technetium-tc-99m-medronate and Breast-Neoplasms

According to the inclusion and exclusion criteria, we searched for relevant original articles in some big Chinese and English databases. The qualities of the studies were evaluated with QUADAS quality assessment tool. A software program, Meta-disc, was used to obtain the pooled estimates and heterogeneity test for sensitivity, specificity, SROC curve, and so on. Finally the 17 article were included. On a per-patient basis, the pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR), Q*, SROC area under curve for 99mTc-MDP bone scan and computed tomography (CT) were 0. 87 and 0.99, 0.81 and 0.98, 3.88 and 13.86, 0.2 and 0.03, 27.73 and 612.17, 0.8418 and 0.9732, 0.9097 and 0.9952, respectively. On a per-focus basis, the pooled SEN, SPE, LR+, LR-, DOR, Q*, SROC area under curve for 99mTc-MDP bone scan was 0.86, 0.97, 13.32, 0.16, 102.4, 0.8944, 0.9528, respectively. For CT, only 1 article were included. This paper demonstrate: whether 99mTc-MDP or CT both have high diagnostic efficiency for bone metastase of breast cancer.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Super scan pattern on technetium-99m methyldiphosphonate (Tc-99m MDP) bone scintigraphy is a special condition of extremely high bone uptake relative to soft tissue with absent or faint renal radioactivity visualization, which is usually seen in diffuse bone metastases or discrete endocrine entities. Here, two cases with super bone scan are presented. One was a young man diagnosed with gastric cancer. The other was a middle-aged woman with a history of breast cancer with recent recurrence. Both cases had 18-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) diagnosis simultaneously. Based on imaging of (18)F-FDG PET/CT, diffusely incremental (18)F-FDG avidity in spine/pelvis on PET and subtle erosion of cortical bone on CT were seen. The cytological results of bone marrow biopsy showed evidence of malignant metastasis. However, there were several focal discrepant findings between the (18)F-FDG PET/CT and Tc-99m MDP bone scan. According to integration of both imaging findings and the result of bone marrow biopsy, we believe that the disseminated malignant spread in bone marrow is a primitive alternation in the super bone scan and that it is also as a result of neoplasm-related endocrine factors.

Topics: Adult; Bone Marrow Neoplasms; Bone Neoplasms; Breast Neoplasms; Carcinoma, Ductal, Breast; Diagnosis, Differential; Female; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Multimodal Imaging; Neoplasms, Unknown Primary; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Adult; Artifacts; Axilla; Biopsy; Breast Diseases; Breast Neoplasms; Carcinoma; Carcinoma, Ductal, Breast; Chemotherapy, Adjuvant; Drug Resistance, Multiple; Drug Resistance, Neoplasm; False Positive Reactions; Female; Forecasting; Humans; Lymphatic Metastasis; Magnetic Resonance Imaging; Mammography; Middle Aged; Multicenter Studies as Topic; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasms, Multiple Primary; Organophosphorus Compounds; Organotechnetium Compounds; Patient Selection; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Ultrasonography

Skeletal metastases are one of the major clinical problems for the oncologist. Over the last several decades bone scintigraphy has been used extensively in detecting bone involvement since it can provide information about disease location, prognosis and the effectiveness of treatment. Bone scan offers the advantage of total body examination, and images bone lesions earlier than other techniques. In this paper the main clinical problems related to the most common applications of bone scan in breast, prostate, lung cancer and other tumours are discussed. The experience carried out at the National Cancer Institute of Milan by using bone SPECT to detect single bone metastases is reported. One hundred and eighteen patients with bone metastases (from different tumour types: breast, lung, prostate, lymphomas, etc.) were studied by planar scintigraphy, SPECT and other radiological modalities (CT, MRI or X-rays). The overall performances of bone SPECT were sensitivity: 90.5% (19/21), specificity 92.8% (90/97), positive predictive value 73% (19/26), negative predictive value 97.8% (90/92), accuracy 92.4% (109/118). Considering breast cancer, the most frequent pathology in our series, and the lumbar spinal tract, the most common skeletal segment involved, the figures of merit of SPECT were: sensitivity 100% (4/4), specificity 95.3% (41/43), positive predictive value 66.7% (4/6), negative predictive value 100% (41/41), accuracy 95.7% (45/47). In conclusion bone SPECT showed very good performances, in particular improving the predictive value of planar scan in the diagnosis of vertebral metastases.

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Humans; Lung Neoplasms; Male; Predictive Value of Tests; Prostatic Neoplasms; Radiopharmaceuticals; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

The wide availability and the extensive use of screening mammography have resulted in an earlier diagnosis of breast cancer and in a significant reduction in the relative risk of dying from this disease. Despite technical improvements and major advantages associated with the use of mammography (and breast ultrasound), this procedure has some limitations in clinical practice, especially in women with dense breast tissue, implants, severe dysplastic disease, or significant architectural distortion following breast surgery or radiation therapy. Different noninvasive imaging techniques have been evaluated to overcome these limitations. Nuclear medicine also has been actively involved in the detection of breast cancer, using various types of radiopharmaceuticals. Currently, there are three radiotracers commonly used for breast imaging or scintimammography in either clinical practice or research: 99mTc-sestamibi and 99mTc-tetrofosmin (two agents used for myocardial perfusion imaging) and 99mTc-MDP (methylene diphosphonate, used for bone scintigraphy). 99mTc-sestamibi was the first radiopharmaceutical to be approved by the FDA for scintimammography. Several prospective studies have shown that the overall sensitivity of 99mTc-sestamibi scintimammography in detection of breast cancer was 85%, the specificity was 89%, and the positive and negative predictive values were 89% and 84% respectively. Similar numbers have been demonstrated for 99mTc-tetrofosmin and 99mTc-MDP scintimammography. Although not indicated as a screening procedure for the detection of breast cancer, scintimammography may play a useful and significant role in various specific clinical indications such as nondiagnostic or difficult mammography, and evaluation of high-risk patients, tumor response to chemotherapy, and axillary lymph node metastatic involvement.

Topics: Breast Neoplasms; Female; Humans; Mammography; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon

Topics: Ascites; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Breast Neoplasms; Carcinoma, Ductal, Breast; Female; Follow-Up Studies; Humans; Middle Aged; Radionuclide Imaging; Tarsal Bones; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Bone scintigraphy is very sensitive in detecting metastases in an early stage, when changes in osteoblast function precede morphologic changes. In many oncologic situations, however, osteoarticular abnormal changes seen on the bone scan are not caused by tumor infiltration. They may be due to tumor associated conditions, such as carcinoma polyarthritis and hypertrophic pulmonary osteoarthropathy. They also may be due to therapy-associated conditions, such as the flare effect on metastases due to hormonal treatment, chemotherapy or radiotherapy, and osteonecrosis as a complication of radiotherapy or the use of corticosteroids. The introduction of Colony Stimulating Factors (CSF) to reduce myelotoxicity have allowed higher doses of chemotherapeutic agents to be administered. Currently, there is research being performed on the clinical effects of CSF in phase-II studies. In addition to the flare response of metastases, increased uptake in the axial skeleton and/or juxta-articular areas on bone scintigraphy in five patients receiving CSF has been observed. This new phenomenon could be explained by a reaction to a very cellular marrow caused by the use of CSF. The clinical relevance of this finding remains to be established. The authors present an overview of these old and new phenomena seen on the bone scan with clinical and roentgenologic correlation.

Topics: Adult; Aged; Bone and Bones; Breast Neoplasms; Female; Granulocyte Colony-Stimulating Factor; Humans; Iatrogenic Disease; Male; Middle Aged; Neoplasms; Paraneoplastic Syndromes; Radionuclide Imaging; Rhabdomyosarcoma; Technetium Tc 99m Medronate; Teratoma; Testicular Neoplasms

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Carcinoma; Diphosphates; Diphosphonates; Fractures, Bone; Humans; Lung Neoplasms; Male; Osteomyelitis; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Compounds; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

To investigate the value of diffusion-weighted (DW), perfusion-sensitive, and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) techniques in assessing the response of bone metastases from breast cancer to radiotherapy, with particular emphasis on the role of intravoxel incoherent motion (IVIM)-DW parameters as a potential valuable imaging marker of tumor response.. Fifteen women having breast cancer and bone metastases underwent MRI before and after radiotherapy (3 weeks [time 1], 2 months [time 2], and 4 months [time 3]), consisting of DW, perfusion-sensitive (IVIM), and DCE acquisitions. MR-based DW and perfusion parameters, including water diffusivity (D), perfusion fraction (f), pseudodiffusion (D*), total apparent diffusion coefficient (ADC-total), fractionated ADCs (ADC-high and ADC-low), and initial area under the gadolinium concentration curve after the first 60 seconds (IAUGC60), were determined. The morphologic MRI findings were also recorded. A one-way repeated measures analysis of variance was used to compare the value of MR-based parameters at the different time points.. A significant variation between pretreatment (time 0) and post-treatment (times 1, 2, and 3) was found for ADC-total and D parameters (P < .001). A statistically significant reduction was also found for IAUGC60 values between times 0 and 3 (P < .001). A significant change across the different time points was observed for D* and IAUGC60 parameters (P < .001). On the contrary, there was no statistically significant change over time for parameters ADC-total, D, f, and IAUGC60 comparing response between each metastasis, that is, the response to therapy was similar for each metastasis.. DW, IVIM, and DCE-MRI techniques show effectiveness in assessing the response to radiotherapy in bone metastases from breast cancer.

Topics: Aged; Aged, 80 and over; Algorithms; Artifacts; Bone Neoplasms; Breast Neoplasms; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Humans; Image Enhancement; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Motion; Outcome Assessment, Health Care; Prognosis; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Treatment Outcome

Lutetium-177-labeled ethylenediamine-N,N,N',N'-tetrakis (methylene phosphonic acid) (¹⁷⁷Lu-EDTMP), a beta-emitting bone-seeking therapeutic radiopharmaceutical being assessed as an agent for palliation of bone pain, can emit suitable gamma-photons for scintigraphy. This investigation sought to characterize its optimal conditions for whole-body gamma camera imaging in patients.. Eleven patients with bone metastases underwent whole-body bone scanning using both ⁹⁹mTc-methyl-diphosphonate (⁹⁹mTc-MDP) and ¹⁷⁷Lu-EDTMP (29.4 ± 12.5 MBq/kg BW) utilizing a dual-head camera. For lutetium-177 imaging, two types of collimators, low-energy high-resolution (LEHR) and medium-energy general-purpose (MEGP), and two different peak energies of 113 and 208 keV were used.. The femur-to-muscle uptake ratio (F/M) of ⁹⁹mTc-MDP was 2.69 ± 1.06. For ¹⁷⁷Lu-EDTMP, the significantly highest F/Ms were found at 24 h (12.59 ± 5.73) and 48 h (12.54 ± 5.23) by applying MEGP collimators and collecting the 208 keV photons. In all the combinations of collimator and peak energy, the F/Ms at 24 and 48 h are significantly higher than those at 1 h, except the combination of LEHR collimator and 208 keV peak energy. Lesion-to-normal bone uptake ratios of the ⁹⁹mTc-MDP bone scan and images at the 24 and the 48-h phases of Lu-EDTMP were analyzed. MEGP and 208 keV had significantly higher values in lesion-to-normal bone uptake ratios. The combination of LEHR and 208 keV provided the poorest images.. ¹⁷⁷Lu-EDTMP can provide fine whole-body images with the best results when applying medium-energy collimation and collecting the 208 keV energy photons and alternatively by collecting both 208 and 113 keV photons for higher count statistics. The most appropriate time point for imaging is around 24 h after injection.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Female; Gamma Cameras; Humans; Male; Middle Aged; Organometallic Compounds; Organophosphorus Compounds; Pain; Palliative Care; Prostatic Neoplasms; Radioisotopes; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Time Factors; Whole Body Imaging

To evaluate the accuracy of ¹⁸F-fluoride PET/computed tomography (CT) to detect bone metastases (BMs) in a breast and prostate cancer population, using magnetic resonance imaging (MRI) or thin-slice CT as a gold standard.. We have prospectively included 34 patients with breast (N=24) or prostate cancer (N=10) at high risk of BMs. Whole-body PET/CT (low-dose CT) and bone scintigraphy (BS) with single photon emission CT were obtained for all 34 patients and the results compared with a radiological gold standard.. Out of the 386 foci detected by PET/CT, 219 (56.7%) could be verified by CT or MRI. Eighty-six additional foci were detected by BS (n=46) or seen only by CT (n=9), MRI (n=23), or both CT and MRI (n=8). The total number of verified lesions was therefore 274 (58.1%), including 119 (43.4%) benign and 155 (56.6%) BM. The sensitivity, specificity, and accuracy of ¹⁸F-fluoride PET/CT were 76, 84.2, and 80%, respectively. For BS, they were 44.8, 79.2, and 60%, respectively. Sensitivity significantly decreased for the lytic lesions. The accuracy of PET/CT was significantly superior to BS for pelvic and lumbar lesions. PET/CT provided a correct diagnosis (M+/M0) in 32 of 33 patients (one false positive) compared with 28 of 33 with BS (four false positive, one false positive).. ¹⁸F-fluoride PET/CT is significantly more accurate than BS for detecting BMs from breast and prostate cancers.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Positron-Emission Tomography; Prostatic Neoplasms; Reference Standards; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Theoretically, the bisphosphonates used to treat metastatic bone disease could influence the results of nuclear bone scans which use the structurally similar technetium 99m methylene diphosphonate (99mTc MDP). A prospective clinical study was designed to explore this hypothesis.. Patients with metastatic breast cancer receiving intravenous bisphosphonate (IVBP) therapy who had > or =3 osseous lesions on nuclear bone scan were eligible. A baseline bone scan (number 1) was performed as clinically indicated and IVBP with zoledronic acid was administered within 72 hours. A second bone scan (number 2) was performed within 72 hours of zoledronic acid dosing. Both bone scans were reviewed in a blinded fashion and assessed for changes in the number and intensity of osseous lesions. Ten patients were planned to yield at least 30 lesions.. Ten patients were enrolled. One patient withdrew consent and 1 was excluded due to protocol deviation. Among the 8 patients were 163 assessable osseous lesions. The median time from bone scan number 1 to IVBP was 1 day (range, 1-2 days). The median time from IVBP to bone scan number 2 was 2 days (range, 1-3 days). The paired imaging showed no changes in the total number of bone metastases. One hundred sixty-one lesions were identical in both scans; in 1 patient there were 2 lesions that were discordant, one more intense, the other less intense.. These data do not support the hypothesis that IVBP therapy interferes with bone scan results.

Topics: Adult; Aged; Bone Density Conservation Agents; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Imidazoles; Infusions, Intravenous; Jaw Diseases; Middle Aged; Osteonecrosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Zoledronic Acid

The purpose of this study was to compare the diagnostic accuracy of whole-body MRI (WB-MRI) and bone scintigraphy (BS) for the screening of bone metastases for the first time in a large and homogeneous patient collective with breast cancer in a systematic and controlled study.. 213 breast cancer patients were evaluated for bone metastases under randomized, double-blinded and prospective conditions at two hospitals. All participants were examined by WB-MRI and BS over an average period of four days. The examinations were performed separately at two different locations. The WB-MRI protocol included T 1-TSE and STIR sequences. WB-MRI and BS were reviewed independently by experienced radiologists and nuclear medicine specialists in a consensus reading.. In 66 % of cases bone metastases were excluded by both procedures, and bone metastases were detected concordantly in 2 % of cases. In 7 % of cases there were discrepant results: in 7 cases BS was false-positive when WB-MRI was negative. In 5 / 7 cases BS was negative when WB-MRI identified bone metastases. In 89 % of cases BS was uncertain when WB-MRI was true-negative. In 17 % of cases WB-MRI showed important (non-) tumor-associated findings. The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy for WB-MRI were 90 %, 94 %, 82 %, 98 % and 99 % and for BS those were 40 %, 81 %, 36 %, 91 % and 93 %.. It could be demonstrated that WB-MRI is superior to BS for detecting bone metastases in breast cancer patients. These results should be considered for the next version of the S 3 guideline "Diagnosis, Therapy and Follow-Up of Breast Cancer".

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Breast Neoplasms, Male; Double-Blind Method; Female; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate; Whole Body Imaging

The purpose of this study was to investigate the pitfalls of using 2-[18F]-fluoro-2-deoxy-D: -glucose positron emission tomography (FDG-PET) for the evaluation of osteoblastic bone metastases in patients with breast cancer by comparing it with (99m)Tc-hydroxymethylene diphosphonate bone scintigraphy.. Among the 89 breast cancer patients (mean age 59+/-15 years) who had undergone both FDG-PET and bone scintigraphy within 1 month between September 2003 and December 2004, 55 with bone metastases were studied. The bone metastases were visually classified by multi-slice CT into four types according to their degree of osteosclerosis and osteolysis-osteoblastic, osteolytic, mixed and invisible-and compared in terms of tracer uptake on FDG-PET or bone scintigraphy and SUV(mean) on FDG-PET. Differences in the rate of detection on bone scintigraphy and FDG-PET were analysed for significance by the McNemar test.. The sensitivity, specificity and accuracy of bone scintigraphy were 78.2%, 82.4% and 79.8% respectively, and those of FDG-PET were 80.0%, 88.2% and 83.1%, respectively, revealing no significant differences. According to the CT image type, the visualisation rate of bone scintigraphy/FDG-PET was 100%/55.6% for the blastic type, 70.0%/100.0% for the lytic type, 84.2%/94.7% for the mixed type and 25.0%/87.5% for the invisible type. The visualisation rates of bone scintigraphy for the blastic type and FDG-PET for the invisible type were significantly higher. The SUV(mean) of the blastic, lytic, mixed and invisible types were 1.72+/-0.28, 4.14+/-2.20, 2.97+/-1.98 and 2.25+/-0.80, respectively, showing that the SUV(mean) tended to be higher for the lytic type than for the blastic type.. FDG-PET showed a low visualisation rate in respect of osteoblastic bone metastases. Although FDG-PET is useful for detection of bone metastases from breast cancer, it is apparent that it suffers from some limitations in depicting metastases of the osteoblastic type.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Osteoblasts; Positron-Emission Tomography; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate

Bone is one of the most common sites of metastasis in breast cancer patients. Although bone scintigraphy is widely used to detect metastatic breast cancer, the usefulness of 18FDG-PET for detecting bone metastasis has not been clearly evaluated. The purpose of this study was to compare the diagnostic accuracy of 18FDG-PET with bone scintigraphy in detecting bone metastasis in breast cancer patients.. Forty-four women aged 35 to 81 years (mean, 56 years) with breast cancer were examined in this study. Both 18FDG-PET and bone scintigraphy were performed for each patient with 0-69 day intervals (mean, 11.5 days). The results of each image interpretation were compared retrospectively. Whole-body bones were classified into 9 anatomical regions. Metastases were confirmed at 45/187 regions in 14 patients by bone biopsy or clinical follow-up including other imaging techniques for a period of at least 6 months afterwards.. On a region basis, the sensitivity, specificity, and accuracy of 18FDG-PET were 84%, 99% and 95%, respectively. Although these results were comparable to those of bone scintigraphy, the combination of 18FDG-PET and bone scintigraphy improved the sensitivity (98%) and accuracy (97%) of detection. False negative lesions of bone scintigraphy were mostly bone marrow metastases and those of 18FDG-PET were mostly osteoblastic metastases. 18FDG-PET was superior to bone scintigraphy in the detection of osteolytic lesions (92% vs. 73%), but inferior in the detection of osteoblastic lesions (74% vs. 95%).. This study shows that 18FDG-PET tends to be superior to bone scintigraphy in the detection of osteolytic lesions, but inferior in the detection of osteoblastic lesions. 18FDG-PET should play a complementary role in detecting bone metastasis with bone scintigraphy.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Middle Aged; Positron-Emission Tomography; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Whole Body Imaging

The purpose of this study was to determine the potential role of Tc depreotide scintigraphy for the evaluation of bone metastases compared with Tc methylenediphosphonate (MDP) bone scintigraphy and for the prediction of treatment response in breast cancer patients in whom first- or second-line hormonal therapy was to be initiated.. Twelve patients with a diagnosis of advanced breast cancer were included. All patients underwent both a bone scan and a depreotide scan and at least one other conventional imaging procedure, including plain film radiography (n=11), computed tomography (n=6) or magnetic resonance imaging (n=5), for confirmation of metastatic disease. The mean time interval between the bone scan and the depreotide scan was 30.6 days. Follow-up data were retrieved from routine clinical evaluation by means of physical examination, imaging and blood analysis.. On a patient basis we found a sensitivity, specificity and accuracy of, respectively 100%, 50% and 83.3% for the bone scan and 62.5%, 100% and 75% for the depreotide scan in the diagnosis of bone metastasis. In eight patients with available follow-up data two with a positive depreotide scan remained stable and five of six patients with a negative depreotide scan had progressive disease.. In this small series of breast cancer patients Tc depreotide scintigraphy proves less sensitive but more specific as compared to Tc-MDP bone scintigraphy in measuring the extent of bone metastasis. On the other hand Tc depreotide scintigraphy elucidates, non-invasively, tumour characteristics and may be indicative for prognosis and response to hormonal treatment.

