Omission of bone scanning according to staging guidelines leads to futile therapy in non-small cell lung cancer

Abstract

The leading European and American professional societies recommend that bone scans (BS) should be performed in the staging of lung cancer only in those patients with bone pain. This prospective study investigated the sensitivity of conventional skeletal scintigraphy in detecting osseous metastases in patients with lung cancer and addressed the potential consequences of failure to use this method in the work-up of asymptomatic patients. Subsequent to initial diagnosis of non-small cell lung cancer, 100 patients were examined and questioned regarding skeletal complaints. Two specialists in internal medicine decided whether they would recommend a bone scan on the basis of the clinical evaluation. Skeletal scintigraphy was then performed blinded to the findings of history and physical examination. The combined results of magnetic resonance imaging (MRI) of the vertebral column, positron emission tomography (PET) of skeletal bone and the subsequent clinical course served as the gold standard for the identification of osseous metastases. Bone scintigraphy showed an 87% sensitivity in the detection of bone metastases. Failure to perform skeletal scintigraphy in asymptomatic patients reduced the sensitivity of the method, depending on the interpretation of the symptoms, to 19-39%. Without the findings of skeletal scintigraphy and the gold standard methods, 14-22% of patients would have undergone unnecessary surgery or neoadjuvant therapy. On this basis it is concluded that bone scans should not be omitted in asymptomatic patients.

Mortality following bone metastasis and skeletal-related events among patients 65 years and above with lung cancer: A population-based analysis of U.S. Medicare beneficiaries, 1999-2006

“…16-27%). [2324] Prior to 1991, several studies found skeletal metastases in non-small cell lung cancer to range from 8% to 34%. [25–31] With the advent of newer imaging techniques such as the positron emission tomography (PET) in the 1990s, bone metastasis has been noted to range from 24% to 30% for non-small cell lung cancer.…”

Diagnostic imaging to detect and evaluate response to therapy in bone metastases from prostate cancer: current modalities and new horizons

“…This result can be linked to the different behaviour of 18F/11C-choline in osteoarticular disease. Moreover, as expected, 18F-FDG PET/CT has low sensitivity (between 56 % and 72 %) in the detection of BMT in patients with PC, although as suggested by several authors, and as mentioned above, it may occasionally be suitable for prostate imaging in a limited subset of selected patients with aggressive histology and poorly differentiated cancer [111,[117][118][119]. Considering the areas of assessment of response to therapy, all of the above-mentioned metabolic methods may have value since their uptake is linked to the phenomenon of bone remodelling or to the metabolic activity of neoplastic cells.…”

Staging of Non-Small Cell Lung Cancer

“…In a series of 100 patients evaluated for the presence of skeletal metastases with clinical evaluation, bone scanning, MRI, and PET imaging, 27% of asymptomatic patients were found to have bony metastases compared with 32.4% of patients with symptomatic complaints. 51 The high frequency of asymptomatic bony metastases supports a routine evaluation in patients with a higher likelihood of distant spread. Among the noninvasive modalities, PET scanning appears to have the highest accuracy for identifying bony metastases.…”