT scan and bone scan or PET scan for evaluation of metastatic (stage IV) disease. We aim to assess the relevance of LFTs in the detection of metastases in Stage III breast cancer.
Design: Single institution retrospective cohort study
Setting: Tertiary care cancer center
Patients: Patients with clinical or radiographic stage III breast cancer diagnosed from January 1, 2005 to December 31, 2009 who received treatment in our institution.
Interventions: Pre-operative liver function tests (LFTs), Abdominal CT scans, PET scans and bone scans obtained at the time of diagnosis.
Main Outcome Measures: Primary outcome was presence of metastatic disease in women with suspected stage III breast cancer. Secondary outcomes were additional imaging studies ordered due to abnormal LFT values and additional costs accrued.
Results: From 2005-2009, 124 of 170 patients with newly diagnosed Stage III breast cancer had LFTs, of whom 26.6% had abnormal results. Overall, 5.9% of Stage III patients (n = 10) had metastases; all detected from the recommended CT (n=112) and bone scans (n=117). Only 3 patients had abnormal lab values and underlying metastases (2.4%). The positive predictive value of LFTs in stage III disease was 0.091.
Conclusions: LFTs in clinical Stage III breast cancer patients have a low positive predictive value and provide little additional value in detecting metastases while adding cost. Despite a relatively low incidence, detection of stage IV disease preoperatively through current NCCN recommendations of CT and bone scans in stage III patients can save unnecessary treatment costs and resources.
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