Topics: Adult; Aged; Antineoplastic Agents, Hormonal; Bone Neoplasms; Breast Neoplasms; Female; Hormones; Humans; Male; Middle Aged; Organotechnetium Compounds; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Somatostatin; Technetium Tc 99m Medronate; Treatment Outcome

At present, bone metastases are usually assessed using conventional technetium-99m methylene diphosphonate whole-body bone scan, which has a high sensitivity but a poor specificity. However, positron emission tomography with (18)F-2-deoxyglucose (FDG-PET) can offer superior spatial resolution and improved specificity. We attempted to evaluate the usefulness of FDG-PET for detecting bone metastases in breast cancer and to compare FDG-PET results with bone scan findings.. The study group comprised 48 patients with biopsy-proven breast cancer and suspected of having bone metastases who underwent bone scan and FDG-PET to detect the bone metastases. The final diagnosis of bone metastases was established by operative, histopathological findings or during a clinical follow-up longer than 1 year by additional radiographs or following FDG-PET/bone scan findings showing progressive widespread bone lesions.. A total of 127 bone lesions including 105 metastatic and 22 benign bone lesions found by either FDG-PET or bone scan were evaluated. Using FDG-PET, 100 metastatic and 20 benign bone lesions were accurately diagnosed, and using bone scan 98 metastatic and 2 benign bone lesions were accurately diagnosed. The diagnostic sensitivity and accuracy of FDG-PET were 95.2% and 94.5%, and of bone scan were 93.3% and 78.7%, respectively.. Our findings suggest that FDG-PET shows a similar sensitivity and a better accuracy than bone scan for detecting bone metastases in patients with breast cancer.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Technetium Tc 99m Medronate

Different radiopharmaceuticals have been used to detect breast cancer. Among them, sestamibi has been extensively studied and has come to have a well-recognized role in the evaluation of palpable breast lesions. The goal of this study was to compare the diagnostic value of 99mTc-labeled compounds, such as methylene diphosphonate (MDP) and pentavalent dimercaptosuccinic acid (DMSA-V), with sestamibi for palpable breast lesions, in the scope of a multicenter trial sponsored by the International Atomic Energy Agency.. Patients from 7 countries were included: 47 women (mean age, 54 +/- 13 y) examined with MDP and sestamibi and 111 women (mean age, 55 +/- 12 y) examined with DMSA-V and sestamibi. Cancer was diagnosed in 41 of 49 lesions from the MDP group and in 78 of 113 lesions from the DMSA-V group. Axillary lymph node involvement was observed in 18 of 30 patients from the first group and in 27 of 53 patients from the second group. Prone scintimammography was performed using a dose of 740 MBq of each tracer, and diagnostic values were calculated from a masked interpretation of scans.. In the first group, the sensitivity for sestamibi and MDP studies was 82.9% and 65.9%, respectively, with a specificity of 87.5% and 50%, respectively. In the second group, the sensitivity for sestamibi and DMSA-V studies was 87.2% and 65.4%, respectively, with a specificity of 77.1% and 74.3%, respectively. Regarding axillary involvement, the sensitivity was 33.3% for sestamibi in both groups, whereas the values for MDP and DMSA-V were 16.7% and 7.4%, respectively. In contrast, the specificity for sestamibi was 83.3% and 92.3% for the first and second groups, respectively, and the specificity for MDP and DMSA-V was 91.7% and 100%, respectively.. Sestamibi is the most adequate alternative among the mentioned 99mTc-labeled radiopharmaceuticals for the evaluation of palpable breast lesions.

Topics: Axilla; Breast Neoplasms; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

The purpose of the present study was to compare scintimammography using technetium-99m hexakis 2-methoxyisobutylisonitrile (MIBI) with that using 99mTc-hydroxymethylene diphosphonate (HMDP) in the detection of breast cancer and its axillary lesions. The study population comprised 50 consecutive females with breast cancer who were scheduled for surgery. All patients underwent scintimammography with 99mTc-MIBI and 99mTc-HMDP. The images were acquired 5 min (early) and 2 h (delayed) after injection of each radiopharmaceutical. Regions of interest were placed over the breast tumour (T), the axillary lesion (A) and the normal ipsilateral breast tissue (N). The two count ratios were calculated, i.e. the tumour to normal breast tissue ratio (T/N) and the axillary lymph node to normal breast tissue ratio (A/N). For the breast tumours, using 99mTc-MIBI the positive rate was 86% (43/50) for the early and 72% (36/50) for the delayed images. The corresponding values using 99mTc-HMDP were 72% (36/50) and 40% (20/50), respectively. Histopathological examination revealed metastatic lymph node involvement in 22 patients. For the axillary lesions, using 99mTc-MIBI the positive rate was 72.7% (16/22) for the early and 54.5% (12/22) for the delayed images. Using 99mTc-HMDP, the positive rate was only 18.2% (4/22) for the early and 4.5% (1/22) for the delayed images. Using 99mTc-MIBI, the mean T/N (+/- SD) ratios on early and delayed images were 2.69 +/- 1.64 and 2.03 +/- 1.16, respectively, and the mean A/N (+/- SD) ratios on early and delayed images were 2.20 +/- 1.23 and 1.80 +/- 1.20, respectively. The corresponding values using 99mTc-HMDP were 1.77 +/- 0.91, 1.42 +/- 0.72, 1.27 +/- 0.63 and 1.08 +/- 0.25, respectively. The T/N and A/N ratios on the early and delayed 99mTc-MIBI images were both significantly higher than those obtained using 99mTc-HMDP. 99mTc-MIBI scintimammography is more sensitive than 99mTc-HMDP scintimammography for the detection of breast cancer and its axillary lymph node metastases.

Topics: Adult; Aged; Axilla; Breast Neoplasms; Female; Humans; Lymphatic Metastasis; Mammography; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

To calculate radiation doses of rhenium-186 ((186)Re) etidronate in painful bone metastases using quantitative bone single-photon emission computed tomography (SPECT) and to determine the threshold dose for predicting pain relief. We also wanted to determine whether technetium-99m ((99m)Tc) methylene diphosphonate (MDP) concentrations predict radiation doses of (186)Re etidronate in painful lesions.. Forty-eight patients with breast and prostate cancer were evaluated. Patients received therapeutic doses of (186)Re etidronate. The area under the pain over time curve (AUPC) was measured for 8 weeks after treatment. Response was calculated as the percentage of change in AUPC. Quantitative bone SPECT (QBS)-measured concentration of (186)Re etidronate was used for calculating radiation doses. Receiver operating characteristics curve analysis determined the radiation dose threshold that best separated responders from nonresponders. SPECT-measured concentration of (186)Re etidronate in the urinary bladder was correlated with its concentration in the voided urine. Concentration of (99m)Tc MDP was compared with radiation doses to painful metastases.. The radiation dose threshold was 2.10 Gy. For a decrease of 50% in the AUPC, the positive predictive value (PPV) of this value was 75% and the negative predictive value (NPV) was 88%. For a decrease in pain of 33%, the PPV was 84% and the NPV was 81%. In prostate cancer patients only, the PPV was 81% and the NPV was 92%. The correlation between in vivo/in vitro measured urine concentration was 0.90. The correlation between (99m)Tc MDP concentration and radiation doses of (186)Re etidronate was 0.92.. QBS-measured radiation doses of (186)Re etidronate in painful metastases are a good predictor of pain relief. Bone SPECT using (99m)Tc MDP predicts radiation doses delivered by (186)Re etidronate.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Dose-Response Relationship, Radiation; Etidronic Acid; Female; Humans; Male; Middle Aged; Organometallic Compounds; Pain; Pain Measurement; Palliative Care; Prostatic Neoplasms; Radiopharmaceuticals; Radiotherapy Dosage; ROC Curve; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Accumulation of 99mTc-HMDP was recognized by three-phase bone scintigraphy in a case of primary breast cancer. A 67-year-old female was found to have a 14 x 13 mm mass in the upper lateral area of the left breast. At operation the histopathological finding was a proven solid-tubular carcinoma. On the first phase images, there was no abnormal accumulation in the tumor. On the second phase images, there was abnormal accumulation in the tumor, however, abnormal accumulation was observed followed by a decrease in accumulation. The third phase image showed no abnormal extra-skeletal accumulation. Color Doppler ultrasound sonography showed an abundance of color signals within the breast tumor. Increased 99mTc-HMDP accumulation in the second phase image might reflect tumor hypervascularization. It is concluded that three-phase bone scintigraphy using 99mTc-HMDP has the ability of positive description in primary breast cancer.

Topics: Adenocarcinoma; Aged; Bone and Bones; Breast Neoplasms; Female; Humans; Radionuclide Imaging; Technetium Tc 99m Medronate; Ultrasonography

Our goal was to determine if a healing flare response seen on bone scintigraphy occurs following chemotherapy with Taxol (paclitaxel; Bristol-Myers Squibb Co., Princeton, NJ), a novel antimicrotubule agent for metastatic breast cancer.. We performed 74 bone scans on 21 females with breast cancer and bone metastases entering a Phase II trial of Taxol chemotherapy with granulocyte colony stimulating factor (G-CSF). All patients had baseline scans within 6 wk prior to therapy, after the second cycle (4-6 wk) of Taxol, and then after 6-12 mo. All bone scans were reviewed by two nuclear medicine physicians, without knowledge of the patients' clinical history. Skeletal radiographs, CT and MRI scans, as well as clinical history were compared with scan findings.. Seven of the 21 patients showed improvement in bone scan findings. Of these seven, three had a flare response following two cycles (4-6 wk) of Taxol, characterized by increased activity in baseline lesions and the appearance of new lesions, followed by improvement on follow-up scans. Evidence of clinical response (> or = 50% reduction in tumor mass) was seen in all of these patients. Seven patients showed no change in baseline findings on follow-up bone scans. Seven patients had post-Taxol scans showing new lesions, with no overall improvement on later follow-up.. Flare on bone scintigraphy may be seen shortly after commencing Taxol chemotherapy. Bone scans done within the first 3 mo must be interpreted with caution and should be correlated with clinical and radiological findings to avoid inappropriate discontinuation of Taxol chemotherapy.

Topics: Adenocarcinoma; Bone Neoplasms; Breast Neoplasms; Female; Follow-Up Studies; Granulocyte Colony-Stimulating Factor; Humans; Middle Aged; Paclitaxel; Radionuclide Imaging; Recombinant Proteins; Technetium Tc 99m Medronate; Time Factors

From 1977 to 1987, 7,604 out of a total of 20,483 Danish breast cancer patients had a bone scintigraphy in order to exclude or localise osseous metastases. The scintigrams were performed and interpreted at 14 local hospitals. In 1979, standardised guidelines for interpretation were agreed upon. Until 1983, the scintigrams were described centrally, based on the local reports. From 1979, the frequency of positive bone scintigrams suggesting bone metastases stabilised at about 5% of the patients compared with 12 and 20% in 1977-78. The local take-over of description did not change the frequency. The frequency was also stable from 1979 when evaluated in age groups. With increasing age the frequency of positive scintigrams increased. The frequency of positive scintigrams was significantly lower in patients entering a protocol than in those not entering a protocol. The conclusion is that on a nation-wide basis it is possible to establish a stable, uniform interpretation of bone scintigrams after a two-year introduction period.

Topics: Adult; Age Factors; Aged; Bone Neoplasms; Breast Neoplasms; Diagnosis, Differential; Diphosphates; Female; Humans; Intraoperative Period; Middle Aged; Multicenter Studies as Topic; Polyphosphates; Radionuclide Imaging; Technetium; Technetium Compounds; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Time Factors

Topics: Breast Neoplasms; Humans; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Sodium Fluoride; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

A 99mTc-methylene diphosphate (MDP) bone scintigraphy scan was performed to follow up metastatic breast cancer. A circular region of radiotracer uptake in the location of the patient's left breast implant was seen. Review of the same-day chest CT and the prior CT showed that the patient's breast implant had ruptured in the interim. The 99mTc-MDP uptake in the capsule of the breast implant was attributed to rupture, likely secondary to inflammation. This is an example of an unusual presentation of breast implant rupture discovered on a 99mTc-MDP bone scintigraphy scan.

Topics: Bone Neoplasms; Breast Implants; Breast Neoplasms; Female; Humans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Aged; Bone and Bones; Breast Neoplasms; Female; Humans; Hypercalcemia; Neoplasm Metastasis; Paraneoplastic Syndromes; Parathyroid Hormone-Related Protein; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

A 65-year-old woman with known breast cancer presented with lower back pain over 1 month. Multiple sclerotic foci of increased tracer uptake in the bones were noted on the Tc-MDP bone scintigraphy and SPECT/CT images, suggesting osteoblastic metastasis. Unexpectedly, symmetric Tc-MDP activity was visualized in the soft tissue near the umbilical area, corresponding to the sites of insulin injection.

Topics: Abdomen; Aged; Biological Transport; Breast Neoplasms; Female; Humans; Injections; Insulins; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate

A 61-year-old woman diagnosed with left breast cancer underwent a bone scan for the evaluation of possible bone metastases. Multiple foci of elevated activity were noticed in the spine and pelvis. In addition, a focus of intense activity was observed in the right lung on the SPECT/CT images without corresponding anatomic abnormality.

Topics: Biological Transport; Bone Neoplasms; Breast Neoplasms; Female; Humans; Lung; Middle Aged; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate

The aim of this study was to compare the diagnostic precision of bone scintigraphy with BONENAVI version 1 and BONENAVI version 2 in bone metastasis of primary breast cancer.. The subjects were 56 consecutive patients (all women, mean age 59 ± 12.7 years) who underwent bone scintigraphy with Tc-MDP and were diagnosed with bone metastasis of primary breast cancer from January 2012 to November 2014. Bone scintigraphy was performed with BONENAVI version 1 and BONENAVI version 2 to calculate artificial neural network (ANN), bone scan index (BSI), and hot-spot values, with ANN ≥ 0.5 considered to reflect bone metastasis for the calculation of sensitivity. Mean ANN, BSI, hot-spot values, and sensitivity were compared between BONENAVI version 1 and BONENAVI version 2, with P < 0.05 considered a significant difference.. With BONENAVI version 1, mean ANN was 0.73 ± 0.29, BSI was 1.47 ± 1.85, the hot-spot value was 12.4 ± 12.5, and sensitivity was 76.8% (43/56). With BONENAVI version 2, the mean ANN was 0.86 ± 0.19, BSI was 1.53 ± 2.09, hot-spot value was 12.9 ± 15.6, and sensitivity was 94.6% (53/56). BONENAVI version 2 yielded significantly better ANN and sensitivity than BONENAVI version 1 (both P < 0.01).. BONENAVI version 2 has improved sensitivity for detecting bone metastasis of primary breast cancer compared to BONENAVI version 1.

Topics: Bone Neoplasms; Breast Neoplasms; Diagnosis, Computer-Assisted; Female; Humans; Image Processing, Computer-Assisted; Middle Aged; Sensitivity and Specificity; Technetium Tc 99m Medronate

Metastatic calcification relates to abnormal calcification resulting from hypercalcaemia in otherwise normal tissues. Hypercalcaemia can occur secondary to chronic renal failure, hyperparathyroidism, hypervitaminosis D, and metastatic neoplasms. Specific symptoms are often lacking, but calcification may be a marker of disease severity and its chronicity. We present cases with different patterns of soft tissue calcification on Tc99m MDP bone scan.

Topics: Aged; Bone Neoplasms; Breast Neoplasms; Calcinosis; Carcinoma; Female; Humans; Hypercalcemia; Kidney Failure, Chronic; Lung; Male; Middle Aged; Neoplasm Metastasis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thoracic Wall

Ovarian thecoma is a benign and rare neoplasm that accounts for 0.5% to 1% of all ovarian tumors. A 55-year-old woman with known breast cancer underwent a metastatic workup before surgery. The Tc-MDP whole-body bone scan revealed intense uptake in the left pelvic region. Hybrid SPECT/CT imaging showed that the elevated Tc-MDP activity was in a tumor with calcification in the left adnexa. Dynamic enhanced MRI revealed marked enhancement of the tumor. Resection of the tumor was subsequently performed, and pathologic analysis confirmed the diagnosis of an ovarian thecoma.

Topics: Breast Neoplasms; Female; Humans; Incidental Findings; Middle Aged; Ovarian Neoplasms; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate; Thecoma; Whole Body Imaging

Collagen injection has been used as dermal filler in plastic and cosmetic surgery. A technetium Tc methylene diphosphonate bone scintigraphy was performed in a 47-year-old woman as part of the breast cancer evaluation. The images showed intense methylene diphosphonate activity on both sides of the frontal head, where she received collagen injection 1 year prior. The activity was visualized again in all 3 follow-up bone scans over the subsequent 3 years.

Topics: Artifacts; Bone and Bones; Breast Neoplasms; Collagen; Dermal Fillers; Female; Humans; Injections, Subcutaneous; Middle Aged; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed

A 27-year-old woman, who has received a hydroxyapatite orbital implant in the right eye due to a trauma 6 years ago, was newly diagnosis with left breast invasive ductal carcinoma. Tc-MDP bone scan showed an increased radiotracer accumulation in the right orbit and SPECT/CT confirmed the focal accumulation at the site of the implant, without any sign of local malignant lesions or orbital infection. Radionuclide imaging could provide certain useful information in diagnosing or differential diagnosing orbital disease.

Topics: Adult; Breast Neoplasms; Carcinoma, Ductal; Diagnosis, Differential; Female; Humans; Orbital Implants; Orbital Neoplasms; Radiopharmaceuticals; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate

Despite increasing reliance on CT, MRI, and FDG PET/CT for oncological imaging, whole-body skeletal scintigraphy remains a frontline modality for staging and surveillance of osseous metastatic disease. We present a 54-year-old woman with metastatic breast cancer who received palliative external-beam radiation to the left ilium. Serial follow-up Tc-MDP bone scans demonstrated progressive soft-tissue uptake in her left lower extremity, extending from thigh to leg, with associated enlargement and skin thickening, consistent with lymphedema related to radiation-induced fibrosis. Correlative abdominopelvic CT scans confirmed fibrotic changes in the left thigh.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Fibrosis; Fluorodeoxyglucose F18; Humans; Lymphedema; Magnetic Resonance Imaging; Middle Aged; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Radiotherapy; Technetium Tc 99m Medronate

We evaluated the association between intestinal visualization on bone scintigraphy and IV CT contrast in patients with breast cancer.. 452 patients with breast cancer underwent a 99mTc methylene diphosphonate (MDP) bone scan for surveillance of bone metastasis. Presence, site and intensity of intestinal uptake were visually assessed. For patients with intestinal visualization, medical records were reviewed to identify the alleged potential causes. When IV CT contrast was administrated on the same day as bone scan, the time between IV CT contrast injection, 99mTc MDP administration and bone scan was assessed.. Intestinal 99mTc MDP uptake was observed in 44 of the 452 patients (9.7%). Bone scans showed no thyroid or gastric uptake that suggested free pertechnetate. There were no patients with documented causes of intestinal uptake except for one patient with vesicoenteric fistula. Of the 452 patients, 149 (33.0%) underwent IV contrast-enhanced CT on the same day as bone scan. Forty of the 44 patients (90.9%) with intestinal uptake on bone scan underwent IV contrast-enhanced CT on the same day, whereas 109 of 408 (26.7%) patients without intestinal uptake on bone scintigraphy underwent IV contrast-enhanced CT on the same day (p < 0.001). The patients who underwent IV contrast injection between Tc-99m MDP administration and acquisition of bone scans had significantly more frequent intestinal uptake than patients who underwent IV contrast injection either before 99mTc MDP administration or after bone scanning (42.4% vs. 1.8%, p < 0.001).. IV CT contrast injection administered on the same day as bone scintigraphy is significantly associated with 99mTc MDP uptake in the intestines among patients with breast cancer.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Incidental Findings; Injections, Intravenous; Iodine; Male; Middle Aged; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tissue Distribution; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

A 64-year-old woman with a newly diagnosed left breast cancer underwent a presurgical Tc-MDP whole-body imaging, which showed 1 intense activity in the midline upper abdomen and another overlapping the upper thoracic spine. An F-NaF PET/CT scan performed a day later also revealed the elevated activity in the same regions. The activity corresponded to calcified subcutaneous implants, which were placed there more than 30 years ago.

