Role of Radionuclide Bone Scan in early breast cancer.

Saurabh, Gupta (2014) Role of Radionuclide Bone Scan in early breast cancer. Masters thesis, Cancer Institute (WIA), Chennai.


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INTRODUCTION : Use of radionuclides to image the skeletal system for early detection of focal pathology is referred to as bone scan. Bone scan can pick up the asymptomatic alterations in the skeletal system much earlier than their appearance on conventional radiographs. Bone scan is used in multiple pathologies concerning the skeletal system such as in detection of primary bone cancer, cancers spread to bone from other primary sites, skip lesions or involvement of multiple bones. Bone scans can also be useful in detecting different benign conditions of bone likeinflammation or infection causing bone destruction or pathological fractures. Bone scan has an advantage over other conventional imaging modalities in that it images the entire skeletal system and also considers the aspect of remodelling & bone mineralization, thus acting as a functional imaging modality rather than simply imaging the anatomy. 5-15% change in the turnover of bone can be picked up by bone scan, irrespective of the pathology.Radiation exposure by a single bone scan is 6.3 mSv.This is far less as compared to a CT scan (3.5-25 mSv) or a PET CT (22-23 mSv). Bone scan utility in early breast cancer is a topic for debate. Bone scan is a very sensitive imaging modality for detection of skeletal metastases, but its specificity is comparatively low. AIMS & OBJECTIVES : To identify the utility of baseline bone scans in early breast carcinoma by studying its:- • impact on initial treatment decision • Positive Predictive value • usefulness as a baseline test for future comparisons MATERIAL & METHODS : Case records of all the early breast cancer patients who were treated at the institute between Jan1, 2000 to Dec 31, 2004 were studied for the pattern of bone scan uptake. Patients had a preoperative baseline bone scan performed 3-4 hours after injection of 25mCi of 99mTc-labeled methylene diphosphonate. All scans were reported by a nuclear medicine consultant. Plain radiographs/CT or both were taken of areas of increased tracer uptake. The criteria for considering a bone scan as positive was that if complimentary imaging studies like plain x-rays or CT scan were confirmatory for the site of uptake in bone scan or in due course of time, patient relapses in the site of initial bone scan uptake.Patients were regularly followed-up, and the time and site of any relapse was recorded. The AJCC TNM system (7th Edition) for clinical staging and tumoursize (T) was used. CONCLUSION : As a policy, the institute has been performing bone scan for early stage breast cancer patients for the past 15 years. This retrospective analysis shows a low positive predictive value of baseline radionuclide bone scans in this group of patients, especially in those with primary tumour less than 3cms. Also, the usefulness of these scans as baseline test for future comparison proved to be limited to about 10% of the patients. Thus, we recommend that baseline radionuclide bone scans can be avoided in early stage breast cancer patients except in those who are symptomatic & in patients with primary tumour more that 3cm in size with or without clinically significant axillary lymph nodes.

Item Type: Thesis (Masters)
Uncontrolled Keywords: radionuclide bone scan ; early ; breast cancer.
Subjects: MEDICAL > Surgical Oncology
Depositing User: Kambaraman B
Date Deposited: 26 Jul 2017 02:49
Last Modified: 26 Jul 2017 02:49

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