To the Editor.—We take issue with an article by Wiener and Sachs (Arch Surg 113:126-127, 1978) who categorically state that routine liver scanning for metastatic disease in patients with breast cancer should be abandoned unless there is evidence of abnormal liver function. The strength of their argument is based almost soley on the ability to separate patients requiring a liver scan by means of liver function studies. The points are made that in eight patients with documented false-positive scans, seven of eight of these patients had normal liver function tests and therefore could have been spared the unnecessary liver scan. In those 19 patients with abnormal liver scans who had histological documentation of metastases, 16 of the 19 patients had abnormal liver function tests, indicating again that a positive liver scan can be predicted based on abnormal liver function tests.
It is well known that liver function tests when