Routine Preoperative Chest X Rays in Breast Surgery – Are They Necessary?

• Obtaining a chest radiograph:
  • Is reasonable if acute cardiopulmonary disease is suspected
  • If there is a history of chronic stable cardiopulmonary diseases:
    • In patients older than age 70 years who have not had chest radiography within 6 months
• The American Society of Clinical Oncology and the National Comprehensive Cancer Network:
  • Do not recommend routine preoperative chest imaging:
    • In asymptomatic patients with normal clinical examinations undergoing surgery for breast neoplasms:
      • Routine systemic imaging leads to unnecessary cost and risk of false-positive findings
• In 1979, the Royal College of Radiologists published a multicenter study:
  • That retrospectively examined 10,619 preoperative chest x-rays in patients undergoing elective non-cardiopulmonary surgery and concluded that:
    • Preoperative chest x-rays did not influence the decision to operate or choice of anesthetic
• Since then, studies have confirmed that preoperative chest x-rays did not influence postoperative outcome
• Therefore, the low benefit does not justify their cost for the general population undergoing ambulatory procedures:
  • As only 2% of such images lead to a change in management
• References:
  • The American Society of Breast Surgeons Releases List of Five Things Clinicians and Patients Should Question. http://www.choosingwisely.org/the-american-society-of-breast-surgeons-releases-list-of-five-things-clinicians-and-patients-should-question/. Accessed January 7, 2020.
  • NCCN Breast Cancer Guidelines 2018. National Comprehensive Cancer Network website. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed October 17, 2019.
  • Mohammed TL, Kirsch J, Amorosa JK, et al. ACR Appropriateness Criteria routine admission and preoperative chest radiography. Updated 2015. https://acsearch.acr.org/docs/69451/Narrative. Accessed October 21, 2019.
  • Munro J, Booth A, Nicholl J. Routine preoperative testing: a systematic review of the evidence. Health Technol Assess. 1997;1(12):1-62.
  • Preoperative chest radiology. National study by the Royal College of Radiologists. Lancet. 1979;2(8133):83-86.
  • Archer C, Levy AR, McGregor M. Value of routine preoperative chest x-rays: a meta-analysis. Can J Anaesth. 1993;40(11):1022-1027.

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