Topics: Breast Implants; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Middle Aged; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Sodium Fluoride; Technetium Tc 99m Medronate

The superiority of sodium F-fluoride PET (F-PET)/computed tomography (CT) over planar and single field-of-view single-photon emission computed tomography (SPECT) bone scintigraphy with Tc-methylene diphosphonate in bone metastases detection has been established. The present study prospectively compares whole-body Tc-methylene diphosphonate SPECT (WB-SPECT) and F-PET performance indices for the detection of bone metastases in breast cancer.. A total of 41 pairs of studies in female breast cancer patients (average age 58 years, range 30-75) were included. Half-time WB-SPECT and F-PET/CT were performed at a 4-day average interval (range 0-36 days), with subsequent fusion of CT to WB-SPECT. Two readers independently interpreted the studies, with differences resolved by consensus. Composite gold standard included the CT component of the F-PET/CT study with follow-up CT, MRI, F-fluoro-deoxyglucose-PET/CT, and bone scans.. On patient-based analysis, metastases were diagnosed in 21 patients, with 19 patients detected by WB-SPECT and 21 with F-PET, the latter being the only modality to detect a single metastasis in two patients. The sensitivity of WB-SPECT and F-PET was 90 and 100% (P=NS), and the specificity were 95 and 85%, respectively (P=NS). On lesion-based analysis, 284 total sites of increased uptake were found. WB-SPECT detected 171/284 (60%) and F-PET 268/284 (94%) lesions, with good interobserver agreement for WB-SPECT (κ=0.679) and excellent agreement for F-PET (κ=0.798). The final analysis classified 204 lesions as benign and 80 as metastases. WB-SPECT identified 121 benign and 50 malignant sites compared with 192 and 76, respectively, for F-PET. WB-SPECT and F-PET had a sensitivity of 63 vs. 95%, P-value of less than 0.001, and a specificity of 97 vs. 96% (P=NS), respectively, on lesion-based analysis.. F-PET had higher sensitivity for the diagnosis of bone metastases from breast cancer compared with WB-SPECT, showing a statistically significant 32% increase on lesion-based analysis.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Female; Fluorine Radioisotopes; Humans; Middle Aged; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prospective Studies; Radiopharmaceuticals; Sodium Fluoride; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

A 49-year-old woman with history of breast cancer presented with pain at the level of the left anterior proximal tibia. An x-ray of the tibia demonstrated a lytic cortical lesion that prompted a whole-body 99mTc-MDP bone scan. The bone scan revealed intense bone remodeling at the level of the tibial lytic lesion and in the cervical spine. CT demonstrated an expansile lesion eroding the vertebral bodies of C6 and C7 with a large soft tissue component. A biopsy of the cervical spine mass demonstrated features diagnostic of Rosai-Dorfman disease without evidence of neoplastic cells.

Topics: Breast Neoplasms; Female; Histiocytosis, Sinus; Humans; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Radiopharmaceuticals; Spine; Technetium Tc 99m Medronate; Tibia; Tomography, X-Ray Computed; Whole Body Imaging

In previous work, we demonstrated the presence of hydroxyapetite (type II microcalcification), HAP, in triple negative MDA-MB-231 breast cancer cells. We used (18)F-NaF to detect these types of cancers in mouse models as the free fluorine, (18)F(-), binds to HAP similar to bone uptake. In this work, we investigate other bone targeting agents and techniques including (99m)Tc-MDP SPECT and Osteosense 750EX FMT imaging as alternatives for breast cancer diagnosis via targeting HAP within the tumor microenvironment.. Thirteen mice were injected subcutaneously in the right flank with 10(6) MDA-MB-231 cells. When the tumor size reached ~0.6 cm(3), mice (n=9) were injected with ~37 MBq of (99m)Tc-MDP intravenously and then imaged one hour later in a NanoSPECT/CT or injected intravenously with 4 nmol/g of Osetosense 750EX and imaged 24 hours later in an FMT (n=4). The imaging probe concentration in the tumor was compared to that of muscle. Following SPECT imaging, the tumors were harvested, sectioned into 10 μm slices, and underwent autoradiography or von Kossa staining to correlate (99m)Tc-MDP binding with HAP distribution within the tumor. The SPECT images were normalized to the injected dose and regions-of-interest (ROIs) were drawn around bone, tumor, and muscle to obtain the radiotracer concentration in these regions in units of percent injected dose per unit volume. ROIs were drawn around bone and tumor in the FMT images as no FMT signal was observed in normal muscle.. Uptake of (99m)Tc-MDP was observed in the bone and tumor with little or no uptake in the muscle with concentrations of 11.34±1.46 (mean±SD), 2.22±0.95, and 0.05±0.04%ID/cc, respectively. Uptake of Osteosense 750EX was also observed in the bone and tumor with concentrations of 0.35±0.07 (mean±SD) and 0.04±0.01picomoles, respectively. No FMT signal was observed in the normal muscle. There was no significant difference in the bone-to-tumor ratio between the two modalities (5.1±2.3 for SPECT and 8.8±2.2 for FMT) indicating that there is little difference in tumor uptake between these two agents.. This study provides evidence of the accessibility of HAP within the breast tumor microenvironment as an in vivo imaging target for bone-seeking agents. SPECT imaging using (99m)Tc-MDP can be rapidly translated to the clinic. FMT imaging using Osteosense 750EX is not currently approved for clinical use and is limited to animal research.

Topics: Animals; Bone and Bones; Breast Neoplasms; Calcinosis; Cell Line, Tumor; Humans; Mice; Optical Imaging; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

In this report, we present a case of liver uptake seen on a bone scan that was due to diffuse metastatic disease from breast carcinoma. We discuss possible etiologies for the uptake and offer an algorithm to narrow the differential diagnosis.

Topics: Algorithms; Biological Transport; Bone and Bones; Breast Neoplasms; Female; Humans; Liver; Middle Aged; Neoplasm Metastasis; Radionuclide Imaging; Technetium Tc 99m Medronate

Fluorine-18 deoxyglucose positron emission tomography computed tomography (18F-FDG-PET/ CT) and bone scintigraphy (BS) are widely used for the detection of bone involvement. The optimal imaging modality for the detection of bone metastases in hormone receptor positive (+) and negative (-) groups of breast cancer remains ambiguous.. Sixty-two patients with breast cancer, who had undergone both 18F-FDG-PET/CT and BS, being eventually diagnosed as having bone metastases, were enrolled in this study.. 18F-FDG-PET/CT had higher sensitivity and specificity than BS. Our data showed that 18F-FDG- PET/CT had a sensitivity of 93.4% and a specificity of 99.4%, whiel for BS they were 84.5%, and 89.6% in the diagnosis of bone metastases. κ statistics were calculated for 18F-FDGPET/CT and BS. The κ-value was 0.65 between 18F-FDG-PET/CT and BS in all patients. On the other hand, the κ-values were 0.70 in the hormone receptor (+) group, and 0.51 in hormone receptor (-) group. The κ-values suggested excellent agreement between all patient and hormone receptor (+) groups, while the κ-values suggested good agreement in the hormone receptor (-) group.. The sensitivity and specificity for 18F-FDG-PET/CT were higher than BS in the screening of metastatic bone lesions in all patients. Similarly 18F-FDG-PET/CT had higher sensitivity and specificity in hormone receptor (+) and (-) groups.

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Positron-Emission Tomography; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Bone scan abnormalities, especially rib lesions, are often confusing for physicians due to a high number of false-positive lesions. This study investigated risk factors that are associated with bone metastasis in 613 breast cancer patients with bone scan abnormalities. Significantly increased rates of bone metastasis were observed in patients with multiple lesions, large tumor sizes, and lymph node involvement. In addition, patients with concurrent lesions of rib and other sites exhibited a significant higher rate of metastatic disease compared to those with other site lesions (P = 0.009). In the subset of 324 patients with rib abnormalities, the rate of metastasis was extremely low in patients with pure rib lesions (1.2%; 95% CI: 0.1%-4.1%). Concurrent lesions of rib and other sites were more likely to be rib metastasis compared to pure rib lesions (P < 0.001). Moreover, multiple rib lesions and lesions located on bilateral ribs were more likely to be rib metastasis (P < 0.001). Our data suggest that patients with pure rib abnormalities could be recommended for follow-up only. However, if concurrent lesions of rib and other sites were detected on bone scans, additional radiological examinations should be performed to patients.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; China; Comorbidity; Female; Humans; Incidence; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Radiopharmaceuticals; Reproducibility of Results; Ribs; Risk Assessment; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

We prospectively evaluated the use of combined (18)F-NaF/(18)F-FDG PET/CT in patients with breast and prostate cancer and compared the results with those for (99m)Tc-MDP bone scintigraphy and whole-body MRI.. Thirty patients (15 women with breast cancer and 15 men with prostate cancer) referred for standard-of-care bone scintigraphy were prospectively enrolled in this study. (18)F-NaF/(18)F-FDG PET/CT and whole-body MRI were performed after bone scintigraphy. The whole-body MRI protocol consisted of both unenhanced and contrast-enhanced sequences. Lesions detected with each test were tabulated, and the results were compared.. For extraskeletal lesions, (18)F-NaF/(18)F-FDG PET/CT and whole-body MRI had no statistically significant differences in sensitivity (92.9% vs. 92.9%, P = 1.00), positive predictive value (81.3% vs. 86.7%, P = 0.68), or accuracy (76.5% vs. 82.4%, P = 0.56). However, (18)F-NaF/(18)F-FDG PET/CT showed significantly higher sensitivity and accuracy than whole-body MRI (96.2% vs. 81.4%, P < 0.001, 89.8% vs. 74.7%, P = 0.01) and bone scintigraphy (96.2% vs. 64.6%, P < 0.001, 89.8% vs. 65.9%, P < 0.001) for the detection of skeletal lesions. Overall, (18)F-NaF/(18)F-FDG PET/CT showed higher sensitivity and accuracy than whole-body MRI (95.7% vs. 83.3%, P < 0.002, 87.6% vs. 76.0%, P < 0.02) but not statistically significantly so when compared with a combination of whole-body MRI and bone scintigraphy (95.7% vs. 91.6%, P = 0.17, 87.6% vs. 83.0%, P = 0.53). (18)F-NaF/(18)F-FDG PET/CT showed no significant difference from a combination of (18)F-NaF/(18)F-FDG PET/CT and whole-body MRI. No statistically significant differences in positive predictive value were noted among the 3 examinations.. (18)F-NaF/(18)F-FDG PET/CT is superior to whole-body MRI and (99m)Tc-MDP scintigraphy for evaluation of skeletal disease extent. Further, (18)F-NaF/(18)F-FDG PET/CT and whole-body MRI detected extraskeletal disease that may change the management of these patients. (18)F-NaF/(18)F-FDG PET/CT provides diagnostic ability similar to that of a combination of whole-body MRI and bone scintigraphy in patients with breast and prostate cancer. Larger cohorts are needed to confirm these preliminary findings, ideally using the newly introduced simultaneous PET/MRI scanners.

Topics: Adult; Aged; Bone and Bones; Breast Neoplasms; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Predictive Value of Tests; Prospective Studies; Prostatic Neoplasms; Radiopharmaceuticals; Sodium Fluoride; Technetium Tc 99m Medronate; Whole Body Imaging

Metastatic breast cancer often metastasizes to bone. The purposes of the study were (1) to evaluate the use of (99m)Tc-MDP bone scintigraphy for detection of metastatic bone lesions, and (2) to determine the efficacy of zoledronic acid in mice with breast cancer bone metastasis. All tumor-bearing mice were analyzed with radionuclide bone scintigraphy, X-ray, and histological analysis. The metastatic bone tissue was also harvested and analyzed by western blotting and real-time qPCR. Interestingly, zoledronic acid significantly decreased both the tumor burden and the incidence of bone metastasis in mice. In addition, histomorphometric, stereological, and molecular biology analyses demonstrated that zoledronic acid may function to inhibit breast cancer cell growth in the bone microenvironment and regulate the function of osteoblasts and osteoclasts in tumor-bearing mice. Finally, the attenuation of breast cancer bone metastasis using zoledronic acid can be accurately characterized by (99m)Tc bone scintigraphy in mice.

Topics: Animals; Biomarkers, Tumor; Blotting, Western; Bone Density Conservation Agents; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Imidazoles; Mice; Mice, Inbred BALB C; Mice, Nude; Radionuclide Imaging; Radiopharmaceuticals; Real-Time Polymerase Chain Reaction; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Technetium Tc 99m Medronate; Tumor Cells, Cultured; Xenograft Model Antitumor Assays; Zoledronic Acid

The aim of this study was to compare bone scintigraphy (BS) and positron emission tomography/computed tomography (PET/CT) for the detection of bone metastases from breast cancer.. Twenty patients with breast cancer and bone pain were submitted to both bone scintigraphy and 18-F-fluorodeoxyglucose PET/CT imaging between July 2012 and June 2013. Scintigraphy was performed following an intravenous injection of technetium-99m-methylene diphosphonate (99mTc-MDP) around 10 days before the PET/CT scan, performed using an intravenous injection of 18-F-fluorodeoxyglucose followed by whole-body computed tomography (CT) to characterize metastases by both methods. Student's t-test for paired samples was used in the comparative data analysis, with significance at p<0.05.. CT identified 429 metastatic implants in the 20 patients, with scintigraphy showing 244 of these lesions (57%) and PET/CT showing 307 (72%); however, there was no statistically significant difference between the mean number of lesions detected per patient with the two imaging modalities (p=0.367).. In the present study, no difference was found between PET/CT and bone scintigraphy in the detection of bone metastases from breast cancer.

Topics: Bone Neoplasms; Breast Neoplasms; Carcinoma; Female; Fluorodeoxyglucose F18; Humans; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

By analyzing bone scans we aimed to determine whether the assessment of the central skeleton is sufficient for osseous staging in breast cancer patients. This might be of interest for future staging modalities, especially positron emission tomography/computed tomography, usually sparing the peripheral extremities, as well as the skull.. In this retrospective study, a total of 837 bone scans for initial staging or restaging of breast cancer were included. A total of 291 bone scans in 172 patients were positive for bone metastases. The localization and distribution of the metastases were re-evaluated by two readers in consensus. The extent of the central skeleton involvement was correlated to the incidence of peripheral metastases.. In all 172 patients bone metastases were seen in the central skeleton (including the proximal third of humerus and femur). In 34 patients (19.8 %) peripheral metastases of the extremities (distally of the proximal third of humerus and femur) could be detected. Sixty-four patients (37.2 %) showed metastases of the skull. Summarizing the metastases of the distal extremities and skull, 79 patients (45.9 %) had peripheral metastases. None of the patients showed peripheral metastases without any affliction of the central skeleton. The incidence of peripheral metastases significantly correlated with the extent of central skeleton involvement (p<0.001).. Regarding bone scans, an isolated metastatic spread to the peripheral skeleton without any manifestation in the central skeleton seems to be the exception. Thus, the assessment of the central skeleton should be sufficient in osseous breast cancer staging and restaging. However, in case of central metastases, additional imaging of the periphery should be considered for staging and restaging.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Comorbidity; Female; Germany; Humans; Middle Aged; Neoplasm Staging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Risk Assessment; Risk Factors; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

We aimed to compare the role of (18)F-fluoride PET/CT, FDG PET/CT and (99m)Tc-MDP bone scans in the detection of bone metastases in patients with lung, breast and prostate carcinoma.. This was a prospective study including patients for staging (S) and restaging (R). Seventy-two patients (23S, 49R) with infiltrating ductal breast carcinoma, 49 patients (25S, 24R) with prostate adenocarcinoma and 30 patients (17S, 13R) with non-small-cell lung carcinoma (NSCLC), without known bone metastases but with high risk/clinical suspicion for the same, underwent a (99m)Tc-MDP bone scan, FDG PET/CT and (18)F-fluoride PET/CT within 2 weeks. All scans were reviewed by two experienced nuclear medicine physicians, and the findings were correlated with MRI/thin-slice CT/skeletal survey. Histological verification was done wherever feasible.. Sensitivity and negative predictive value (NPV) of (18)F-fluoride PET/CT was 100 % in all three malignancies, while that of FDG PET/CT was 79 % and 73 % in NSCLC, 73 % and 80 % in breast cancer and 72 and 65 % in prostate cancer. Specificity and positive predictive value (PPV) of FDG PET/CT were 100 % in NSCLC and prostate and 97 % and 96 % in breast cancer. As compared to the (99m)Tc-MDP bone scan, all parameters were superior for (18)F-fluoride PET/CT in prostate and breast cancer, but sensitivity and NPV were equal in NSCLC. The MDP bone scan had superior sensitivity and NPV compared to FDG PET/CT but had low specificity and PPV.. To rule out bone metastases in cases where there is a high index of suspicion, (18)F-fluoride PET/CT is the most reliable investigation. (18)F-fluoride PET/CT has the potential to replace the (99m)Tc-MDP bone scan for the detection of bone metastases.

Topics: Adult; Aged; Brain Neoplasms; Breast Neoplasms; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

To evaluate the incremental value of single-photon emission computed tomography-computed tomography (SPECT-CT) over planar scintigraphy and SPECT alone for equivocal bone scintigraphy lesions in patients with breast cancer and to assess its impact on patient management.. A total of 102 patients with 115 equivocal lesions on planar scintigraphy underwent SPECT and SPECT-CT of selected volume. Images were evaluated in separate sessions to minimize recall bias. A scoring scale of 1-5 was used, where 1 is definitely metastatic, 2 is probably metastatic, 3 is indeterminate, 4 is probably benign, and 5 is definitely benign. With receiver operating characteristic analysis, area under the curves was constructed for each modality. Clinical/imaging follow-up and/or histopathology were taken as the reference standard.. There were 52 indeterminate lesions on planar scintigraphy, 15 on SPECT, and three on SPECT-CT. Area under the curve for SPECT-CT was significantly larger compared with planar scintigraphy (P<0.001) and SPECT (P=0.033). This improvement was mostly for lytic lesions (P<0.0001). In patients (n=67) in whom the lesions under evaluation were the only lesions and hence whose management was decided, SPECT-CT was superior to SPECT (P=0.045) and planar scintigraphy (P <0.001).. SPECT-CT is better than planar scintigraphy and SPECT alone for characterizing equivocal bone scintigraphy lesions in patients with breast cancer and can have a significant impact on patient management.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Middle Aged; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Whole Body Imaging

Topics: Biological Transport; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Liver Neoplasms; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A patient with a history of breast cancer underwent 3-phase (99m)Tc-methylene diphosphonate (MDP) imaging followed 3 d later by 3-phase (99m)Tc-sestamibi (MIBI) imaging. During the vascular and blood-pool phases, a lymph node over the right clavicle was seen on both the (99m)Tc-MIBI and the (99m)Tc-MDP scans at as early as 30 s and then became hotter. Four months after receiving chemotherapy, the patient achieved a complete response. The lymph node over the right clavicle vanished on ultrasound examination. The similar distribution of the blood-pool phase between the (99m)Tc-MDP and (99m)Tc-MIBI scans indicated that (99m)Tc-MIBI may similarly provide information on vascularization of the lymph node. In addition to indicating vascularization, our (99m)Tc-MIBI protocol may simultaneously provide information on P-glycoprotein expression important for predicting chemotherapy sensitivity. With information on the resistance of a tumor to drugs and the environment in which it dwells, chemotherapy sensitivity might be predicted more precisely.

Topics: ATP Binding Cassette Transporter, Subfamily B, Member 1; Breast Neoplasms; Female; Gene Expression Regulation, Neoplastic; Humans; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Treatment Outcome

Schmorl's node (SN) is a common entity characterized by protrusion of intervertebral disc material through a break in the subchondral end plate of a vertebral body. They can show increased 99mTC methylene diphosphonate uptake on bone scintigraphy mimicking metastasis and can be symptomatic. Differentiation of SN from metastasis is essential for appropriate patient management. Here, we present a case where increased 99mTC methylene diphosphonate uptake in a dorsal vertebra was found to be because of SN by using single-photon emission computed tomography-computed tomography.

