Scintigraphic and radiographic patterns of skeletal metastases in breast cancer: value of sequential imaging in predicting outcome

Objective To determine whether temporal changes in scintigraphic and bone radiographic findings have prognostic significance in patients with skeletal metastases from breast cancer.Design Clinical information and films were retrospecitvely reviewed in 101 randomly selected patients with skeletal metastases. Images from sequential bone scans and bone radiographs were correlated with survival after detection of the metastases.Results Time to detection of skeletal metastases and the length of time for which patients were classified as radiologically stable after development of skeletal metastases correlated with survival (r=0.843; r=0.821, respectively). Failure to develop a radiographically and scintigraphically stable pattern after treatment was associated with significantly decreased survival compared with the rest of the patients (mean survival 2.1±1.3 years vs 4.3±2.3 years; p<0.001). Scintigraphic regression of metastases was associated with significant survival benefit and longer stabilization of disease compared to all other patterns (mean survival 5.0±2.7 years for regressive disease vs 3.7±1.9 years for stable disease and 2.2±1.3 years for progressive disease; p<0.001).Conclusions Sequential scintigraphic and radiographic imaging is useful in breast cancer patients not only for detection of metastases and monitoring of treatment effect, but also because these studies provide valuable prognostic information.