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:
    • 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.

#Arrangoiz #BreastSurgeon #BreastCancer #CancerSurgeon #Surgeon #Teacher

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