Topics: Adult; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Magnetic Resonance Imaging; Neoplasm Metastasis; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The aim of this study was to examine the relation between pain and bone metastases in a group of patients with prostate or breast cancer that had been referred for bone scintigraphy. Whole-body bone scans, anterior and posterior views obtained with a dual detector gamma camera were studied from 101 consecutive patients who had undergone scintigraphy (600 MBq Tc-99m MDP) because of suspected bone metastatic disease. At the time of the examination, all patients were asked whether they felt any pain or had recently a trauma. This information was correlated with the classifications regarding the presence or absence of bone metastases made by a group of three experienced physicians. In patients with prostate cancer, we found metastases in 47% (18/38) of the patients with pain, but only in 12% (2/17) of the patients without pain (p = 0.01). In patients with breast cancer, on the other hand, metastases were more common in patients without pain (71%; 10/14) than in patients with pain (34%; 11/32) (p = 0.02). In conclusion, a significant relation between pain and skeletal metastases could be found in patients with prostate cancer and a reverse relation in patients with breast cancer.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Middle Aged; Pain; Pain Measurement; Predictive Value of Tests; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Surveys and Questionnaires; Sweden; Technetium Tc 99m Medronate

This report describes a 72-year-old female patient with a previous history of cured breast cancer who presented with acute monocular visual disturbances, intense unilateral headache, painful temporal artery palpation, high erythrocyte sedimentation rate, and pain and weakness of the femoral muscles. These symptoms and signs were suggestive of temporal arteritis, but the finding of the temporal artery biopsy was negative, and the patient did not respond to corticosteroid treatment. Later, whole body bone scintigraphy revealed dissemination of malignancy throughout her skeleton including the skull. To our knowledge, this is the first report to show that a metastasis in the temporal bone can closely mimic temporal arteritis.

Topics: Aged; Breast Neoplasms; Diagnosis, Differential; Female; Giant Cell Arteritis; Humans; Radionuclide Imaging; Skull Neoplasms; Technetium Tc 99m Medronate; Temporal Bone

Topics: Breast Neoplasms; Carcinoma, Lobular; Female; Humans; Kidney; Lymphatic Metastasis; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Time Factors

The aim of this multicenter study was to investigate whether a computer-assisted diagnosis (CAD) system could improve performance and reduce interobserver variation in bone-scan interpretations of the presence or absence of bone metastases.. The whole-body bone scans (anterior and posterior views) of 59 patients with breast or prostate cancer who had undergone scintigraphy for suspected bone metastatic disease were studied. The patients were selected to reflect the spectrum of pathology found in everyday clinical work. Thirty-five physicians working at 18 of the 30 nuclear medicine departments in Sweden agreed to participate. The physicians were asked to classify each case for the presence or absence of bone metastasis, without (baseline) and with the aid of the CAD system (1 y later), using a 4-point scale. The final clinical assessments, based on follow-up scans and other clinical data including the results of laboratory tests and available diagnostic images (such as MRI, CT, and radiographs from a mean follow-up period of 4.8 y), were used as the gold standard. Each physician's classification was pairwise compared with the classifications made by all the other physicians, resulting in 595 pairs of comparisons, both at baseline and after using the CAD system.. The physicians increased their sensitivity from 78% without to 88% with the aid of the CAD system (P < 0.001). The specificity did not change significantly with CAD. Percentage agreement and kappa-values between paired physicians on average increased from 64% to 70% and from 0.48 to 0.55, respectively, with the CAD system.. A CAD system improved physicians' sensitivity in detecting metastases and reduced interobserver variation in planar whole-body bone scans. The CAD system appears to have significant potential in assisting physicians in their clinical routine.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Diagnosis, Computer-Assisted; Female; Humans; Male; Middle Aged; Observer Variation; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Whole Body Imaging

Extraosseous uptake often seen on Tc-99m methylene diphosphonate bone scintigraphy has clinical significance. In a routine follow-up study on a 54-year-old female patient with breast cancer, we encountered a rare finding of pericardial metastasis clearly demonstrated by Tc-99m methylene diphosphonate bone scintigraphy. This incidental finding of increased uptake in the periphery of the cardiac contour on a bone scan reflects radionuclide accumulation in pericardium, myocardium, or pericardial effusion itself. In our case, an additional computed tomography examination of the chest was useful for making the definitive diagnosis of dystrophic calcification of the pericardium.

Topics: Bone and Bones; Breast Neoplasms; Female; Heart Neoplasms; Humans; Incidental Findings; Middle Aged; Pericardium; Radionuclide Imaging; Technetium Tc 99m Medronate

A rare case of osteogenic sarcoma (OGS) of the left humerus metastasizing to the right breast is presented. This lesion was detected by serendipitous observation on (99m)Tc-MDP skeletal scintigraphy that demonstrated a rounded focus just outside the skeletal outline of the right chest. The focus remained at a similar location on repeat postwash view. Clinical examination revealed a breast mass corresponding to the site of uptake, and a biopsy of this mass revealed it to be a metastasis of osteogenic sarcoma. The present case demonstrates a rare site of metastasis from OGS of the left humerus to the contralateral breast and hence is reported here as an unusual case vignette.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Female; Humans; Humerus; Incidental Findings; Osteosarcoma; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Rare Diseases; Sensitivity and Specificity; Technetium Tc 99m Medronate

Incidental extraosseous uptake seen on Tc-99m methylene diphosphonate (MDP) bone scan is not unusual. We discuss here an incidental thyroid uptake in a 55-year-old female patient affected by breast cancer treated by total mastectomy, who underwent total body bone scintigraphy as a staging study. In the positron emission tomography era, traditional nuclear medicine imaging still has an important role in the diagnostic field, and incidental findings may be very useful in patient management, revealing unknown diseases and allowing correct therapeutic decisions.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Goiter, Nodular; Humans; Incidental Findings; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thyroid Gland

The aim of the study was to evaluate the value of the single photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging in the diagnosis of benign and malignant lesions in bones.. One hundred and forty one bone lesions of 125 cancer patients, for whom the natures of the lesions were not able to be determined by the 99Tc(m)-MDP whole-body bone scan, were examined by the SPECT, CT and SPECT/CT fusion imaging simultaneously. All of the images were blindly interpreted independently by two experienced nuclear medicine physicians. The natures of the lesions were eventually confirmed by MRI, pathology or follow-up diagnosis six months later.. The diagnostic sensitivity of SPECT, SPECT+CT and SPECT/CT for the 141 bone lesions was 82.5%, 93.7%, and 98.4% respectively. The specificity was 66.7%, 80.8%, and 93.6% respectively. The accuracy was 73.8%, 86.5%, and 95.7% respectively. The specificity and accuracy of SPECT/CT for diagnosing bone lesions were significantly higher than those of SPECT and SPECT+CT (P<0.05).. SPECT/CT can effectively differentiate benign and malignant bone lesions.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Female; Humans; Lung Neoplasms; Male; Middle Aged; Prostatic Neoplasms; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

A 64-year-old woman presented with a painless breast mass. Tc-99m methoxyisobutylisonitrile scintigraphy of both breasts showed a local area of abnormal uptake in the left breast in 5 min and 2 h. A skeletal scan showed very intense concentration of activity in the primary breast tumor in the left breast. A left mastectomy and an axillary dissection were performed. The predominant histologic type of the mass was an osteosarcoma, and the diagnosis of a primary osteogenic sarcoma of the breast was made. Primary osteogenic sarcoma of the breast is rare and represents less than 1% of all primary breast malignancies.

Topics: Breast Neoplasms; Female; Humans; Middle Aged; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Rare Diseases; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Topics: Aged; Breast Neoplasms; Carcinoma, Ductal; Female; Humans; Peritoneal Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole Body Imaging

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Esophageal Neoplasms; Female; Humans; Kidney Neoplasms; Male; Middle Aged; Neoplasm Staging; Patient Satisfaction; Prospective Studies; Prostatic Neoplasms; Radiopharmaceuticals; Sensitivity and Specificity; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, X-Ray Computed; Whole Body Imaging

Bisphosphonates are widely clinically used inhibitors of bone resorption. Pre-clinical studies indicate that bisphosphonates also inhibit the growth of various cancer cells in vitro, but their in vivo anti-cancer activity varies greatly, depending on the tumor type. We compared the various cellular effects of bisphosphonates in breast cancer and mesothelioma cells, with differences in growth inhibition responses to bisphosphonate-treatment in vivo. We show that the growth inhibitory effects of nitrogen-containing bisphosphonates are significantly affected by excess Ca(2+) in a cell- and bisphosphonate-specific fashion. Furthermore, excess pyrophosphate-resembling bisphosphonates prevent nitrogen-containing-bisphosphonate-induced accumulation of unprenylated Rap1A, p38 phosphorylation and growth inhibition in human MDA-MB-231 breast cancer and mouse AB-12 mesothelioma cells. For some, but not all tested, pyrophosphate-resembling bisphosphonate: nitrogen-containing bisphosphonate combinations these results may be partially explained by the ability of the excess pyrophosphate-resembling bisphosphonates to chelate Ca(2+). In mice, subcutaneous AB-12 and MDA-MB-231 tumors exhibit positive staining for Ca(2+) minerals, as revealed with Von Kossa stainings. We further show that the AB-12 tumors accumulate significantly more of the bone scanning bisphosphonate, Tc99m-medronate, as compared with MDA-MB-231 tumors. In conclusion, our results suggest that Ca(2+) regulates the growth inhibitory effects of bisphosphonates in a target cell and drug-specific fashion. These findings may be of physiological relevance since many tumor types are calcified. They further suggest that bisphosphonates can accumulate in tumors that are growing at the visceral sites and that differences in tumor accumulation of bisphosphonates may regulate their in vivo sensitivity to these drugs.

Topics: Blotting, Western; Breast Neoplasms; Calcium; Cell Line, Tumor; Cell Survival; Connexin 43; Diphosphonates; Female; Flow Cytometry; Fluorescent Dyes; Humans; Isoquinolines; Mesothelioma; Nitrogen; p38 Mitogen-Activated Protein Kinases; Radiopharmaceuticals; rap1 GTP-Binding Proteins; Receptors, Antigen, T-Cell; Technetium Tc 99m Medronate

To determine if a correlation exists between the semiquantitative bone scintigraphy index (SQBSI) and serum tartrateresistant acid phosphatase 5b (TRACP5b) activity, a novel osteoclast marker that has been shown to be useful for monitoring bone metastasis in breast cancer (BC) patients.. Among patients enrolled in 2 prospective studies conducted at Tri-Service General Hospital, Taipei, Taiwan, between December 2000 and July 2002, we identified post hoc 52 patients with both BC and bone metastasis who had detailed records of clinical condition, bone scintigraphy, and concordant serum TRACP5b levels. Between January 1, 2003, and December 31, 2005, we performed bone scintigraphy and serum TRACP5b activity assays to monitor these patients, while they were treated according to clinical need. To assess clinical condition, we obtained information from patient records, such as performance status and visual analogue pain score, as well as from selected laboratory tests for tumor markers and serum TRACP5b activity. Those patients with BC and bone metastasis who had undergone whole-body bone scintigraphy and serum TRACP5b activity determination before any therapeutic intervention were designated the pretreated group (n=30). We developed our own formula for calculating SQBSI on the basis of bone scintigraphy findings.. A significant correlation was observed between SQBSI and serum TRACP5b activity in pretreated BC patients with bone metastasis, but the strength of the correlation lessened after treatment. No significant correlation was noted between the change in serum TRACP5b activity and the change in SQBSI in treated patients. Compared with the change in SQBSI, the change in TRACP5b activity had higher sensitivity, specificity, and positive predictive value as well as a greater likelihood ratio for reflecting the clinical scenarios of bone morbidity over time.. As monitors of the response of bone metastasis in BC to treatment, serial determinations of serum TRACP5b activity and SQBSI were both shown to be useful by our preliminary findings. However, serum TRACP5b activity proved the better monitoring tool. If follow-up studies were conducted within 6 months, the combined use of SQBSI and TRACP5b would allow distinction of genuine disease progression from the "flare" phenomenon, in which bone metastasis can appear to progress in bone scintigraphic images although clinical symptoms improve. Larger prospective studies are needed to confirm these findings.

Topics: Acid Phosphatase; Biomarkers, Tumor; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Disease Progression; Female; Follow-Up Studies; Humans; Isoenzymes; Middle Aged; Osteoclasts; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Remission Induction; Sensitivity and Specificity; Tartrate-Resistant Acid Phosphatase; Technetium Tc 99m Medronate; Whole Body Imaging

Traditionally, Tc 99m methyl diphosphate (MDP) bone scintigraphy provides high-sensitivity detection of skeletal metastasis from breast and lung cancers in regular follow-up. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), based on the glucose metabolism of malignant cells, plays a role in describing tumor growth, proliferation of neoplasm and the extent of metastasis. In general, concordant findings of skeletal metastasis are seen on both types of image, especially in cases of breast and lung cancer. However, there were extremely discordant findings of skeletal metastasis between bone scans and F 18 FDG PET/CT imaging in two cases among 300 consecutive F 18 FDG PET/CT follow-up exams of patients with malignancies, during the past year, in our center. Both cases, one of breast cancer and one of lung cancer, had negative bone scintigraphic findings, but a diffusely high grade of F 18 FDG avid marrow infiltration in the axial spine, leading to the diagnosis of stage IV disease in both cases. Owing to variant genetic aberrance of malignance, F 18 FDG PET/CT reveals direct evidence of diffuse, rapid neoplasm metabolism in the bone marrow of the spine, but not of secondary osteoblastic reactions in vivo . F 18 FDG PET/CT should always be employed in the follow-up of patients with malignancies.

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Middle Aged; Positron-Emission Tomography; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Current imaging guidelines recommend that many cancer patients undergo soft-tissue staging by computed tomography (CT) whilst the bones are imaged by skeletal scintigraphy (bone scan). New CT technology has now made it feasible, for the first time, to perform a detailed whole-body skeletal CT. This advancement could save patients from having to undergo duplicate investigations. Forty-three patients with known malignancy were investigated for bone metastasis using skeletal scintigraphy and 16-detector multislice CT. Both studies were performed within six weeks of each other. Whole-body images were taken 4 h after injection of 500 Mbq (99m)Tc-MDP using a gamma camera. CT was performed on a 16-detector multislice CT machine from the vertex to the knee. The examinations were reported independently and discordant results were compared at follow-up. Statistical equivalence between the two techniques was tested using the Newcombe-Wilson method within the pre-specified equivalence limits of +/-20%. Scintigraphy detected bone metastases in 14/43 and CT in 13/43 patients. There were seven discordances; four cases were positive on scintigraphy, but negative on CT; three cases were positive on CT and negative on scintigraphy. There was equivalence between scintigraphy and CT in detecting bone metastases within +/-19% equivalence limits. Patients who have undergone full whole-body staging on 16-detector CT may not need additional skeletal scintigraphy. This should shorten the cancer patient's diagnostic pathway.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Esophageal Neoplasms; Female; Humans; Kidney Neoplasms; Male; Middle Aged; Neoplasm Staging; Patient Satisfaction; Prospective Studies; Prostatic Neoplasms; Radiopharmaceuticals; Sensitivity and Specificity; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, X-Ray Computed; Whole Body Imaging

An 80-year-old woman with multifocal invasive lobular carcinoma of the right breast treated 6 years previously with mastectomy, locoregional radiotherapy, and tamoxifen was referred for a bone scan to investigate generalized arthralgias. The patient reported right-sided headaches, blurred vision, and dizziness in the previous 3 months. The bone scan revealed a large area of unusual and abnormal Tc-99m methylene diphosphonate (MDP) uptake in the right frontoparietal skull region. CT and MRI of the brain were performed to evaluate the possibility of cerebral metastases. The CT revealed extensive abnormal thickening and enhancement of the dura in the right frontoparietal region. No calcification of the dura or bony destruction of the overlying skull was evident on CT. MRI similarly revealed extensive thickening and irregularity of the dura. The usual causes of increased skull Tc-99m MDP uptake on bone scanning such as skull metastases and dural calcification were not evident on CT or MRI.

Topics: Aged; Breast Neoplasms; Dura Mater; Female; Humans; Magnetic Resonance Imaging; Meningeal Neoplasms; Neoplasm Invasiveness; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Bone Neoplasms; Breast Neoplasms; Carcinoma, Ductal; Female; Humans; Incidental Findings; Meningeal Neoplasms; Meningioma; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole-Body Counting

The aim of this retrospective study was to determine the predictors of a positive bone scan in female patients with breast carcinoma. The participants were 126 females with newly diagnosed breast carcinoma and a baseline bone scan. Patients who had started treatment before their bone scan were excluded. Bone scans were assessed as "no metastases" or "definite skeletal metastases" without knowledge of the patient's predictor variables. Those with "possible metastases" were correlated with other available imaging and clinical information, and recategorized as "no metastases" or "definite skeletal metastases". Results were compared with predictor variables. Significant predictors were increasing age, a higher histopathological grading and positive progesterone receptor status following a forward-stepwise logistic regression analysis. Axillary nodal status, tumour size and oestrogen receptor status did not correlate with a positive bone scan. Not every patient needs a staging bone scan. This study is important because it predicts the need for baseline scintigraphy for specific patients in whom skeletal metastases are more likely to be present or to develop. The findings are particularly valuable in times of worldwide resource scarcity and evolving surgical practice.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Chi-Square Distribution; Female; Humans; Logistic Models; Middle Aged; Neoplasm Staging; Predictive Value of Tests; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Risk Factors; Statistics, Nonparametric; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Osteoblasts; Positron-Emission Tomography; Practice Guidelines as Topic; Practice Patterns, Physicians'; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Positron-Emission Tomography; Prognosis; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Treatment Outcome

Diffuse metastatic visceral calcification is rare in breast cancer. We report on a 57-year-old woman with breast cancer and hypercalcemia who had diffuse metastatic visceral calcifications on lungs, myocardium, stomach, and thyroid on a (99m)Tc-methylene diphosphonate bone scan. Visceral calcifications were completely resolved 6 months after successful anticancer and zoledronic acid treatments. Bone scanning offers a useful diagnostic tool for both identifying visceral calcification and assessing the response to therapy in chemosensitive malignities with hypercalcemia such as breast cancer.

Topics: Antineoplastic Agents; Bone and Bones; Breast Neoplasms; Calcification, Physiologic; Calcium; Diphosphonates; Female; Heart Neoplasms; Humans; Imidazoles; Lung Neoplasms; Middle Aged; Neoplasm Metastasis; Stomach Neoplasms; Technetium Tc 99m Medronate; Thyroid Neoplasms; Time Factors; Zoledronic Acid

The aim of this study was presentation of a whole-body MRI technique with a moving table as a screening tool for bone metastases in patients with breast cancer. Twenty-two patients with breast carcinoma underwent both a planar whole-body bone scintigraphy and whole-body MRI at 1.5 T. The MRI images were acquired with a moving table at six different anatomical positions within a measurement time of 20 min. Coronal images were acquired using a short-tau inversion recovery sequence, accomplished by an axial T2-weighted turbo-spin-echo sequence through the head, and a T1-weighted opposed-phase sagittal 2D fast low-angle shot sequence covering the whole spine. The MRI findings indicating bone metastases were compared with findings from bone scintigraphy. Metastatic lesions were confirmed by follow-up examinations over 1 year. Twelve patients showed bone metastases. Whole-body MRI was superior to bone scintigraphy in predicting lesion origin with a sensitivity of 92% (bone scintigraphy 83%), a specificity of 90% (scintigraphy 80%) and an accuracy of 91% (scintigraphy 82%). The MRI showed additional findings such as metastases of the lung and liver. Whole-body MRI with moving table technique may be an effective method of total body screening for bone in selected patients with breast carcinoma and a high risk of distant metastases, although with the higher costs of MRI bone scintigraphy must still be considered as the first method for screening patients with breast cancer.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Cohort Studies; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Radiographic Image Enhancement; Radionuclide Imaging; Risk Assessment; Sensitivity and Specificity; Technetium Tc 99m Medronate

Breast metastasis from a primary ovarian neoplasm is very rare. We report a case of breast metastasis along with involvement of the liver, spleen, and pelvis from ovarian carcinoma in a 54-year-old woman demonstrated by whole-body bone scanning. Ovarian metastatic deposits frequently show calcification, and a Tc-99m MDP bone scan could be useful in determining the extent of calcified soft tissue metastatic spread in these patients. A review of the literature of breast metastases form ovarian carcinoma is discussed.

