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[Soft-tissue sonography in the follow-up care of breast cancer: indications of liver metastases caused by lymphatic spread].

AIM
During follow-up care of breast cancer patients a prospective study was carried out to answer two questions: 1. Can soft-tissue sonography improve early detection of locoregional metastases? 2. Can a combination of soft-tissue sonography and ultrasound liver examination provide information about the lymphogenous spread of metastases?


METHOD
312 unselected breast cancer patients were examined sonographically. The examinations included 9 lymph node regions of the efferent lymphatic ducts, along with the chest wall and the liver. Further examinations of the soft-tissue metastases were carried out with a different imaging technique or histologically, or with a combined sonographic and clinical follow-up, as a control.


RESULTS
Sonography revealed 112 locoregional metastases in 49 patients (15.7%); 62 of these metastases (55%) were non-palpable. Especially metastases in the axillary level II and III areas, interpectoral and intramuscular recurrences and internal mammary lymph node metastases were found to be non-palpable, except in a very advanced stage. Liver metastases often occurred in conjunction with internal mammary lymph node metastases. Liver metastases were the only manifestation of distant metastasis in three patients with internal mammary lymph node metastases, all of whom were in the fifth year after mastectomy.


CONCLUSION
Soft-tissue sonography greatly improves early detection of locoregional metastases of breast cancer. There seems to be the possibility that liver metastases of breast cancer can develop lymphogenously via internal mammary lymph node metastases.