Bone marrow scintigraphy in the diagnosis of bone metastasis in prostate cancer

We investigated bone marrow scintigraphy in 20 patients with prostate cancer to determine the usefulness of this procedure in the diagnosis of bone metastasis. Thirteen of 17 patients whose bone scans revealed hot spots showed accumulation defects in bone marrow scintigrams. Follow-up study and X-ray, computed tomography and/or magnetic resonance imaging findings confirmed the presence of bone metastases in these patients. On the other hand, 4 patients with abnormal bone scans had normal bone marrow scintigrams, and were subsequently demonstrated to have degenerative changes of the spine. Bone marrow scanning there appears to be useful in distinguishing metastatic lesions from degenerative changes in cases with suspected bone lesions.     

Role of radioisotopic investigations in breast cancer diagnosis and follow-up

Breast cancer represents the disease with the highest incidence in the female population. In the last years there was observed, in western countries, an increase of morbidity by breast tumors and in the same time, a decrease of mortality in direct relation with an earlier diagnosis. Until the spread at distance, breast cancer it's a loco-regional disease that can be curable by surgical treatment and adjuvant therapy, like chemotherapy or radiotherapy. The principal goal is to diagnose it before distal metastases appear, most frequently bone metastasis. Certain role has nuclear medicine in the diagnosis and prognosis of breast cancer because it's more sensitive and gives functional imaging. The aim of this study is to answer the question: what technique, in what indication. The detection of sentinel lymph node has now a clear place in the algorithm, the scintimammography test is important, especially for prediction of tumor resistance to chemotherapy. The bone scintigraphy (which explores the entire body in one time)is generally used in the detection of bony metastases and FDG tomoscintigraphy for the evaluation of local and distal recurrences, or response to chemotherapy. The measure of the isotopic ejection fraction, actually considered the gold standard, is very useful and also very easy to perform, in patients who will receive chemotherapy.     

Sentinel lymph node imaging and research after bone scintigraphy in breast cancer patients

The aim of the study is to see if Bone Scan (BS) - when performed the day before the operation-interferes with the results of the Sentinel Lymph Node (SLN) technique using radiocolloids (their pre-operative imaging and their peroperative research). Therefore, the data of 393 patients who had one selective lymphadenectomy of the SLN(s) followed by the complete axillary node (AxN) clearance for Breast Cancer and among whom 309 patients had one BS the day before the operation (and just before the injection-s for the SLN) and 84 did not, were analysed and compared. The two series presented the same characteristics with regard to: age, clinical staging of the tumour, kind of injection-s performed (intradermic and paratumoural and/or intraparenchymal and peritumoral), pathological size of the tumour, percentage of cases with no AxN invasion, total number of AxN removed by the surgeons. The percentages of no axillary SLN visualisation, the mean numbers of axillary SLN visualised on pre-operative lymphoscintigram as well as of SLN removed by the surgeons were not statistically different in the groups of patients with (respectively, 12.11, 2.6 and 3.03) and without BS (respectively, 12.99, 2.7 and 2.96). More noteworthy, the false negative (FN) rate of the SLN technique, albeit having a higher observed value in the group with BS (9.6%, 12/125), did not differ significantly from that in the group without BS (5.6%, 2/36). The accuracies (overall correct classification rates), the sensitivities and the negative predictive values of the SLN technique also did not differ significantly between the two groups. It is concluded that the SLN technique can be accurately performed just after one BS.     

99mTc-nanocolloid bone marrow scintigraphy in prostatic cancer

Bone marrow scintigraphy was performed in 23 patients with histologically proven carcinoma of the prostate, using a new radiopharmaceutical, Technetium-99m nanocolloid. The results suggest that although bone marrow scintigraphy is less sensitive than conventional bone scintigraphy in the detection of skeletal metastases from prostatic carcinoma, the technique may have a place in the management of patients with advanced metastatic disease, especially those who are anaemic, by identifying those patients at risk from myelosuppressive therapy.     

骨质疏松性骨折与骨转移瘤的骨显像鉴别诊断

目的 分析骨质疏松性骨折的骨显像特征,评价其用于与转移性骨肿瘤鉴别诊断的价值.方法 回顾性研究53例骨质疏松性骨折患者的临床及骨显像资料,提出骨质疏松性骨折的特征性影像表现,并通过对53例骨质疏松性骨折患者和随机抽取的100例骨转移瘤患者的阅片试验,评价骨显像用于骨质疏松性骨折与肿瘤骨转移鉴别诊断的可行性及其临床诊断效...     