Topics: Antineoplastic Agents; Bone Neoplasms; Breast Neoplasms; Carcinoma, Papillary; Female; Humans; Incidental Findings; Middle Aged; Ovarian Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole-Body Counting

Retrieving diagnostic tissue from a rib lesion can be challenging. Using a hand-held intraoperative gamma probe to target and biopsy the areas of increased radioisotope uptake has been limited largely to use by thoracic surgeons and interventional radiologists. Such techniques also have been used by orthopaedic oncologists in localizing osteoid osteomas. We pursued a similar technique in localizing the rib lesion. During the 10 months, two patients with a history of cancer and recent bone scans indicative of possible rib metastasis required biopsies for definitive tissue diagnosis. Both patients had gamma-probe localization of their rib lesions intraoperatively using minimally invasive techniques. The operation of the probe was simple with a short learning curve. Both patients had biopsies that yielded diagnoses verifying the abnormality on the staging bone scan. Localization was sensitive and accurate with histologic confirmation in both patients. The length and extent of surgery were markedly reduced with no complications. These results match those reported in the literature by thoracic surgeons and radiologists. The hand-held gamma probe assisted biopsy of suspicious rib abnormalities can be an effective surgical technique that the orthopaedic surgeon should consider. Additional experience with the technique will allow an assessment of the sensitivity and specificity.

Topics: Aged; Biopsy, Needle; Bone Neoplasms; Breast Neoplasms; Equipment Design; Female; Gamma Cameras; Humans; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Ribs; Risk Assessment; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

The aim of this study is to specify the precise role of bone scintigraphy and serum CEA and CA 15-3 assays in the monitoring of breast cancers in order to optimize their use and to determine whether it is possible to guide the prescription of bone scan by the use of CEA and CA 15-3 assays in the monitoring of breast cancer.. For this purpose, from November 1997 to May 2002, 98 consecutive female breast cancer patients (median age, 52 years; range 35-77 years) underwent bone scintigraphy during follow-up. In these patients values of tumor markers were compared with the results of bone scintigraphy. Some of the patients with bone metastasis were checked repeatedly at intervals of 6 to 12 months, resulting in 49 patients with bone metastasis and 74 patients without bone metastasis being included in the study.. In patients with bone metastasis, serum CEA levels were abnormal in 23/49 cases and CA 15-3 serum concentrations were elevated above the cut-off in 33/49 cases. Among patients without bone metastasis, CEA and CA 15-3 serum concentrations were normal in 50/74 and 55/74 cases respectively. The combination of the two markers improved the diagnostic sensitivity.. Although serial tumor marker measurements are an efficient and cost effective method of monitoring disease progression, it does not allow prediction of the bone scan results; so it is not justifiable to reject a bone scintigraphy on the basis of these markers.

Topics: Adult; Aged; Biomarkers, Tumor; Bone Neoplasms; Breast Neoplasms; Carcinoembryonic Antigen; Carcinoma; Female; Humans; Middle Aged; Mucin-1; Radionuclide Imaging; Radiopharmaceuticals; Statistics as Topic; Technetium Tc 99m Medronate

Topics: Arachnoid Cysts; Bone Neoplasms; Breast Neoplasms; Craniocerebral Trauma; Female; Humans; Incidental Findings; Middle Aged; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

To compare and establish the value of 99mTc-MIBI (methoxyisobutiylisonitrile) and 99mTc-MDP (methylene diphosphonate) scintigraphy in patients with suspicion of breast cancer.. The study included 105 patients. All patients were evaluated before surgery by 99mTc-MIBI and 99mTc-MDP scintigraphy. Thoracic SPECT study (Multispect II, Siemens) was performed 10 min. after i.v. injection of 99mTc-MIBI and 2 hours after i.v. injection of 99mTc-MDP. Final diagnosis was achieved after operation by histology.. 99mTc-MIBI scintigraphy showed a better sensitivity (87%) than the 99mTc-MDP scintigraphy (81%) and the results are similar in specificity and validity, too.. The results suggest that 99mTc-MIBI scintigraphy is a useful method in the preoperative diagnosis of patients with suspicion of breast cancer.

Topics: Breast Neoplasms; Diagnosis, Differential; Female; Humans; Mammography; Predictive Value of Tests; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon

We report an unusual severe systemic reaction that occurred in a woman after a (99m)Tc-methylene diphosphonate bone scan and for which no alternative explanation could be found. The bone scintigram showed diffusely increased uptake in the liver and kidneys accompanied by reversible dysfunction of these organs and dermatologic manifestations. We speculate that an immune-mediated mechanism may have caused this unusual reaction.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Female; Hepatorenal Syndrome; Humans; Kidney; Liver; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole-Body Counting

Topics: Bone and Bones; Breast Neoplasms; Female; Humans; Lung Neoplasms; Middle Aged; Pleural Effusion, Malignant; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Axilla; Breast; Breast Neoplasms; Carcinoma, Ductal, Breast; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

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.

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Breast Neoplasms; False Negative Reactions; Female; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sentinel Lymph Node Biopsy; Technetium Tc 99m Medronate

Bone scans showing solitary hot spots in the ribs pose diagnostic problems in patients with proved extraskeletal cancers. The authors wanted to determine the importance of solitary rib lesions and their correlation with other clinical manifestations.. The study included 199 patients with solitary rib hot spots on their bone scans. The follow-up radiographic and scintigraphic images were reviewed to determine their origin. The correlation between the occurrence of a malignant rib lesion and clinical data were determined using Pearson chi-square tests.. Ninety-three patients had an established cause of the rib hot spot. Eleven (11.8%) had a solitary malignant rib hot spot and 82 (88.2%) had a solitary benign rib hot spot. None of the hot spots at costochondral junctions were malignant. Of the 11 patients with proved metastatic rib hot spots, 1 of 11 (9.1%) had localized bone pain, 5 of 6 (83.3%) were concordant with primary tumors, 4 of 7 (57.1%) had elevated tumor markers, and 5 of 11 (45.5%) had concurrent extraskeletal metastases. For the 82 patients with benign rib hot spots, the figures were 2 of 82 (2.4%), 43 of 57 (75.4%), 26 of 69 (37.7%), and 19 of 82 (23.2%), respectively. Statistical analysis did not show a significant correlation between the incidence of metastases in solitary rib hot spots and clinical manifestations.. Most solitary rib hot spots on bone scans were benign. The interpretation of a solitary hot spot in the ribs is difficult even with the help of these clinical manifestations. Follow-up bone scintigrams or radiographs are needed for further investigation of solitary rib hot spots.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Bone Diseases; Bone Neoplasms; Breast Neoplasms; Diagnosis, Differential; Female; Follow-Up Studies; Head and Neck Neoplasms; Humans; Kidney Neoplasms; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Ribs; Statistics as Topic; Technetium Tc 99m Medronate

Assessment of bone marrow metastases using Tc-99m-labeled antigranulocyte antibodies and Tc-99m-labeled nanocolloids is discussed in osseous metastasizing breast cancer. A 53-year-old patient with bone metastases of breast cancer (pT2 pN1biv cM1) developed leukocytopenia WHO Grade III following polychemotherapy. Bone marrow scintigraphy with Tc-99m labeled nanocolloids and Tc-99m-labeled antigranulocyte antibodies revealed pronounced bone marrow infiltration as the cause. Comparing both procedures, the images with antigranulocyte antibodies showed a clearly better bone marrow image, considerably higher contrast and almost no superimposition of the liver over the spine. In osseous metastasizing breast cancer, scintigraphy with Tc-99m-labeled antigranulocyte antibodies enables assessment of metastases in the entire bone marrow.

Topics: Bone Marrow Neoplasms; Breast Neoplasms; Carcinoma, Ductal, Breast; Female; Follow-Up Studies; Granulocytes; Humans; Immunoglobulin G; Middle Aged; Neoplasm Staging; Predictive Value of Tests; Radioimmunodetection; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate

Topics: Aged; Breast Neoplasms; Combined Modality Therapy; Female; Humans; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Skull Neoplasms; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Topics: Adult; Breast Neoplasms; Female; Humans; Neoplasm Staging; Pelvic Neoplasms; Postoperative Period; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole-Body Counting

A 62-year-old woman with right breast carcinoma who had a breast biopsy 3 weeks earlier was referred for a whole-body Tc-99m MDP bone scan to identify possible osseous metastases. Twenty-four hours later, she underwent lymphoscintigraphy using four peritumoral injections of 250 microCi filtered Tc-99m sulfur colloid of 0.22 microm each. The lymphoscintigraphic images showed good delineation of three right axillary lymph nodes in relation to the rib cage. Performing a bone scan just before lymphoscintigraphy for sentinel node detection may help the surgeon to identify sentinel lymph nodes. This is more anatomically precise than using a flood source to delineate body contour. A Tc-99m MDP bone scan followed by lymphoscintigraphy should be considered in patients with breast carcinoma who will have both bone imaging and lymphoscintigraphy.

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

Topics: Aged; Breast Neoplasms; Carcinoma; Female; Humans; Ligamentum Flavum; Ossification, Heterotopic; Paraparesis; Sensitivity and Specificity; Spinal Cord Compression; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, Emission-Computed, Single-Photon

The purpose of this study was to determine the potential role of positron emission tomography (PET) using 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) for the evaluation of bony metastasis compared with 99Tcm-methylene diphosphonate (99Tcm-MDP) bone scintigraphy in patients with breast cancer. Fifty-one female patients with breast cancer who had PET together with a bone scan within 1 month between September 1994 and March 1997 were included in this study. The median age was 49 years (range 29-79 years). The sensitivity, specificity and accuracy of the bone scan were 77.7%, 80.9% and 80.3%, respectively. On the other hand, for the detection of bone metastases PET had a sensitivity, specificity and accuracy of 77.7%, 97.6% and 94.1%, respectively. In the diagnosis of bony metastasis derived from breast cancer, FDG-PET was statistically superior to bone scintigraphy in its specificity. In conclusion, FDG-PET appears to be a powerful tool not only in the diagnosis of the primary lesion and soft tissue metastasis, but also in the diagnosis of bony metastasis among patients with breast cancer.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Middle Aged; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Topics: Breast; Breast Neoplasms; Female; Humans; Posture; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Topics: Breast; Breast Neoplasms; Female; Humans; Lymph Nodes; Prone Position; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Topics: Adult; Bone and Bones; Breast Neoplasms; Calcinosis; Female; Humans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

We report a case of metastatic breast cancer that showed extraosseous accumulation of 99mTc-HMDP in left axillary lymph nodes on bone scintigraphy. Our patient had a giant left breast mass and multiple lymph node metastases with atypical calcifications. It is known that breast cancer sometimes is positively visualized as extraosseous accumulation on bone scintigraphy. Accumulation to metastatic lymph nodes of breast cancer has rarely been reported. It is suggested that bone scintigraphy is of benefit in detecting the metastatic lymph nodes of breast cancer as a screening or follow-up method.

Topics: Axilla; Bone and Bones; Breast Neoplasms; Carcinoma, Ductal, Breast; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Bone scintigraphy is widely used to detect bone metastasis owing to its high sensitivity, but solitary focus of increased uptake often causes diagnostic problem because of its low specificity. The purpose of this study was to assess the significance of solitary hot spot detected in patients with extraskeletal malignancies. We reviewed 1,167 consecutive bone scintigraphies of patients with history of lung, breast or prostatic cancer. There was 185 bone scans showing solitary hot spot (lung; 121, breast; 36, prostate; 28). Of the solitary hot spots, 30 (24.8%) in lung cancer, 8 (22.2%) in breast cancer, and 4 (14.3%) in prostatic cancer were a result of metastatic disease. There was no significant difference in the frequency of bone metastasis according to the site of primary tumor. It was relatively higher in the location of pelvis, scapula and thoracic spine. Clinical symptoms, particularly local bone pain, were helpful to diagnose the solitary hot spot.

Topics: Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Lung Neoplasms; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

In this study, we made an intra-individual comparison of the uptake of 99Tcm-MDP and 99Tcm-MIBI in breast cancer. Twenty women with large breast masses (one dimension > or = 3 cm on mammography) underwent SPET in the supine position with both agents. All transverse sections demonstrating tumour activity were added together and the net (total) tumour uptake in a region of interest was compared to that of surrounding tissue activity (background). We also evaluated maximum tumour uptake versus background activity. Tumour uptake was observed in all examinations. In contrast to MIBI, eight MDP examinations showed increased uptake in normal breast parenchyma in addition to tumour uptake. There was no significant difference in net tumour uptake between the two tracers and non-parenchymal (indifferent) background activity, but the maximum tumour activity of MIBI was significantly higher than that of MDP. In the eight MDP examinations with parenchymal activity, mammograms were required to identify tumour uptake correctly. In conclusion, MDP may provide similar images to MIBI in postmenopausal women not receiving hormone replacement therapy. For other patients, MIBI gives better tumour depiction.

Topics: Adult; Breast Neoplasms; Female; Humans; Middle Aged; Radiography; Radiopharmaceuticals; Supine Position; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Tissue Distribution; Tomography, Emission-Computed, Single-Photon

The aim of this prospective study was to determine the diagnostic value of Tc-99m MDP scintimammography (SMG) for the detection of breast cancer in patients with breast masses and to compare the results with Tc-99m MIBI scintimammography. Twenty patients, categorized as suspicious, positive or benign for breast cancer according to the mammographic findings were included in the study. Dual phase Tc-99m MIBI and Tc-99m MDP SMG were performed in the prone lateral position within 5 days of each other. Although early and late Tc-99m MIBI SMG showed equal (90.4%) sensitivity, the specificity of late Tc-99m MIBI (87.5%) was found superior to early (62.5%) imaging. The overall sensitivity and specificity of early Tc-99m MDP SMG were 71.4% and 62.5%, respectively. Although late Tc-99m MDP imaging showed 100% specificity, its sensitivity was only 23.8%. In the patients with palpable masses, both early Tc-99m MDP and Tc-99m MIBI showed equal sensitivity (100%), but the sensitivity of early Tc-99m MIBI (37.5%) was found slightly higher than Tc-99m MDP (25.0%) for nonpalpable breast lesions. The sensitivity of Tc-99m MIBI and Tc-99m MDP SMG in detecting metastatic axillary involvement was 66.6% and 50%, respectively. High sensitivity and specificity together with its low cost, easy availability and the possibility of detecting bone metastases seems to make Tc-99m MDP a contributive agent in the evaluation of breast lesions as an alternative to Tc-99m MIBI.

Topics: Adult; Aged; Aged, 80 and over; Breast; Breast Neoplasms; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Mammography; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

The authors report an unusual presentation of a solitary bone metastasis in the left midtibial shaft with no other skeletal involvement in a patient with breast carcinoma. The incidence of solitary bone metastasis below the knees is rare. Clinically, the lesion was tender when palpated. A bone scan revealed increased blood flow and blood pool activity, with intense midtibial bony uptake in delayed images. These findings are similar to those of acute osteomyelitis. Biopsy revealed bony metastasis from the patient's breast carcinoma.

Topics: Acute Disease; Biopsy; Bone Neoplasms; Breast Neoplasms; Carcinoma; Diagnosis, Differential; Female; Humans; Middle Aged; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia; Whole-Body Irradiation

A 47-year-old woman with adenocarcinoma of the right breast had bone scintigraphy with Tc-99m MDP. Bone imaging did not show any metastases. However, a large area of increased tracer uptake was seen extending from the abdomen to the pelvis. Abdominal ultrasound revealed a large solid and heterogeneous mass, measuring 18 x 11 x 14.3 cm, that originated in an empty uterus. A biopsy of the surgical specimen showed a leiomyoma of the uterus.

Topics: Adenocarcinoma; Biopsy; Breast Neoplasms; Female; Humans; Leiomyoma; Middle Aged; Neoplasms, Multiple Primary; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Ultrasonography; Uterine Neoplasms

Topics: Adult; Breast Neoplasms; False Positive Reactions; Female; Humans; Phyllodes Tumor; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Leiomyoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Urinary Bladder; Uterine Neoplasms

A case of transient splenic accumulation of the bone-seeking agent Tc-99m HMDP is reported. This effect was caused by transient megaloblastic anemia induced by 5-fluorouracil chemotherapy. The extent of splenic uptake reflected the development and severity of megaloblastic anemia. The mechanism of splenic accumulation is thought to be similar to transient iron deposition in the spleen by megaloblastic anemia.

Topics: Anemia, Megaloblastic; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Breast Neoplasms; Female; Fluorouracil; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Spleen; Technetium Tc 99m Medronate

To assess the value of scintimammography with both 99mTc-MIBI and 99mTc-MDP in detecting breast cancer.. A total of 35 women with clinical findings of suspicious breast lesions were studied with both 99mTc-MIBI and 99mTc-MDP scintimammography. All patients underwent surgery within one week and the final diagnostic results (histopathological) were obtained.. Eighteen of 35 abnormalities of breast were pathologically confirmed as breast cancer and 17 as benigN lesions. In this group of patients studied, the sensitivity, specificity and accuracy of 99mTc-MIBI scintimammography were 77.8%, 88.2% and 82.9%, respectively and those of 99mTc-MDP scintimammography were 72.2%, 88.2% and 80.0%, respectively. There was no significant difference between 99mTc-MIBI and 99mTc-MDP scintimammography.. This study showed the high diagnostic accuracy of both 99mTc-MIBI and 99mTc-MDP scintimammography in detecting breast cancer. Both can be used as non-invasively assess breast cancer invasiveness before surgery.

Topics: Adult; Aged; Aged, 80 and over; Breast; Breast Neoplasms; Female; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Considering the current need to improve cost-effectiveness in cancer patient management, a prospective study was undertaken in order to define the optimal combination of bone scan and tumour marker assays in breast and lung cancer strategies, as has been done in the case of prostate cancer. All patients with breast or lung cancer referred to the Nuclear Medicine Department of the Grenoble Teaching Hospital between December 1995 and April 1997 were included. A blood sample was drawn in each case for marker assay (CA15-3 or CEA and CYFRA 21-1) on the same day as the bone scan. Two hundred and seventy-five patients were included: 118 with lung cancer and 157 with breast cancer. With regard to lung cancer, no information useful for guiding bone scan prescription was obtained through CEA and CYFRA 21-1 assays. For breast cancer, the results suggest that in asymptomatic patients, a CA15-3 level of less than 25 U/ml (upper normal value chosen as the threshold) is strongly predictive of a negative bone scan; by contrast, high tumour marker levels are predictive of neoplastic bone involvement. When a doubtful bone scan is obtained in a patient with breast cancer, a normal marker level makes it highly probable that bone scan abnormalities are not related to malignancy.

Topics: Aged; Aged, 80 and over; Antigens, Neoplasm; Biomarkers, Tumor; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Breast Neoplasms, Male; Carcinoembryonic Antigen; Female; Humans; Keratin-19; Keratins; Lung Neoplasms; Male; Middle Aged; Mucin-1; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

In this study, we evaluated the efficacy of bone marrow immunoscintigraphy (BMIS) for the detection of skeletal metastases in 23 patients with histologically confirmed breast cancer. All patients underwent whole-body BMIS 3-6 h after the intravenous injection of 0.20-0.33 mg of the intact anti-NCA 95 MAb BW 250/183 labelled with 259-555 MBq 99Tcm and a whole-body 99Tcm-MDP bone scan. In four patients, BMIS SPET of the lumbar spine was also performed. Serum alkaline phosphatase was determined in all patients and the level of human anti-mouse antibody (HAMA) in 16. Final diagnosis was confirmed by radiology and 2 years follow-up. Compared with the 99Tcm-MDP bone scan, BMIS demonstrated better specificity (88% vs 75%) and a better positive predictive value (92% vs 85%). There were no significant differences between BMIS and the bone scan in the detection of skeletal metastases (P > 0.05). In one patient with normal planar BMIS of the lumbar spine, SPET disclosed a metastatic lesion in the bone marrow. The correlation coefficient between BMIS and bone scan and between BMIS and serum alkaline phosphatase was r = 0.688 and r = 0.483 respectively. One patient developed a minor HAMA response after BMIS. Patients with diffuse increased activity of the skull on the bone scan had a significantly higher skull to whole body ratio on BMIS (P < 0.01). Thus BMIS can improve the specificity and positive predictive value of bone scanning in the detection of skeletal metastases, with a low HAMA response. Diffuse increased activity of the skull on bone scans could be explained by bone marrow extension. SPET scanning of the spine may improve the sensitivity of BMIS.

Topics: Adult; Aged; Antibodies, Monoclonal; Antigens, Neoplasm; Bone Marrow; Bone Marrow Neoplasms; Bone Neoplasms; Breast Neoplasms; Cell Adhesion Molecules; Female; Humans; Lumbosacral Region; Membrane Glycoproteins; Middle Aged; Radioimmunodetection; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Whole-Body Counting

We present the bone scintigrams of two patients, which demonstrate diffuse extraosseous uptake of a bone agent in metastatic masses in the liver, one from a primary lung tumor and one from a primary breast tumor. The bone imaging agent did not localize in the brain metastases in these patients. CTs of the abdomen in both patients showed massive metastases in the liver with multiple areas of tumor necrosis. The CT of the abdomen of the breast cancer patient showed multiple small hepatic calcifications. Autopsy revealed massive tumor necrosis with calcifications in the enlarged liver. In routine bone scintigraphy, diffuse uptake of bone agents in the liver of a patient with a known malignancy should be considered suggestive of massive hepatic metastases.

