Lung Carcinoma

Bone scans have been used to screen patients for metastases in newly diagnosed non-small cell lung cancer as part of the staging process. With the advent of CT and MRI, evidence of metastatic deposits in the hilar and mediastinal lymph nodes, liver and adrenals can be identified in order to establish non-resectability of the primary. The additional information gleaned from bone scan screening will not alter the staging or management even though it has been reported that the bone scan may be positive in about 40% of patients on initial presentation.

Most small cell lung carcinomas will have metastasized by the time the patient is first seen and these are readily revealed by physical examination, laboratory findings and radiographic techniques. Resectability is not an issue in this tumor category, and although it is reported that about 50% will show bone lesions by scintigraphy it has little influence on management in the initial phase.

Bone scanning is generally relegated to monitoring chemotherapy, assessing bone pain for possible local radiation therapy or orthopedic intervention to preclude fracture in the long bones or spinal cord compression, disclosing hypertrophic pulmonary osteoarthropathy as a cause of lower extremity pain (Fig. 10) or identifying nonmalignant causes of pain such as trauma, infection and osteonecrosis.

Breast Carcinoma

Present day evaluations of large clinical trials indicate that the frequency of bone metastases in stage I and stage II breast cancer patients is less than 10%. Most investigators are of the opinion that the use of bone scintigraphy for staging is unnecessary in stage I and most stage II individuals in view of the newer diagnostic radiographic methods that are available and the results of cost-effectiveness analyses. Bone scans have a role if the primary tumor is large or histologically aggressive, if

Figure 10. Hypertrophic pulmonary osteoartropathy. Radiophosphate bone scan in a patient with lung carcinoma. Note the extensive increased cortical activity in the femora and tibiae due to subperiosteal bone remodelling. Upper extremities were also involved.
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