Value of bone scanning in the follow-up of breast cancer patients

Abstract

The aim of the study was to assess the value of routine bone scintigrams, independent of the primary tumor stage or the presence of symptoms, in the postsurgical follow-up of breast cancer patients for the early detection of bone metastases. For this purpose 1,000 patients with postsurgical breast cancer without previous documentation of metastatic disease, who were admitted to the special oncology hospital, Onkologische Klinik Bad Trissl, entered a prospective study in 1987-1988. The parameters followed were the TNM stage of the primary tumor, the presence of pain, bone pain as revealed by a thorough physical examination, and the patient's history for the assessment of risk factors. In addition, a whole-body skeletal scintigram, supplementary X-rays, and additional diagnostic measures were performed, if necessary, to detect bone metastases. It was shown that in 856 of 894 patients (groups 1-6) without clinical symptoms, the clinical examination and radiological and scintigraphic diagnostic measurements, demonstrating the absence of bone metastases, gave matching results, but in 12 of the 894 patients the results of all examinations remained questionable. In another 12 of the 894 patients (groups 1-3) radiological and/or scintigraphical evidence for the presence of bone metastases was found. In 14 of 79 cases (groups 7-10) with clinically suspicious symptoms these were proven to be signs of metastases by subsequent scintigrams, supplementary X-rays, and additional diagnostic measures. In 65 of the 79 patients with clinically suspicious symptoms, bone metastases could not be confirmed by obtaining bone scintigrams or X-rays while in the other 14 patients (groups 9 and 10) evidence for the presence of bone metastases was found in the scintigrams and/or X-rays. However, 10 of these 14 patients were high-risk patients for developing bone metastases as they had axillary lymph node infiltration. The other 4 patients were of the low-risk group as they had positive receptor status or no axillary lymph node infiltration at the time of primary diagnosis. In 13 of 27 patients (groups 11-14) with clinical symptoms indicating the presence of bone metastases this diagnosis was confirmed by scintigrams and/or X-rays (groups 11 and 12), while it was possible to exclude the presence of bone metastases in spite of the symptoms in 11 of the 27 patients. In the other 3 patients the results of the additional examinations remained questionable.(ABSTRACT TRUNCATED AT 400 WORDS)

Prognostic significance of the number of bone scan abnormalities at the time of initial bone metastatic recurrence in breast carcinoma

“…The role of imaging for detection of metastatic disease during follow‐up of patients with Stage I–III breast carcinoma increasingly has been called into question during the past decade 16, 24–26. At one time, bone scintigraphy was commonly used as part of routine follow‐up during the first several years after diagnosis of breast carcinoma, but the absence of a proven clinical benefit for early identification of asymptomatic metastatic disease has resulted in the discontinuation of this practice 24, 27–32. Bone scintigraphy is now generally performed only in patients with new biochemical abnormalities (e.g., elevated alkaline phosphatase, CEA), bone symptoms, or suspicious findings on other radiological studies.…”

“…Given the extensive literature on the use of skeletal scintigraphy in breast carcinoma,5, 10, 18, 27–32, 36, 37 it is somewhat surprising that the clinical significance of the pattern of metastatic involvement has received relatively limited attention. Although solitary scan lesions in cancer patients have had prevalences of metastatic disease ranging from 10% to 64% in several small series,10, 38–41 it remains unclear whether identifying bone metastases at this early stage rather than when skeletal involvement is more extensive is of value.…”

Primäre und sekundäre Neoplasien des Skeletts

“…Die Skelettszintigraphie zur Suche nach Skelettmetastasen osteotrop metastasierender Tumoren ist eine alte und etablierte Methode. Seit Jahren wird allerdings eine kritische Kosten/Nutzen-Diskussion darüber geführt, die z. T. auch von berufsständischen Interessen getragen erscheint [84]. So kam eine italienische Multicenterstudie mit 1243 konsekutiven Patienten mit Mammakarzinom zu der Schlussfolgerung, dass zwar eine frühere Entdeckung von Knochenmetastasen bei regelmäûigem Einsatz der Knochenszintigraphie möglich, dabei aber kein Einfluss auf die Prognose im 5-Jahres-Verlauf zu erkennen war.…”