Topics: Adenocarcinoma; Adult; Aged; Bone and Bones; Breast Neoplasms; Carcinoma, Small Cell; Female; Humans; Liver; Liver Neoplasms; Lung Neoplasms; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Bone and Bones; Breast Neoplasms; Carcinoma, Ductal, Breast; Female; Humans; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasms, Multiple Primary; Radionuclide Imaging; Technetium Tc 99m Medronate

Since breast cancer is frequently associated with bone metastasis, bone scintigraphies have been performed to determine pre-operative staging and to survey postoperative bone metastasis. The sternum, in particular, is a site at which is difficult to differentiate between benign bone disease and bone metastasis, because of varied uptake and wide individual variations. In this study, chronological bone images were scintigraphied in six cases with solitary sternal metastasis and three cases with benign bone disease including two fracture cases and one arthritis case. On bone scintigrams in which solitary sternal metastasis appeared, increased uptake was found in five cases, and photon deficiency was observed in one case. During follow-up scintigraphies, abnormal accumulations, such as hot spots and cold lesions, increased in the bone metastasis while abnormal uptake disappeared or was unchanged in the benign bone disease cases. On CT, four cases showed osteolytic change, and one exhibited osteosclerotic change. These findings indicate that sternal metastasis usually shows osteolytic change, even if a hot lesion is recognized on bone scintigraphy. In solitary sternal metastasis, for which early diagnosis is difficult, both an integrated diagnosis using other imaging techniques and chronological bone scintigraphy are important.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sternum; Technetium Tc 99m Medronate

Eight patients were inadvertently administered, and imaged with, 99mTc-labeled MDP which was 45 months expired. Two cases are presented. All patients were subsequently imaged with normal MDP. The images obtained with expired MDP were clinically acceptable. No differences in scan abnormalities were observed compared with normal MDP for any of the patients. None of the patients suffered any side effects attributable to the expired MDP.

Topics: Adult; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Drug Stability; Female; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Safety; Technetium Tc 99m Medronate

The aim of this study was to evaluate breast parenchymal activity on scintimammography with bone-seeking agents and 99mTc-MIBI. Scintimammography was performed with bone-seeking agents in 61 patients and with 99mTc-MIBI in 33 patients. Activity in the breast parenchyma contralateral to the suspected lesion was visually assessed by two independent observers. Increased breast parenchymal activity was shown in 19 of 61 patients examined with bone-seeking agents, while it was demonstrated in only two of 33 patients examined with 99mTc-MIBI. Breast parenchymal activity of bone-seeking agents was higher in patients aged 50 years or younger than in those older than 50. Increased parenchymal activity of bone-seeking agents may disturb visualization of primary breast cancer especially in relatively young patients. Low parenchymal activity is suggested to be a favorable characteristic of 99mTc-MIBI as a scintimammographic agent.

Topics: Adult; Aged; Bone Neoplasms; Breast; Breast Neoplasms; Female; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Breast scintigraphy (BS) with the bone-seeking agent 99mTc-medronate (MDP) can be usefully combined with mammography to diagnose and characterize questionable breast lumps. However this radiotracer does not seem to provide any further prognostic information about breast cancer. Therefore we investigated the prognostic yield of MDP-BS searching for correlations between scintigraphic findings and the major biological and histologic parameters.. We retrospectively analyzed a series of 44 primary breast cancers. All patients had undergone 99mTc-MDP bone scan for preoperative staging, as well as conventional breast imaging. We statistically compared the cancer/background ratio (c/b index) with lesion histotype, diameter, grading, and the tissue concentrations of steroid receptors, cathepsine D, type 1 timidine kinase, pS2 and p53 proteins.. MDP-BS failed to depict 11 of 44 lesions (O 0.5-2 cm), detected 7 of 16 mammographically questionable lesions and correctly visualized the two multifocal cases. Also, MDP-BS depicted no metastatic axillary lymph nodes. We found no statistically significant correlation between the c/b index and the prognostic markers.. Differently from BS with 99mTc-MIBI, 201T1, 18F-FDG, 111In-OCT and radiolabeled estrogens and despite its good overall accuracy, MDP-BS appears to have no prognostic role. In fact, despite the well-known capability of soft tissue lesions to take up the tracer, MDP tumor trapping seems to depend mainly on the increased permeability of neovessels and on interstitial space enlargement. Few reports are available in the literature on the correlation between in vivo MDP uptake by the breast cancer and prognostic parameters. Thus, we tested possible correlations between the amount of MDP taken up by the breast cancer, histologic features and cell concentrations of some major biomarkers. The lack of any statistical significance is in agreement with the theory, and confirms the little prognostic value of MDP-BS. Nevertheless, further trials are warranted on larger series of cases to validate our personal findings.

Topics: Adult; Aged; Biomarkers, Tumor; Breast; Breast Neoplasms; Female; Humans; Immunohistochemistry; Lymphatic Metastasis; Middle Aged; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Statistics, Nonparametric; Technetium Tc 99m Medronate

Topics: Aged; Aged, 80 and over; Breast Neoplasms; Carcinoma; Female; Humans; Radionuclide Imaging; Radiopharmaceuticals; Skull Neoplasms; Technetium Tc 99m Medronate; Temporal Bone

Topics: Breast Neoplasms; Carcinoma; Chronic Disease; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Mastoid; Mastoiditis; Middle Aged; Radiopharmaceuticals; Skull Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Topics: Adrenal Glands; Adult; Breast Neoplasms; Female; Humans; Nephritis; Radiation Injuries; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

The role of scintimammography with 99mTc-MDP was investigated in patients with mammographic or clinical evidence of breast lesions, suspicious for malignancy, in our Department at the National Cancer Institute of Naples. The end-point of the study was to assess the uselfulness of this test in diagnosing or ruling out breast cancer in more than 2000 women. Scintimammography results were compared with those of mammography and ultrasound and categorized according to histological findings. Overall sensitivity was 92%, specificity was 90%, and accuracy 91%. Sensitivity was affected by the lesions exceeding 12 mm and specificity by sclerotic and/or hyaline or myxoid fibroadenomas, which may be positive. The major advantages of scintimammography appeared in the study of calcifications without a mass and of the indirect mammographic signs of breast cancer, such as distortion and asymmetry. Scintimammography with 99mTc-MDP is a reliable, safe and highly cost-effective procedure to diagnose or to rule out breast cancer, after mammography and ultrasound have yielded questionable results.

Topics: Breast Neoplasms; Calcinosis; Diagnosis, Differential; Female; Humans; Mammography; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate

A patient with disseminated osseous metastases due to breast cancer reported multifocal pain. Because of persisting pain after a first cycle of chemotherapy, 1,295 MBq Re-186 HEDP was administered intravenously. Excellent pain relief was observed. Subsequently, the patient received further combined chemotherapy and Re-186 HEDP therapy and remained pain free. Tc-99m MDP bone imaging showed a significant regression of osseous metastases. It may be speculated that the combination of Re-186 HEDP and chemotherapy results in significantly increased palliation of metastatic bone disease.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Breast Neoplasms; Carcinoma, Ductal, Breast; Combined Modality Therapy; Etidronic Acid; Female; Humans; Middle Aged; Palliative Care; Radioisotopes; Radionuclide Imaging; Radiopharmaceuticals; Rhenium; Technetium Tc 99m Medronate

Topics: Breast Neoplasms; Female; Humans; Lymphoma, Non-Hodgkin; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Adult; Breast Neoplasms; Female; Humans; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

99mTechnetium methylene diphosphonate (99mTc MDP) bone scintigraphy is currently the method of choice for the detection of bone metastases, but 18F-fluoro-deoxy-D-glucose positron emission tomography (18FDG PET) offers superior spatial resolution and improved sensitivity. We have compared 18FDG PET with 99mTc MDP bone scintigraphy in patients with skeletal metastases from breast cancer and have analyzed the data in subgroups based on radiographic characteristics of lesions.. Twenty-three women with breast cancer and confirmed bone metastases were studied with both 99mTC MDP bone scintigraphy and 18FDG PET, and the number of lesions detected and the quantitation of uptake (standardized uptake values [SUVs]) of 18FDG in osteolytic and osteoblastic metastases were compared. Survival was compared for both lytic and blastic bone metastases and for patients with high and low accumulation of 18FDG.. 18FDG PET detected more lesions than 99mTc MDP scintigraphy (mean, 14.1 and 7.8 lesions, respectively; P < .01). However, 18FDG detected fewer bone metastases compared with 99mTc MDP scintigraphy in a subgroup of patients with osteoblastic disease (P < .05). Higher SUVs were observed for osteolytic than osteoblastic disease (mean, 6.77 and 0.95, respectively; P < .01). Survival was lower in patients with osteolytic disease compared with the remainder (P=.01). A difference in survival was not found for those patients with high SUVs (> 3.6; P=.4).. 18FDG PET is superior to bone scintigraphy in the detection of osteolytic breast cancer metastases, which led to a poorer prognosis. In contrast, osteoblastic metastases show lower metabolic activity and are frequently undetectable by PET. The biologic explanation for this observation remains to be elucidated.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Middle Aged; Radiopharmaceuticals; Survival Analysis; Technetium Tc 99m Medronate; Tomography, Emission-Computed

The aim of this study was to evaluate the diagnostic role of bone scan in patients with breast carcinoma. With this purpose, we have studied 591 patients (4 males). In 261 of them, we were able to establish the stage of disease: 33 in stage I, 137 in stage II, 71 in stage III y 20 in stage IV. Metastatic lesions were detected in 6% of patients in stage I, 8.8% in stage II, 12.7% in stage III y 50% in stage IV. Altogether, 71 from 591 patients (12%) had metastatic lesions. In 4 patients (5.3%) we obtained a false positive result. The bone lesions found in the scintigraphic studies were classified as not metastatic lesions in 236 patients (39.9%) but 26 of them were malignant (11%). Another 193 patients (32.6%) presented scintigraphic studies considered as equivocal for metastasis and 33 of them were also malignant (17%). In 150 patients scintigraphic studies did not present lesions during the follow up. In other 156 patients isolated lesions were detected and 24 of them (15.4%) were malignant. Only 4 <> lesions were detected and not any <> image was observed in this study.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Breast Neoplasms, Male; Carcinoma; Evaluation Studies as Topic; False Positive Reactions; Female; Humans; Male; Middle Aged; Neoplasm Staging; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Aged; Bone Neoplasms; Breast Neoplasms; Female; Femoral Neoplasms; Humans; Humerus; Lymphatic Metastasis; Radionuclide Imaging; Radiopharmaceuticals; Skull Neoplasms; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Focal soft-tissue accumulation of bone-seeking radiopharmaceuticals has many causes but is usually less intense than skeletal activity. Extraskeletal new bone formation, as seen in myositis ossificans and extraskeletal osteosarcoma, represents an exception where markedly increased uptake can be seen. Technetium-99m-MDP uptake in primary breast carcinoma has been recently investigated using scintamammographic techniques to differentiate malignant from benign lesions. The mechanism of uptake remains unclear but is likely multifactorial and nonspecific. We present a case of primary breast carcinoma with florid 99mTc-MDP activity relative to normal bone. Tumor histopathology in this patient demonstrates malignant new bone formation as the likely mechanism for the marked radiotracer avidity.

Topics: Breast Neoplasms; Carcinoma, Ductal, Breast; Female; Humans; Metaplasia; Middle Aged; Ossification, Heterotopic; Radionuclide Imaging; Sarcoma; Technetium Tc 99m Medronate

Topics: Breast Neoplasms; Female; Humans; Middle Aged; Phyllodes Tumor; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

The diagnostic accuracy of scintimammography with 99mTc-MDP was evaluated in 400 consecutive women with clinical or mammographic suspicion of breast cancer, candidate to surgery and/or excisional biopsy. Lateral views of both glands were acquired, in prone position, 5-10 min after the injection of 550-740 MBq of 99mTc-MDP. The scintigraphic results were compared to mammograms and classified using the histological findings as gold standard.. Mammography was suggestive for cancer in 231 (57%), suspicious in 49 (12%) and indeterminate in 120 (31%) patients. Breast carcinoma was histologically proven in 330 women, benign breast diseases in 70. The tumor size ranged from 4 x 5 to 50 x 60 mm. 99mTc-MDP visualized as foci of increased uptake 305/330 cancers (92%). In particular, in women with indeterminate mammograms the SMM had a diagnostic accuracy of 84%, correctly characterizing 101/120 lesions. Twenty missed cancers had largest diameter < or = 10 mm, 5 < or = 15 mm. Lack of 99mTc-MDP uptake occurred in 64 out of 70 benign lesions. These lesions were classified as truly negative. Conversely, 3 fibroadenoma and 3 epithelial hyperplasia with moderate or severe atypia were falsely positive. The overall specificity was 91.5%; the accuracy was 92%, the positive and negative predictive values were respectively 98% and 72%.. The results obtained in this study suggest that 99mTc-MDP scintimammography accurately detects breast carcinomas with largest diameter > 10 mm; it differentiates malignant from benign lesions, and it shows promising insights in characterizing breast abnormalities mammographically indeterminate.

Topics: Adult; Aged; Aged, 80 and over; Breast; Breast Diseases; Breast Neoplasms; Female; Humans; Mammography; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate

Technetium-99m-MDP and, recently, a 99mTc-labeled synthetic decapentapeptide have been shown to localize in breast lesions. Our goal was to develop an acquisition protocol to improve image quality, to improve detection of axillary lymph nodes with disease and to compare the utility of the new radiotracer to 99mTc-MDP.. Ninety-three patients with documented breast carcinoma were studied. Thirty-eight patients were studied in the supine position with anterior and lateral views: eight patients were injected intravenously with 600-740 MBq 99mTc-EPPT and 30 patients with the same activity of 99mTc-MDP. A second group of 55 patients was studied using the same total activity: 20 patients were injected with 99mTc-EPPT and 35 patients with 99mTc-MDP. To improve results, patients were positioned standing up with their arm raised. The breast with a marker over the nipple touched the collimator in the oblique-lateral position. Early planar images (2-5 min postinjection) were acquired with this positioning for the healthy and the tumor breast, collecting 1500 K counts in a 256 x 256 matrix. Imaging of the axillary regions was performed while the patients were positioned supine and a frontal image was obtained at 10-15 min postinjection for 1800 K counts.. This diagnostic study produced good quality images, with the breast lesions and axilla visualized. The positions had limitations due to the overlapping of other organs and to the proximity with the chest wall.. Using this protocol, all primary lesions and 50% of the axillary lymph nodes with 99mTc-MDP, and 35% with 99mTc-EPPT, were detected as documented by histology. Our protocol may represent an improvement in the diagnosis and staging of breast cancer.

Topics: Axilla; Breast; Breast Neoplasms; Female; Humans; Lymph Nodes; Posture; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

The bone-seeking radiopharmaceutical Sr-89 has been used as a palliative treatment for patients with bone pain caused by bone metastases. The authors report the results of nine patients (three with prostate cancer, four with breast cancer, one with thyroid cancer, and one with lung cancer) who underwent therapy with Sr-89 chloride for painful bone metastases, and evaluate Sr-89 imaging with bremsstrahlung. Two levels of dosage (1.5 and 2.2 MBq/kg) were used. Sr-89 imaging was performed in seven patients 1 week after injection. Abnormal uptake was seen in all and was consistent with the results of Tc-99m HMDP imaging. Six patients were assessed at 3 months and three patients toward the time they were terminal; 78% (seven of nine) derived some benefit. Two patients had a favorable clinical response and showed improvement on Tc-99m HMDP imaging.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Follow-Up Studies; Humans; Lung Neoplasms; Male; Middle Aged; Pain; Palliative Care; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Radiotherapy Dosage; Remission Induction; Strontium Radioisotopes; Technetium Tc 99m Medronate; Terminal Care; Thyroid Neoplasms

Topics: Biopsy; Bone Marrow; Breast Neoplasms; Carcinoma; Female; Humans; Middle Aged; Myocardial Ischemia; Primary Myelofibrosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

The aim of this study was to optimise the parameters affecting the Bremsstrahlung scintigraphy of patients injected with strontium-89 chloride. The parameters considered were : (1) instrumental detection efficiency, and (2) tissue attenuation factor for 89Sr calibrated sources, which permit quantitative evaluation of the activity in a given bone lesion. Some typical examples of in vivo 89Sr imaging are presented to illustrate the clinical utility of the imaging procedure developed by us, which is implemented in our department for all patients treated with 89Sr chloride.

Topics: Bone Neoplasms; Breast Neoplasms; Calibration; Gamma Cameras; Humans; Lung Neoplasms; Male; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Strontium Radioisotopes; Technetium Tc 99m Medronate

We counted the lesions at the time of detection of bone metastases and calculated the rate of increase in the number of bone metastases from changes in serial bone scintigrams, and investigated the usefulness of serial scintigrams as a prognostic indicator in patients with metastatic bone tumors. Subjects were 112 patients with bone metastases from four types of primary lesion: 21 with prostate cancer, 27 breast cancer, 39 lung cancer and 25 stomach cancer. Of these, 18 (prostate), 19 (breast), nine (lung) and eight (stomach) underwent serial bone scintigrams in which bone metastases were first detected and identified as progressing. The numbers of lesions at the time of detection of bone metastases for prostate and stomach cancers were significantly greater than those for lung cancer. The rate of increase in the number of bone metastases for stomach cancer was significantly higher than that for prostate or breast cancers. There was no correlation between the survival time after the detection of bone metastases and the number of lesions at the time of detection in the four types of cancer. However, in prostate cancer, a negative correlation existed between the survival time after the detection of bone metastases and the rate of increase in the number of bone metastases. Thus, in patients with bone metastases from prostate cancer, it appears that the rate of increase in the number of bone metastases, estimated from serial bone scintigrams, was indicative of prognosis.

Topics: Adult; Aged; Aged, 80 and over; Analysis of Variance; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Disease Progression; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Injections, Intravenous; Lung Neoplasms; Male; Middle Aged; Prognosis; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Regression Analysis; Stomach Neoplasms; Survival Rate; Technetium Tc 99m Medronate; Whole-Body Counting

To compare whole body magnetic resonance imaging (MRI) using fast sequences with radioisotope bone scintigraphy (BS) for the detection of metastases in the entire skeleton.. In forty-four patients suffering from carcinoma of lung, breast and prostate whole body MRI could generally be accomplished in about 39 minutes and it was shown to have a higher skeletal metastases detection compared with BS in the spine, pelvis, limb bones, sternum, scapula, and clavicle, but lower in the ribs and skull.. We think for addressing the status of skeletal metastases only, bone scintigram is still preferred over whole body MRI. When bone scintigram is unavailable, whole body MRI is a practical and acceptable alternative especially when extra-osseous metastases are also of concern.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Bronchial Neoplasms; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Prostatic Neoplasms; Radiopharmaceuticals; Technetium Tc 99m Medronate

Signet-ring cell carcinoma of the breast, first recognized in 1976, behaves aggressively and is associated with a poor prognosis. The tumor is a rare type of breast cancer and often metastasizes to the gastrointestinal tract and female genital tract. The authors report a case of a 48-year-old woman with bilateral signet-ring cell carcinoma of the breasts with multiple skeletal metastases and gastric metastasis. The breast cancer was depicted on a Tc-99m MIBI scintimammogram.

Topics: Bone Neoplasms; Breast Neoplasms; Carcinoma, Signet Ring Cell; Female; Humans; Middle Aged; Neoplasms, Multiple Primary; Radionuclide Imaging; Stomach Neoplasms; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Topics: Artifacts; Breast Neoplasms; Carcinoma, Adenosquamous; Female; Humans; Lung Neoplasms; Male; Mastectomy; Middle Aged; Radiography, Thoracic; Radionuclide Imaging; Ribs; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A 49-year-old female with breast cancer after mastectomy and chemotherapy was found suffering from diabetes insipidus and panhypopituitarism syndrome. Whole body bone scan showed hyperfixation in sella turcica. This site is extremely rare, especially in breast cancer metastases.

