99mTechnetium-labeled methylene diphosphonate bone
scan (BS) is the most commonly used imaging test to
screen for skeletal metastases in patients with breast
cancer. Since its introduction into clinical practice, a
large number of studies have been conducted to explore
the role of BS in the baseline staging work-up at the
time of breast cancer diagnosis. Even though the policy
of offering preoperative or perioperative BS is still widely
diffuse, a lot of evidence in the literature suggests that
routine BS examinations are not cost-effective and
should be recommended in selected cases only. Based
on current guidelines, the use of BS as a staging procedure
is considered appropriate in patients with a high
pre-test probability (prevalence) of bone metastases.
This category is represented by patients with newly diagnosed
high-risk breast cancer (i.e. pN2 or T4/pT4) or
with symptoms or laboratory signs suspicious for bone
involvement.