Value of routine 99mTc-MDP bone scintigraphy in the detection of occult skeletal metastases in women with primary breast cancer

Baseline staging bone scans in 208 women with primary breast cancer in University Hospital Kuala Lumpur from January 1993 to December 1995 were reviewed. A positive bone scan was found in 14.7% of women aged below 50 years, and 9.1% of women aged 50 years and above. No patient with T0/T1, 4.7% with T2, 6.6% with T3 and 35.8% with T4 tumours had a positive scan caused by bone metastases. No patient with clinical Stage 0/1, 4% with Stage 2, 9.5% with Stage 3 and 63% with Stage 4 disease had a positive bone scan. Clinical staging alone was inaccurate in 20.2% of patients. Forty per cent of patients with a positive bone scan did not have bone pain. The false positive rate was 0.5% and the false negative rate was 0.96%. We conclude that a routine bone scan is not required in Stage 1 disease or T1 tumours, is indicated in Stage 3 and 4 disease, or T3 and T4 tumours, and should only be performed in selected women with Stage 2 or T2 cancers.     

Whole-body osseous scintigraphy and Ca++ kinetics in patients with renal transplants

Bone scintigraphy with 99mTc-diophosphonate and a whole body scanner was performed on 18 subjects with good renal function who had received a kidney transplant more than six months previously. This demonstrated scintigraphyc abnormalities in 17 of the cases. The alterations were characterized in 44,5% of the cases by focal uptake of the tracer. Diffuse alterations were observed in 4 of the 18 cases studied (22%). In these patients increases of serum alkaline phosphatase and in PTH levels were present. Ca++ exchangeable pool values and accretion rate were normal in the subjects with focal lesions. In the cases where scintigraphy showed diffuse lesions both the above parameters were much increased.     

The role of MIBI scintigraphy in the early detection of breast cancer

The authors investigate the role of MIBI scintigraphy in the early diagnosis of breast cancer. The importance of early diagnosis is emphasized by the fact that breast cancer has the highest morbidity and mortality preceding cervical carcinoma amongst women. Retrospective examinations were made in case of 42 patients operated before because of breast cancer in order to examine accuracy of both mammography and scintigraphy in comparison with the results of histological diagnosis. In these cases sensitivity of scintigraphy turned out to be 69%, while its specificity 42%. In cases of mammographical investigations the sensitivity proved to be 74% and specificity was 61%. Besides mammography, scintigraphy has a very important additional role in the diagnosis of breast cancer. Because of its results and costs scintigraphy is not able to take over the mammography's dominant position (as a popular diagnostic method) but in selected patients' groups it can help to realise tumors as well as to avoid unnecessary operations or needle biopsis. Based on our results this method can give significant additional information in T1b and especially in T1c states of tumors. Therefore this method can be offered as an additional investigation in cases of physically realised or mammographically screened, but not-palpable, larger than 1 cm size lumps when there is little or moderate risk of malignancy.     

Correlation between BMD and bone scintigraphy in patients with prostate cancer

OBJECTIVE: Bone metastasis is a major cause of morbidity in prostatic cancer. Therefore, detecting and monitoring bone lesions are crucial for treatment of prostatic carcinoma. We aimed to evaluate total body bone mineral density and regional bone mineral density in patients with prostate cancer with and without metastases, and to compare them with bone scintigraphy. METHODS: Fifty-four patients with prostatic carcinoma and 20 healthy subjects were investigated with bone scintigraphy and dual-energy X-ray absorptiometry. The bone scintigraphic findings were classified as normal (score 0: n = 22), abnormal but not typical for metastases (score 1: n = 18), and typical pattern of metastases (score 2: n = 14). RESULTS: The patients with bone metastases prostate cancer had significantly higher total bone mineral density and regional bone mineral density of trunk and pelvis than healthy controls and prostate cancer patients without bone metastases. There was a significant positive correlation between bone scan score and total bone mineral density and regional bone mineral density of trunk and pelvis (r = 0.328, P < 0.05, r = 0.60, P < 0.001, r = 0.480, P < 0.001, respectively). CONCLUSION: Our results show that patients of prostate cancer with bone metastases have increased bone mineral density (BMD) in the pelvis and trunk, possibly because of a predominance of osteoblastic over osteolytic metastases demonstrated by Tc-99m MDP bone scan.     