Topics: Adrenal Cortex Hormones; Bone Neoplasms; Breast Neoplasms; Combined Modality Therapy; Diabetes Insipidus; Female; Humans; Hypopituitarism; Mastectomy, Modified Radical; Middle Aged; Radiography, Thoracic; Radionuclide Imaging; Sella Turcica; Technetium Tc 99m Medronate

Topics: Biopsy; Breast Neoplasms; Clavicle; Cobalt Radioisotopes; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Osteoradionecrosis; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Adult; Breast Neoplasms; Breast Self-Examination; Deoxyglucose; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Indium Radioisotopes; Magnetic Resonance Imaging; Mammography; Middle Aged; Radioimmunodetection; Receptors, Somatostatin; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Ultrasonography, Mammary

Tumour markers are a potentially powerful means of obtaining information about cancers whilst causing minimal morbidity, inconvenience and cost. CA15-3 has been suggested as a marker of distant metastasis (M+ disease) in breast cancer. We have measured CA15-3 in 77 patients with carcinoma of the breast in order to determine whether routine assay of this tumour marker would be useful in the oncology unit of a district general hospital. A highly significant correlation existed between elevated CA15-3 levels (> or = 30 U/ml) and M+ disease. The CA15-3 assay was found to have a sensitivity of 70%, a specificity of 96% and a predictive value of 87%, in agreement with previous studies. There was evidence that CA15-3 levels frequently increased in advance of otherwise detectable distant metastases. 70 patients had a 99m Tc bone scan close to the date on which CA15-3 was measured. All patients with a positive bone scan and raised levels of CA15-3 were subsequently confirmed as having bony metastases; no patient with normal bone scan and normal CA15-3 developed M+ disease (to the date of follow-up). CA15-3 levels were raised in 83% of patients who developed non-bony distant metastases. In clinical practice it may be possible to exploit the high specificity of CA15-3, in order to provide additional information to that already determined by current investigations. For example, CA15-3 might be assayed alongside a bone scan to confirm positive or negative results. Another role might be as a screen for breast cancer metastases in departments with limited access to bone scans and other imaging facilities. CA15-3 might also be used in monitoring patients for the development of distant metastases during follow-up. It is, however, unlikely that CA15-3 can substitute directly for a bone scan or other imaging currently used routinely by a department. Clinical trials are now necessary to determine the effect of using tumour markers such as CA15-3 on patient morbidity and mortality.

Topics: Biomarkers, Tumor; Bone Neoplasms; Breast Neoplasms; False Negative Reactions; False Positive Reactions; Follow-Up Studies; Humans; Mucin-1; Prognosis; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate

Technetium-99m-methylene diphosphonate (MDP) uptake within breast lesions was investigated during routine presurgical bone scintigraphy in a cohort of women at high risk for cancer who were candidates for surgery or excisional biopsy. The aim was twofold: (a) to demonstrate positive 99mTc-MDP uptake in primary breast cancer and (b) to differentiate malignant from benign lesions.. Anterior and oblique lateral views of the breasts were acquired 0-4 min, 10-20 min and 2 hr after intravenous injection of 740 MBq of 99mTc-MDP in 200 women with elevated suspicion or proven diagnosis of breast cancer (Group 1) and in 80 women with other solid tumor types (Group 2).. Physical examination and mammography revealed breast abnormalities in all Group 1 subjects. The mammographic findings were definitely positive for carcinoma in 120 patients, highly suspicious in 27 and indeterminate in 53. Breast cancer was later histologically diagnosed in 172 women (86%) and benign disease found in 28 women (14%). Of these patients, 158 (92%) showed focal uptake of 99mTc-MDP in the images collected 10-20 min after injection. This was found to be the best timing for imaging, with tumor-to-background ratios as high as 4.3 (mean +/- s.d. = 3.8 +/- 0.4). Two hr after injection, only 61 of the 158 (38%) malignant lesions were clearly detectable.. Technetium-99m-MDP is concentrated by primary breast carcinoma 10-20 min after injection, enabling successful external gamma imaging. Scintimammography with 99mTc-MDP is an accurate test that differentiates malignant from benign breast lesions, particularly in patients with indeterminate mammograms.

Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Female; Humans; Mammography; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

A patient with a history of breast cancer and known lung metastases was referred for a bone scan to investigate the cause of severe neck and right shoulder pain. The bone scan showed massive uptake of the radiopharmaceutical in the soft tissue surrounding the right shoulder. A review of the patient's history indicated that the patient had undergone radiation therapy to the right upper thorax and breast area 14 months previously and an acute radiation dermatitis of the proximal right arm and should had developed. This had long since resolved. Physical examination and plain radiographs of the right shoulder and humerus failed to demonstrate any abnormality.

Topics: Aged; Bone Neoplasms; Breast Neoplasms; Female; Humans; Radiodermatitis; Radionuclide Imaging; Shoulder; Soft Tissue Injuries; Technetium Tc 99m Medronate

To determine whether temporal changes in scintigraphic and bone radiographic findings have prognostic significance in patients with skeletal metastases from breast cancer.. Clinical information and films were retrospectively reviewed in 101 randomly selected patients with skeletal metastases. Images from sequential bond scans and bone radiographs were correlated with survival after detection of the metastases.. 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 of regressive disease vs 3.7 +/- 1.9 years for stable disease and 2.2 +/- 1.3 years for progressive disease; p < 0.001).. 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.

Topics: Adult; Aged; Analysis of Variance; Bone Neoplasms; Breast Neoplasms; Disease Progression; Female; Follow-Up Studies; Forecasting; Humans; Middle Aged; Osteosclerosis; Outcome Assessment, Health Care; Prognosis; Radiography; Radionuclide Imaging; Remission Induction; Retrospective Studies; Survival Rate; Technetium Tc 99m Medronate; Treatment Outcome

Although bone scintigraphy is an extremely sensitive method for the detection of focal bone disease, small lesions below the resolution of planar imaging may be missed. This is a report of a patient with carcinoma of the breast who showed tumor progression 1 year after initial treatment. Complete evaluation was performed in order to detect the origin of increased level of a tumor marker. Although planar bone scintigraphy could not demonstrate any lesion in the spine, multiple metastases were detected in the lumbar and the thoracic spines on SPECT imaging. Only some of these lesions were seen with MRI. Repeat planar bone imaging 6 weeks later showed multiple bone lesions in the lumbar and thoracic areas.

Topics: Adenocarcinoma; Biomarkers, Tumor; Breast Neoplasms; Female; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Middle Aged; Mucin-1; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, Emission-Computed, Single-Photon

Topics: Aged; Breast Neoplasms; Diagnosis, Differential; Female; Femoral Neoplasms; Humans; Neurilemmoma; Peripheral Nervous System Neoplasms; Radionuclide Imaging; Sciatic Nerve; Technetium Tc 99m Medronate

A patient with diffuse osteoblastic metastases from invasive lobular carcinoma of the breast is presented in whom radionuclide bone scan was negative for skeletal lesions. Skeletal metastases were documented by plain radiography, CT, MRI, and bone marrow biopsy. This case report points to the value of plain-film, CT, and MRI findings in situations of high clinical suspicion of metastatic disease despite a normal scintigraphy.

Topics: Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Carcinoma, Lobular; False Negative Reactions; Female; Humans; Magnetic Resonance Imaging; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Bone and Bones; Breast Neoplasms; Female; Humans; Mammography; Middle Aged; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Retention of 99mTc-MDP in the fetal skeleton and placenta at 30 and 32 wk gestation was observed during bone scan examination of the maternal skeleton for staging of malignant tumors. The implications and significance of these observations are discussed.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Female; Fetus; Gestational Age; Giant Cell Tumor of Bone; Humans; Infant, Newborn; Male; Placenta; Pregnancy; Pregnancy Complications, Neoplastic; Radiation Dosage; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibia

46 patients with recently diagnosed carcinoma of the breast were included in a prospective comparative study of MRI and bone marrow scintigraphy. The aim of the study was to compare these procedures within a histologically unified patient collective. It was shown that MRI was superior to bone marrow scintigraphy in respect of sensitivity (92% vs 58%) and specificity (97% vs. 85%), although only about three quarters of the marrow spaces are examined by MRI screening. Bone marrow scintigraphy suffered particularly from a relatively high number of false positive findings (haemangiomas, degenerative changes). MRI remains the method of choice for investigating the bone marrow.

Topics: Bone Marrow; Bone Neoplasms; Breast Neoplasms; Carcinoma; Evaluation Studies as Topic; False Negative Reactions; False Positive Reactions; Female; Humans; Magnetic Resonance Imaging; Neoplasm Staging; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate; Whole-Body Counting

Topics: Breast Neoplasms; Delayed-Action Preparations; Female; Goserelin; Humans; Middle Aged; Radiography; Spinal Neoplasms; Technetium Tc 99m Medronate

In clinical practice, it may be difficult to distinguish a metastatic bone superscan appearance from a normal bone scan. To determine if assessment of bone marrow is helpful in the diagnosis of bone invasion in patients with suspected bone superscans, the authors performed antigranulocyte antibody bone marrow scans in 10 consecutive cancer patients who had a conventional bone scan interpreted as metastatic superscan appearance. All patients presented with bone marrow scans showing marked absence of tracer uptake in the central skeleton suggesting tumour replacement. Laboratory tests showed decreased peripheral blood cells in 9 patients. Bone radiographs showed metastatic involvement with diffuse osteoblastic lesions in 9 patients. Antigranulocyte bone marrow scans show extensive bone marrow invasion in cancer patients with suspected bone superscans. This result reinforces the concept of these patients having extensive bone invasion despite mild abnormalities in the bone scan. Confirmation of extensive bone invasion on patients with suspected bone superscans may contribute to a proper staging of these patients.

Topics: Adult; Aged; Aged, 80 and over; Bone Marrow; Bone Neoplasms; Breast Neoplasms; Female; Granulocytes; Humans; Male; Middle Aged; Prostatic Neoplasms; Radioimmunodetection; Technetium Tc 99m Medronate

Because of their high affinity for bone, bisphosphonates are used both in the treatment of benign and malignant bone disease and in radiopharmaceutical bone imaging. A prospective study was undertaken to evaluate whether intravenous clodronate (dichloromethylene bisphosphonate) therapy might affect the results of bone scintigraphy with 99mTc-labeled methylene diphosphonate (MDP). In 11 female patients with breast cancer and metastatic bone disease, quantitative bone scans were obtained using a region of interest (ROI) method on Days 0 and 22. After intravenous clodronate therapy from Day 1 to Day 21, all metastatic bone lesions were still detectable, and median ROI ratios did not differ to a statistically significant extent from baseline values. Serum calcium levels decreased (p = 0.0449), whereas parathyroid hormone concentrations showed an increase (p = 0.0053). Mean serum levels of creatinine, inorganic phosphorus, osteocalcin, gamma glutaminyl-transpeptidase and alkaline phosphatase remained unchanged. However, a more than twofold rise in the serum activity of alkaline phosphatase was measured in three patients. We conclude that 3 wk of intravenous clodronate treatment did not impair the sensitivity of 99mTc-MDP bone scintigraphy in detecting bone lesions in patients with metastatic breast cancer.

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Clodronic Acid; False Negative Reactions; Female; Humans; Middle Aged; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate; Time Factors

In a patient with breast tumor, 99mTc-HMDP accumulation in the tumor was recognized in evaluating bone metastasis. Surgery and histopathology revealed that the tumor was a phyllodes tumor. This scintigraphic finding was thought to be rare and phyllodes tumor should be included in differential diagnosis when 99mTc-HMDP accumulation in the breast was recognized.

Topics: Breast Neoplasms; Female; Humans; Middle Aged; Phyllodes Tumor; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

While meningiomas are common intradural tumors, such lesions only rarely arise outside of the meninges. All meningiomas, however, may slowly enlarge causing concern for malignancy. We report the appearance of an intraosseous meningioma in the patient with a history of breast carcinoma where the lesion progressively enlarged over a period of 5 yr to reach approximately three times the original size.

Topics: Adult; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Diagnosis, Differential; Female; Humans; Meningioma; Neoplasms, Second Primary; Radionuclide Imaging; Skull Neoplasms; Technetium Tc 99m Medronate; Time Factors

Topics: Adult; Breast Neoplasms; Female; Humans; Lung Neoplasms; Phyllodes Tumor; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

Combined Tc-99m MDP skeletal imaging and Tc-99m(V) DMSA whole body scans to detect metastases were performed during the follow-up of 30 patients who underwent surgery for breast carcinoma. Eight patients had normal Tc-99m MDP and Tc-99m(V) DMSA scans and were declared free of metastatic disease, further confirmed by no change in symptomatology over a 1-year follow-up period. Twenty-two patients had positive Tc-99m MDP scans with varied skeletal involvement. Tc-99m(V) DMSA scans showed matched areas of increased radiotracer concentration in bony metastases in 20 of these patients. Tc-99m(V) DMSA concentration was not seen in traumatic vertebral collapse or in coexistent osteoarthritic disease in vertebral metastatic involvement. Interestingly, Tc-99m(V) DMSA showed increased concentration in brain and liver metastases. Pentavalent Tc-99m(V) DMSA appears useful for detecting skeletal and soft-tissue metastases in breast carcinoma, and can improve the specificity of Tc-99m MDP bone scans in screening for bone metastases.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Evaluation Studies as Topic; Female; Humans; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sensitivity and Specificity; Soft Tissue Neoplasms; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate

Breast cancer incidence rates in Japan have more than doubled in the decade between 1975 and 1985 due to a well-established and affluent Western life-style. One hundred patients having breast cancer, 107 patients having mastectomies, and 243 patients having no breast cancer were reviewed for whole body and spot views of bone scintigraphy with 99mTc-MDP. The frequency of positive breast uptake in patients with no breast cancer showed a maximum in those patients between the ages of 30 and 40, with a progressive rise and fall before and after the peak, respectively. Patients between the ages of 50 and 60 with breast cancer showed a maximum uptake of 83%, while those patients between the ages of 70 and 80 with breast cancer showed an uptake higher than 50%. There was a markedly higher breast uptake ratio in the breast cancer group compared to the breast cancer free group. Although this scanning agent was of no value in recognition of tumor localization from breast uptake, we have to suspect a high incidence of cancer existence whenever there was unilateral increased breast activity. Even though the mechanism of 99mTc-MDP uptake by breast tissue is unknown, breast concentration of 99mTc-MDP appears to be influenced by hormones, especially estrogen.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone and Bones; Breast; Breast Neoplasms; Child; Female; Humans; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

1725 bone scans, done for evaluation of metastatic involvement from malignant neoplasms, were reviewed. The fraction of positive scans (multiple lesions in the bone scan) was 34% of the patients with different malignancies. In 251 patients (12%) a single bone lesion was detected and 114 of these patients were followed-up and re-scanned once or twice within 1 to 4 years. 39 of the 93 patients with solitary bone lesion who on follow-up developed multiple lesions had carcinoma of the breast as the primary.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Child; Humans; Jordan; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

Etidronate disodium (EHDP) therapy is often instituted emergently for treatment of hypercalcemia associated with malignancy, and a staging bone scan is part of the evaluation of the patient with extensive metastatic disease. In these patients in whom high dose EHDP therapy has been instituted, uptake of the bone scan agent is markedly diminished. The case presented illustrates this finding: a breast cancer patient who had received two 500-mg intravenous doses of EHDP prior to bone scan staging. No skeletal visualization was present at 3 hr after 99mTc-MDP injection. Blood-pool activity and uptake in large metastatic sites were observed.

Topics: Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Carcinoma, Squamous Cell; Drug Interactions; Etidronic Acid; Female; Humans; Hypercalcemia; Radionuclide Imaging; Technetium Tc 99m Medronate

We discuss three cases irradiated to their bone metastases. 99mTc-MDP bone scan before irradiation showed normal uptake in the lesions. In all the cases, the irradiation therapy was effective, but focal increased uptake area corresponding to the site of bone metastasis was revealed by the follow-up bone scan one to three months after irradiation. We concluded that the change of tracer uptake was so-called flare in formerly false negative lesion. The cause of this phenomenon was considered either elevation of osteoblastic activity with control of tumor or progression of osteolysis until tumor got well-controlled.

Topics: Aged; Bone and Bones; Bone Neoplasms; Bone Resorption; Breast Neoplasms; Carcinoma, Squamous Cell; Esophageal Neoplasms; False Negative Reactions; Female; Humans; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Breast Neoplasms; Female; Humans; Mastectomy, Modified Radical; Middle Aged; Postoperative Complications; Radionuclide Imaging; Ribs; Technetium Tc 99m Medronate

In a double-blind, prospective study, the authors analyzed bone scintigrams and magnetic resonance (MR) images of the spine in 71 patients with histologically proved skeletal metastases. Bone scintigrams and MR images were separately reviewed by four independent observers. Bone scintigraphy permitted identification of 499 abnormal vertebrae and MR imaging, 818 abnormal vertebrae. MR imaging depicted additional abnormal vertebrae in 49 patients. The authors conclude that MR imaging is more sensitive than bone scintigraphy in detection of vertebral metastases.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy; Bone Marrow; Breast Neoplasms; Double-Blind Method; Female; Gamma Cameras; Humans; Lung Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate

Bone scanning plays a pre-eminent role in tumor staging procedures, but its reliability is often questioned because of the high incidence of false positive results; not even bone biopsy can always clarify these questionable findings. To verify what actually becomes of the pathological hot spots lacking radiological evidence, we studied 49 patients with this discrepancy and followed them for an average period of 10 years (range: 8-11). The patients were divided into 3 subgroups: 1) 13 N+ patients with multiple hot spots (greater than 2) (N+ IM); 2) 24 N+ patients with single hot spots (less than or equal to 2) (N+ IS); 3) 12 N- patients with single hot spots (less than or equal to 2) (N- IS). Bone metastasis-free survival rate (SLMO) was calculated, which was confirmed by radiology, and overall survival rate (SG). SLMO was considered to coincide with the percentage of "true" false positives. At 10 years SLMO was 7%, 65%, and 83%, whereas SG was 15%, 70%, and 90%, respectively, in the 3 subgroups N+ IM, N+ IS, and N- IS. The Log-rank test demonstrated a highly significant difference (p less than 0.001) between SLMO and SG in these subgroups, due to the poor prognosis of N+ IM patients. The cumulative examination of all N+ N- patients with single hot spots (36 patients) demonstrated 75% probability of "true" false positives at 10 years. Moreover, the risk of bone metastases resulted higher in the hot spots of the spine than in those of the skull and ribs. The possible role is discussed of microfractures and bone traumatisms in the genesis of "true" false positives.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; False Positive Reactions; Female; Follow-Up Studies; Humans; Middle Aged; Prognosis; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Whole-Body Counting

Scintigraphic, radiologic, and clinical follow-up findings were reviewed in cases in which bone scans (n = 301) showed one or two new abnormalities in patients with malignancy but no known metastases. Metastatic disease was confirmed for 25 of 231 scans (11%) with one new abnormality and for 17 of 70 scans (24%) with two new abnormalities. The prevalence of metastases was 0.06 to 0.13 for lesions in all regions of the skeleton, except the sternum (three of six) and the pelvis (10 of 32). On follow-up scans, in the absence of an interval change in therapy, 19 of 21 metastases became more intense, whereas most benign abnormalities either remained unchanged (47%) or resolved (41%). Benign lesions in the ribs, extremities, and pelvis generally resolved within 12-24 months, while most benign skull and spine abnormalities were still apparent after 35-58 months of follow-up.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Lung Neoplasms; Radionuclide Imaging; Ribs; Skull Neoplasms; Spinal Neoplasms; Technetium Tc 99m Medronate

To evaluate the incidence of a positive bone scan at presentation in women with primary breast cancer, 389 consecutive 99Tcm bone scans over a ten-year period (1978-87) were retrospectively and blindly reviewed by a single observer. The study comprised all women clinically staged I-III (UICC criteria) and irradiated with radical intent in the Professorial Unit of Radiotherapy at this institution. The initial scan was performed within six weeks of primary surgery, and was judged to show metastatic disease in only 24/389 (6%) overall. The incidence of a positive scan increased with stage from 2/80 (2.5%), and 9/226 (4%) to 13/83 (16%) for stages I, II, and III respectively. Pre-operative haemoglobin, serum alkaline phosphatase level, age, menstrual status and degree of nodal involvement were not significantly associated with the risk of a positive scan. Patients found to have a positive scan experienced a significantly shorter overall survival than those with a normal scan (p greater than 0.001). After a mean follow-up time of 46 months (range 3-120 months), 45/365 originally normal scans 15% had converted to an abnormal scan, and a further 32 patients developed radiological evidence of bone metastases.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Female; Humans; Menopause; Middle Aged; Radionuclide Imaging; Retrospective Studies; Risk Factors; Survival Rate; Technetium Tc 99m Medronate; United Kingdom

Two hundred and two patients with bone pain from metastatic cancer were treated with 40 microCi/kg of Sr-89. Patients were followed with pain diaries, records of medication taken, sleep patterns, serial bone scans and a Karnofsky Index. One hundred and thirty-seven patients with adequate followup survived at least 3 months, including 100 with prostate and 28 with breast carcinoma. Eighty of the 100 patients with prostate cancer responded, and 25 of the 28 breast cancer patients improved. Ten patients with prostate cancer and five with breast cancer became pain free. Little hematologic depression was noted. Sr-89 kinetic studies showed that strontium taken up in osteoblastic areas remained for 100 days. The tumor-to-marrow absorbed dose ratio was 10:1.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Pain, Intractable; Palliative Care; Prostatic Neoplasms; Radionuclide Imaging; Strontium Radioisotopes; Technetium Tc 99m Medronate

In this article, the authors present their experience with the diagnosis of bone metastases in patients with breast cancer using bone scintigraphy with 99mTc phosphonate and radioimmunological determination of carcinoembryonic antigen (CEA) and tissue polypeptic antigen (TPA). In a group of 395 patients, there was agreement between tumour markers (CEA, TPA) and the results of bone scintigraphy in 331 cases (84%)--negative in 193 cases (49%) and positive (i.e. in terms of bone scintigraphy results and the presence of at least one tumour marker) in 138 cases (35%). On the basis of this good agreement of the results between bone scintigraphy and CEA and TPA levels, the authors recommend the following algorithm in monitoring patients with breast cancer: follow-up of tumour markers at several-month intervals and, any increase in their levels will refer the patient to further examination using imaging techniques including bone scintigraphy.

