Regarding imaging for distant metastases in newly diagnosed invasive ductal carcinoma, which statement best reflects routine practice?

• A. Routine imaging with CT or bone scan is indicated for all patients
• B. Routine imaging is not indicated; imaging is done only if clinical symptoms develop
• C. MRI of the chest is mandatory for initial staging
• D. PET-CT is recommended for all patients

Answer: (B)

Imaging for distant metastasis is used selectively, not routinely, in newly diagnosed invasive ductal carcinoma. The chance that an asymptomatic patient already has distant spread is low, and finding hidden metastases in this setting rarely changes initial management. Therefore doing CT scans, bone scans, or similar imaging for every patient isn’t standard practice.

Imaging is pursued when clinical symptoms or signs raise concern for metastasis (such as bone pain, new liver enlargement or abnormal functional symptoms) or when the initial staging suggests a high-risk situation where knowing metastatic status would alter treatment decisions. MRI of the chest isn’t mandatory for initial staging and is used more selectively for local assessment or surgical planning. PET-CT isn’t recommended for all patients due to cost, radiation exposure, and potential for false positives, which can lead to unnecessary procedures.