Role of Bone Scan versus Conventional Radiology in the Management of Cancer Patients

Abstract

ABSTRACT

Background: The technetium-99 metastable labeled methylene diphosphonate bone scintigraphy has played a significant part in evaluation of metastatic diseases and continues to be the most clinically utilized investigation in the staging and follow-up of cancer patients

Objectives: To assess the role of bone scan in cancer patients management and compare it with conventional radiology

Methods: A descriptive cross-sectional study was done for 481 patients, fine needle aspiration cytology or biopsy positive for cancer, aged 30 to 75 years old between Feb. 2010 and Feb. 2011 in Nuclear Medicine section, Radiology department, Hawler Teaching hospital, Erbil, Iraq. Whole body bone scan was done to all patients using technetium 99 metastable–labeled methylene disphosphonate as bone seeking agent that was giving intravenously in a dose of 740-1110 MegaBecquerel (20-30 milliCuries), and imaging was done after 2-4 hours of tracer injection by a double detector Single Photon Emission Computed Tomography system gamma camera using low energy, high resolution collimator. Abnormal scans were correlated with standard radiographs taken within days of the scan.

Results: Tumors found from most to least commonly involve was the breast, prostate, sarcomas, bronchus and others. The percentage of metastases was high in comparison to previous studies 54% of total number of cases with various tumors, for prostate cancer cases 83%, and breast cancer cases 56.99%. Also, we noticed that there were a large number of cases with typical scan findings of skeletal metastases that did not show radiological abnormalities 14.23%.

Conclusion: Bone scan allows early detection of bone metastases. Here, there is a very high rate of metastases detected in cancer patients by bone scan in comparison to other studies that may be partially explained by the long period elapsed between the primary diagnosis and the date of performing bone scan and that it is not done as a primary assessment procedure for staging. Bone scan, because of its high sensitivity; is recommend to be done for the primary assessment of patient with tumors specially those who are readily metastasized to bone, to detect non-radiologically apparent metastases and help interpretation of future follow up results.