In Reply.—Our main argument was that scintiscanning rarely disclosed liver metastases in those patients routinely scanned at the time of their initial breast surgery—only three of the 234 patients. Liver function tests available from these few and an additional 16 patients showing metastases during later follow-up were abnormal in 18 of the 19 patients.
Most series that have examined the efficacy of the liver scan, including those cited by Krutchik and Buzdar, have included metastases from all primary sources. That there are differing patterns of liver metastases from various primary sources and consequently differing rates of detection is supported by the low yield encountered in the breast patients in our series and by Sears et al.1 Drum and Beard2 have further suggested that different criteria for scintigraphic detection is necessary for liver metastases from the breast compared to that of the colon. We suspect that most breast