Efficacy of bone and liver scanning in breast cancer patients treated with adjuvant chemotherapy

Abstract

One hundred nineteen patients who underwent mastectomy and received adjuvant chemotherapy for breast carcinoma were studied retrospectively. Of these, 102 patients had serial bone scans and 101 patients serial liver scans during a mean follow‐up of 59 months. All had negative scans prior to chemotherapy. Twenty‐three of 102 patients converted to positive bone scans during follow‐up. These 23 patients converted a mean of 29.5 months after surgery. At conversion, 5 of 21 patients had bone pain, and none had elevated alkaline phosphatase. Thirteen of 101 patients developed positive liver scans a mean of 31.5 months after surgery. The liver scan was the first indicator of liver involvement in only 3 of 13 converters. In no case was the liver scan the first indication of metastatic disease. The incidence of bone scan conversion (22%) did not differ significantly from previously reported series of patients not receiving adjuvant therapy, but the mean time to conversion was prolonged (29.5 versus 18.0 months). In addition, none (0/21) of the bone scan converters had elevated alkaline phosphatase at the time of conversion. It is concluded that the interval from initial evaluation to bone scan conversion may be prolonged by adjuvant chemotherapy of breast cancer. It is recommended that patients have bone scans twice yearly for at least 3 to 4 years after surgery. This study emphasizes the singular importance of bone scanning in breast cancer patients who have adjuvant chemotherapy, as the scan may be the only indicator of bone involvement. Liver scans do not appear useful for screening patients without other evidence for metastatic liver involvement.

The implication of hot spots on bone scans within the irradiated field of breast cancer patients treated with mastectomy followed by radiotherapy

“…For detecting bone metastases, the bone scan is a widely used screening test. The bone scan is a very sensitive test, but it is not specifi c [17,18]. Kamby et al [18] reported that the bone scan was an effective method to exclude bone metastasis (sensitivity 96%), but that the fi nding of a hot spot required additional radiological evaluation (specifi city 66%).…”

Positron emission tomography with 2-[18F]-fluoro-2-deoxy-D-glucose in oncology

“…FDG-PET has an additional advantage over other currently used imaging techniques because of its higher speci®city, ranging from 86% to 100% in dierent studies (Adler et al 1993;Nieweg et al 1993a;Scheidhauer et al 1996;Tse et al 1992;Wahl et al 1991). Other studies have illustrated that FDG-PET is also very useful to assess the presence of metastatic disease (Alexander et al 1976;Arnstein et al 1984;Jacobson et al 1995). Furthermore, numerous studies have attempted to relate cellular FDG uptake to the biological properties of the tumour such as the histological grade, the proliferative activity, the doubling time, and the number of viable tumour cells.…”

Breast cancer follow-up strategies in randomized phase III adjuvant clinical trials: a systematic review

“…The primary aim of routine post-operative surveillance after early stage breast cancer surgery, referred to as 'follow-up’, is to enhance survival, psychosocial and physical well-being of patients. The effectiveness of different breast cancer follow-up procedures for early detection of metastatic disease is an old issue, starting in the 1980s [ 7 - 10 ]. In the 1990s, evidences from phase III randomized trials (RCTs) demonstrated that intensive follow-up procedures do not improve outcome or quality of life when compared to patients’ educations about symptoms referral and regular physical examinations [ 11 - 18 ].…”