Definition of Cortical Bone Metastases

Bone metastases discriminate between stage 4S and stage 4 and are considered more difficult to treat than other metastatic sites (Ladenstein et al. 1998); therefore, independent methods for defining cortical bone disease are desirable.

In the case of an MIBG-avid neuroblastoma without any focal distant lesion, no further investigation is generally necessary. If the primary tumor is MIBG negative, a technetium bone scan is recommended (in two-thirds of the cases the primary itself is taking up the technetium tracer) in order to detect MIBG negative distant bone metastases.

In lesions with focal MIBG uptake, controversy exists about the accuracy of MIBG in detecting cortical bone metastases (Suc et al. 1996). Some investigators have suggested evaluation of bone lesions by technetium bone scan (highly sensitive),while others rely on osteosclerotic or osteolytic changes in the plain X-ray radiographs (less sensitive).

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