Skeletal scintigraphy in the inital assessment of women with breast cancer.

The results of 99mTc bone scanning have been retrospectively analyzed on 467 women admitted with a newly diagnosed breast cancer. The outcome of skeletal scintigraphy has been studied with reference to various prognostic variables. 9.8% of the women exhibited a positive scintigram. We could not find any influence of the tumour position on the frequency of positive bone scans. Age in relation to the menopause affected the rate of positive scans in that about three times as many positive scans were recorded in post menopausal women than in those who had not reached the menopause. Clinical staging according to the TNM system as well as the histological status of the axillary nodes correlated well with the rate of scintigrams that indicated a disseminated cancer disease. The tumour size, as measured in the operation specimen, strongly affected the frequency of positive and suspicious scans in accord with the prognostic significance of this parameter. The role of skeletal scintigraphy for an adequate staging of breast cancer patients is discussed.     

Advances in the diagnosis and excision of breast cancer

Until recently little advance in the diagnosis and excision of breast cancer has been made since the inception of needle localization breast biopsy (NLBB). Stereotactic core needle breast biopsy (SCNBB) can avoid most NLBB especially for calcifications. However, when open biopsy is necessary NLBB has been the standard of care. As many as 50 per cent of nonpalpable lesions can be seen by ultrasound (US) to avoid the unpleasantness and complications associated with NLBB. Further SCNBB leaves a blood-filled cavity that can be easily seen by US. Intraoperative US can be used to direct the excision while improving margin negativity. MRI has improved sensitivity in detecting suspicious breast lesions and techniques such as hematoma-directed US-guided breast biopsy can facilitate excision of such masses. Clearly new technologies have improved the ability to diagnosis and excise breast cancer. The onus on the surgeon is to incorporate them into standard practice to improve outcomes.     

The role of skeletal scintigraphy in detection of metastatic breast cancer

The most common site of metastases from breast cancer is the skeleton. Conventional methods of detecting skeletal metastases are not very sensitive. Substantial evidence indicates that skeletal scintigraphy is the most accurate method of demonstrating metastases to bone, particularly in patients with early breast cancer who have no manifestations of metastatic disease. In a study of 50 patients with advanced mammary carcinoma, skeletal metastases were demonstrated by scintigram (and later confirmed) in 84%, but by conventional x-rays in only 50%. More important, in 50 patients with early breast cancer who had negative skeletal x-rays, lesions were found by scintigraphy in 24%. All of these patients developed disseminated carcinoma and 83% of them died within 5 years. In contrast, only 34% of patients with a negative scintigram developed disseminated carcinoma within 5 years.

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Résumé Le cancer du sein métastasie le plus souvent dans le squelette. Les méthodes conventionnelles de détection des métastases osseuses ne sont pas très sensibles. La scintigraphie est la méthode de détection la plus précise, surtout pour les patientes porteuses d'un cancer du sein débutant sans symptomes de métastases. On a pu démontrer par scintigraphie des métastases squelettiques (qui furent confirmées plus tard) chez 84% de 50 malades atteintes de carcinome mammaire au stade avancé, alors que la radiographie conventionnelle n'avait démontré des lésions osseuses que dans 50% des cas. De plus, la scintigraphie a permis de découvrir 24% des métastases dans une série de 50 malades atteintes d'un cancer mammaire débutant et dont les radiographies du squelette étaient normales. Toutes ces patientes présentèrent des signes de dissémination cancéreuse et 83% d'entre elles sont mortes endéans les 5 ans. A l'opposé, 34% seulement des malades avec scintigraphie normale développèrent des signes de généralisation au cours des 5 années du follow-up.

     

Echography in the diagnosis of breast cancer]

Fifty-one patients with clinically palpable breast cancer were examined using small-parts echotomography. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of overall diagnosis were assessed in the two groups of patients: T1 (diameter less than 2 cm) and T2-T3-T4 (diameter greater than 2 cm). The frequency of the main echographic signs associated with breast cancer was also investigated. Diagnostic accuracy was found to be high in the T2-T3-T4 group (93%), but very low in the T1 group (71%). The study confirms the importance of ultrasound as an additional test in the study of breast cancer. However, this method becomes increasingly less sensitive and specific as the size of the tumour decreases.