Topics: Biomarkers, Tumor; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Carcinoembryonic Antigen; Female; Humans; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Of 628 patients with extra-osseous malignancies diagnosed by surgery and/or pathology, 207 (33.0%) were identified as having skeletal metastasis by bone imaging. There was statistical significant difference in the incidence of metastasis in in different malignancies (P less than 0.02). The metastatic rates of nasopharyngeal, lung, prostate and breast cancers were higher than gastrointestinal, kidney, and other malignancies. There was significant differences in the different sites of skeletal metastasis (P less than 0.01). They were thorax, spine, pelvis, limbs and skull in order of incidence. Solitary metastatic rate was 15.9%. Biopsy is advised for patients suspected to have metastatic disease but with only one single "hot spot" in skeletal imaging, particularly in the rib.

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Humans; Lung Neoplasms; Male; Nasopharyngeal Neoplasms; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Tc-99m-HMDP bone imaging was performed in 114 patients with various carcinomas. Ninety-four patients gave positive results. In 65 patients, bone imaging was compared with radiograms. The two methods were both positive in 40 patients (62%). Of these 65 patients, 17 (26.1%) had negative radiograph but positive bone imaging. Bone metastases were mainly found in the axial skeleton. It is important to differentiate bone fracture from metastasis when only one single lesion is found. The best differentiation is bone imaging follow-up.

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Humans; Lung Neoplasms; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Ribs; Technetium Tc 99m Medronate

A patient with breast metastases is presented showing increased nodular renal uptake of tracer on bone scintigraphy that also demonstrated rib metastases and a large metastasis in the pelvis. However, vertebral body metastases were not shown when clearly demonstrated on CT with even partial compression on a thoracic spine film. Most of the renal lesions were hypoechoic on sonography, showed hypoattenuation areas on plain CT and after contrast enhancement but no calcification could be demonstrated. This case once again illustrates the value of scrutinizing the soft tissues on scintigraphy but also the possibility of showing some metastases on CT not visible on scintigraphy.

Topics: Adult; Bone and Bones; Breast Neoplasms; Female; Humans; Kidney; Kidney Neoplasms; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Ultrasonography

Radionuclide bone scans in two patients with breast cancer and concurrent chemotherapy treatment revealed increased band-like uptake of [99mTc]methylene diphosphonate along the medial upper renal cortex corresponding to the portions of the kidneys included within the radiation field. The latency of onset of abnormal uptake was 5 to 9 mo following completion of radiation in one patient, peaked near 13 to 14 mo for both patients, and returned to baseline after 20 to 27 mo. Transient serum creatinine level elevations were also detected. These findings suggest that transient subclinical renal impairment may occur and be detected on bone scans following inadvertent inclusion of renal cortex in radiation fields.

Topics: Breast Neoplasms; Female; Humans; Kidney; Middle Aged; Radionuclide Imaging; Radiotherapy; Spinal Neoplasms; Technetium Tc 99m Medronate

The bone scan findings of 160 consecutive cases of breast cancer metastatic to bone presenting to Guy's Hospital between 1982-1987 were retrospectively assessed for number and distribution of lesions. Twenty-one percent of patients relapsed with a solitary bone metastasis. The spine was the commonest site for both solitary (52% of cases) and multiple (87%) metastases. Solitary bone metastases are more common than previously thought.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate

The detection of focal pathology on a bone scan is dependent on the contrast between uptake in a lesion compared with the affinity of the scanning agent for the surrounding normal bone. Dimethyl-amino diphosphonate (DMAD) has a relatively low uptake in normal bone compared with methylene diphosphonate (MDP). We have compared the bone scan appearance with MDP and DMAD in 11 patients with multiple bone metastases from breast cancer. The median time between scans was 7 days (range 6 to 14). In two patients additional lesions were identified on the DMAD scan. No additional lesions were visible on the MDP scans. In five patients some lesions were visualized more clearly with DMAD and others with MDP. In six patients no differences were seen. Anatomical resolution was generally less clear with DMAD and precise anatomical localization was sometimes impossible. We have demonstrated superior lesion detection with DMAD. The clinical value of this for the detection of early relapse of disease in the skeleton requires further study.

Topics: Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Middle Aged; Organometallic Compounds; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Full-length skeletal scintiscans were acquired onto a data processor in a series of 256 X 256 matrices. A series of interactive computer programs enables the operator to select profiles down the spine and to standardize them by interpolation to a standard length and by normalization to a given count level. The counts within any section of a profile can then be calculated and the profile examined for any significant deviation from a reference 'normal' curve. In a study of 68 patients, 66% of the spinal profiles were judged abnormal, compared with 26% of scans assessed by visual inspection alone. Of 14 patients with positive profiles and negative or equivocal visually assessed scans, 11 had developed metastases within 14 months of the scan. All five patients with positive profile and raised alkaline phosphatase have died of metastatic disease. The technique appears to increase the sensitivity of bone scintigraphy.

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Reference Values; Software; Spine; Technetium Tc 99m Medronate

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Humans; Lung Neoplasms; Male; Pain; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Isolated scintigraphic sternal lesions are rare. In a retrospective review of the bone scan results of 1,104 patients with breast cancer, 34 individuals (3.1%) presented with this abnormality. Of these foci, 26 (76%) were found to represent metastatic disease. There did not appear to be a relationship with axillary lymph node metastasis, the quadrant involved by primary breast tumor, or selected serum chemistries. These sternal lesions may be associated with regional lymphatic tumor spread rather than hematogenous seeding and therefore could be considered a local recurrence.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Radionuclide Imaging; Retrospective Studies; Sternum; Technetium Tc 99m Medronate

The significance of skeletal scintigraphy in staging of early breast cancer is still controversial. The results of bone scanning with 99Tcm diphosphonate and clinical examination in 204 patients with stage I-II breast cancer are reported. Bone scans were positive in 28 cases. However, only one was true positive as confirmed by x-ray examination and/or biopsy, with a detection rate of 0.5%. Physical examination had a detection rate similar to bone scan, but with superior specificity. In our experience bone scan cannot be recommended as a routine staging test in early breast cancer.

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Breast Neoplasms; Female; Humans; Middle Aged; Neoplasm Staging; Postoperative Care; Preoperative Care; Radionuclide Imaging; Technetium Tc 99m Medronate

Baseline staging bone scans in 1,267 consecutive women with breast cancer attending a single clinic between 1980 and 1986 were reviewed. 0.3% of patients with T1, 3% with T2, 8% with T3, 13% with T4 tumors and none of those with Stage 1, 3% with Stage 2, 7% with Stage 3, and 47% with Stage 4 disease had a positive scan due to bone metastases. Two hundred eight-nine (23%) had bone scan abnormalities secondary to radiologically confirmed benign bone disease. In 20 patients, no cause for a bone scan abnormality could be found after a median follow-up of 3.50 yr, a false-positive frequency of 1.6%. The false-negative rate was 0.08%. It is concluded that patients with tumors less than 2 cm are most unlikely to have a positive scan. In this instance, scans are not required routinely. However, we recommend a baseline scan in all patients with Stage 2, 3, or 4 disease.

Topics: Bone Neoplasms; Breast Neoplasms; Evaluation Studies as Topic; Female; Humans; Neoplasm Staging; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Aged; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Female; Fractures, Spontaneous; Humans; Ilium; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Female; Humans; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, X-Ray Computed

Topics: Bone Neoplasms; Breast Neoplasms; Extravasation of Diagnostic and Therapeutic Materials; Female; Humans; Kidney; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

To evaluate the use of radionuclide bone scan in staging patients with primary and local-regional recurrence of breast cancer, we reviewed the results in 265 patients with primary breast cancer who had the scan either preoperatively or within 6 weeks of surgery, and in 39 patients presenting with their first local-regional recurrence. All patients were clinically staged according to the revised 1983 criteria of the American Joint Committee for Cancer Staging and End-Results Reporting. None of the 92 with stage I and four of 95 patients with stage II had a positive scan. Eleven of 41 with stage IIIA and 13 of 37 with stage IIIB had a positive bone scan. In patients with their first local-regional recurrence, 12 of 39 had a positive scan. Follow-up scans were available in 61 patients with clinical stage I and II breast cancer who had adjuvant chemotherapy for pathological involvement of axillary node. There were six conversions observed in 61 scans obtained during the first year. Seven converted in follow-up scans in 47 patients in the second year. We conclude that although bone scans have a low positive yield in stage I and II breast cancer, their use in the preoperative setting and in the follow-up of patients with axillary node involvement detects early converters. Bone scans are justified in stage IIIA and IIIB breast cancer and in patients being evaluated for local-regional recurrence.

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Lymphatic Metastasis; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Radionuclide Imaging; Technetium Tc 99m Medronate

Radionuclide scanning is usually contraindicated in pregnancy because of the danger of fetal radiation exposure. Radionuclide bone scanning with Tc-99m MDP is a sensitive indicator of early osseous metastases in breast cancer. Three cases of breast cancer during pregnancy are reported; modified bone scanning was utilized for staging and decision analysis. Modifications of bone scanning techniques to minimize fetal radiation exposure and fetal dosimetry calculations are described.

Topics: Abdomen; Adult; Bone Neoplasms; Breast Neoplasms; Female; Fetus; Humans; Pregnancy; Pregnancy Complications, Neoplastic; Radiation Dosage; Radionuclide Angiography; Technetium Tc 99m Medronate

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Female; Humans; Middle Aged; Radionuclide Imaging; Sternum; Technetium Tc 99m Medronate

Seventy-nine cases with known carcinoma of the lung or breast who underwent both bone marrow aspiration and Tc-99m MDP bone scintigraphy were reviewed. The bone images were assessed for the presence of the pattern of bone marrow expansion which is visualized by diffuse increased metaphyseal activity, particularly evident at the knees, ankles, and elbows. This pattern was found to be an insensitive marker for the presence of marrow metastases (sensitivity 15%). The specificity of the finding was 86%. When diffuse increased metaphyseal activity is present on a Tc-99m MDP bone scan in a patient with malignant disease, the possibility of bone marrow metastases should be pursued by marrow aspiration and biopsy.

Topics: Biopsy, Needle; Bone and Bones; Bone Marrow; Bone Neoplasms; Breast Neoplasms; False Positive Reactions; Humans; Lung Neoplasms; Neoplasm Metastasis; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

The sensitivity and specificity of bone marrow scintigraphy in demonstrating skeletal metastases was examined in 40 patients with focal metastases. Radiology and MDP scintigraphy were used as reference methods. Sensitivity depends on the region of the skeleton. False negatives are the rule in parts of the skeleton containing little bone marrow. In relation to the entire bone marrow content, sensitivity is 0.64. The high proportion of false negatives (36%) in the presence of confirmed metastases and the incomplete demonstration of the bone marrow makes marrow scintigraphy unsuitable as a screening method. Occasionally lesions confined to the marrow can be demonstrated when radiographs and bone scintigrams are still negative. In advanced cases, marrow scintigraphy can demonstrate the extent of destruction of the bone marrow. Demonstration of displacement or of an 'empty bone' is evidence of invasion of the bone marrow in patients with tumours. In patients with reduced haematopoiesis of unknown origin or unidentified diffuse skeletal uptake, bone marrow scintigraphy may provide valuable information.

Topics: Adult; Aged; Bone Marrow; Bone Neoplasms; Breast Neoplasms; False Negative Reactions; False Positive Reactions; Female; Hodgkin Disease; Humans; Lymphoma; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Medronate

A series of 315 patients with histologically proven breast cancer had skeletal scintigraphy performed for defined reasons other than initial staging. Of these, 173 (55%) were found to be abnormal. The yield of abnormalities was highest (83%) in patients with bone pain or tenderness and radiographic evidence of metastases: 38% in those with bone pain or tenderness alone, 37% in asymptomatic patients with local or regional recurrence and 54% in those with non-bony metastases. The overall actuarial survival over a maximum follow-up of 9 years was significantly worse for those with abnormal scintigraphy. Non-staging skeletal scintigraphy is useful in detecting asymptomatic bone metastases at the time of local or regional recurrence or in the presence of non-bony metastases.

Topics: Actuarial Analysis; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Etidronic Acid; Follow-Up Studies; Humans; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Data on 1,601 patients with node-positive operable breast cancer who were randomized in four different prospective adjuvant therapy trials were analyzed to evaluate the role of routine bone scans and the alkaline phosphatase value at regular intervals in screening for bone involvement. Bone scan was a prerequisite for randomization and was repeated within the first 12 months in 90% (1,441) of the patients. Abnormal or doubtful scan findings had to be verified by x-ray examination. The repeated scan results were normal in 1,263 (87.8%) patients, doubtful but with no radiologic evidence of bone metastasis in 161 (11%), and abnormal (radiologically confirmed) in 17 (1.2%). After a median observation of 4 years bone metastases as the first relapse developed in 136 (8.5%) patients. This occurred in 87 of 1,263 (6.9%) of the patients with normal repeated scan results and in 18 of 161 (11.2%) of those with doubtful repeated scan findings. Based on the results of the first repeated scan, early detection of a first recurrence in bone might have been possible for 2.4% of the population. Serum alkaline phosphatase levels were also without clinical use. Bone scan in the observation of patients with operable breast cancer should be performed only as dictated by the clinical situation.

Topics: Alkaline Phosphatase; Bone Neoplasms; Breast Neoplasms; False Positive Reactions; Female; Follow-Up Studies; Humans; Liver Neoplasms; Risk; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Two cases are reported in which bone imaging with Tc-99m MDP showed sternal areas without tracer uptake corresponding to bone metastases compromising blood supply to the sternum itself. Radiographs were normal in both cases.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Carcinoma, Bronchogenic; Female; Humans; Lung Neoplasms; Male; Neoplasms, Multiple Primary; Radionuclide Imaging; Sternum; Technetium Tc 99m Medronate

Bone lesions with a ring-shaped appearance (the doughnut sign) have been encountered during routine reporting of bone scintigrams performed on patients with multiple myeloma. Such a ring-shaped appearance has been revealed in four (8%) of the last 50 bone scintigrams performed on patients with myeloma at the Royal Marsden Hospital. In contrast, a review of the last 300 bone scintigrams performed on patients with bone metastases failed to reveal any such ring-shaped appearance. Examination of the case notes and radiographs of the multiple myeloma patients did not reveal any correlation between the presence of the ring-shaped appearances and the histology, biochemistry, treatment, or course of the disease nor were any specific radiographic features noted. Three of the four patients have had local radiotherapy to the sites of the lesions. We conclude that the ring-shaped appearance on bone scintigrams is usually related to myelomatous bone lesions, particularly following local radiotherapy to these lesions. The reason for this appearance in three of the four scintigrams may be the stimulation of vascularity and osteoblastic activity around the periphery of the myelomatous lesions by the response of the lesions to radiotherapy.

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Lung Neoplasms; Male; Multiple Myeloma; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Breast Neoplasms; Female; Humans; Neoplasm Staging; Radionuclide Imaging; Receptors, Estrogen; Technetium Tc 99m Medronate

A bone image demonstrating a "photopenic" vertebral lesion was found to be caused by tumor infiltration of adjacent muscle and probable secondary osseous ischemia. Magnetic resonance imaging was valuable in detecting the muscle abnormality.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Muscles; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

Adverse allergic reactions to radiopharmaceuticals are rare but have been documented in the literature. This report presents data consistent with a definite adverse reaction to the radiopharmaceutical [99mTc]MDP.

Topics: Bone Neoplasms; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Diphosphonates; Drug Hypersensitivity; Female; Humans; Lung Neoplasms; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors

A comparison is made between the sensitivity of detection of focal abnormalities in radionuclide bone images by visual examination and by using simple quantification. The quantitative method calculates the ratio of radiopharmaceutical uptake in a region of interest drawn around a lesion to that in an area of normal bone. Quantification is found to be far more sensitive than visual examination in detecting focal metastases. The use of "baseline" images improved the precision of quantitation of rib lesions, but appeared not to alter the sensitivity of visual detection. This method of quantification is therefore limited more by the inability of observers to notice suspicious areas to which it should be applied than by inaccuracies inherent in the method itself. Further work should concentrate more on image enhancement than on improving quantitative techniques.

Topics: Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Radionuclide Imaging; Ribs; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate

Topics: Arm; Breast Neoplasms; Diphosphonates; Female; Humans; Lymphedema; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Thorax

From a series of technetium-99m labelled agents based on a vicinal diphosphonic acid structure, the ligand 1,2-diphosphonoethyleneglycol (DPEG) was selected for clinical study on the basis of a biodistribution in rats which compared well with that of methylene disphonphonate (MDP). The 99Tcm-DPEG agent was assessed in ten patients in whom bone metastases had been demonstrated by 99Tcm-MDP imaging two to seven days previously. Visual comparison of the skeletal images obtained with the two agents revealed the same number of bone metastases at the same locations. Statistical analysis of the data revealed no significant differences between the two radiopharmaceuticals on the basis of lesion to soft tissue ratio and lesion to normal bone ratio, although a slightly higher lesion to soft tissue ratio was found for MDP than for DPEG (p less than 0.03). At least for the formulation tested, it is concluded that this new radiopharmaceutical based on the P-C-C-P structure does not possess diagnostic advantages over 99Tcm-MDP for the detection of bone metastases.

Topics: Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Lung Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

127 breast scans were performed on 83 female patients using technetium-99m diphosphonate. 46 out of 48 patients with breast cancer had positive breast scans manifested by a focal increased uptake in 37 patients and a diffuse increased uptake in the remaining 9 patients. Benign breast lesions such as fibrocystic disease, fibroadenoma and fat necrosis may also concentrate the radioactive agent in a focal or a diffuse pattern. So breast scanning is a sensitive though nonspecific modality to detect malignant breast lesions and it is worthwhile performing it on all women referred for bone scan.

Topics: Breast; Breast Neoplasms; Evaluation Studies as Topic; Female; Humans; Mammography; Radionuclide Imaging; Technetium Tc 99m Medronate

The diagnostic contribution of single photon emission tomography for detection of bone lesions of the skull was explored in 125 cases and compared with planar imaging. Twenty-one localizations (16% of the total group) were only visualized by scintitomography, these were predominantly lesions of the base of the skull and facial bones. Scintitomography gave a false negative result in only one lesion out of 49 visible on skull radiographs. Together with the revelation of unsuspected bone abnormalities, SPECT generally provides a better visualization of the skull lesions and their extent than does planar imaging. In cases where disease of the facial bones and the base of the skull is suspected, scintitomography is an indispensable adjunct to planar scintigraphy.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Maxillary Sinus Neoplasms; Middle Aged; Organ Specificity; Skull; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Accumulation of Tc-99m labeled phosphonate bone scanning agent in a pleural effusion usually shows a mild and diffuse increase in radioactivity of the involved thorax. A malignant neoplasm was thought to account for this accumulation. The photon deficiency of the hemithorax on Tc-99m HMDP bone scintigraphy was shown in a case of massive pleural effusion, which was proved by autopsy to be due to metastatic breast carcinoma in the pleura. Two factors caused these scintigraphic findings: 1) a large amount of fluid in the pleural cavity caused photon attenuation; 2) the higher body background in the noninvolved hemithorax and other areas of the body was due to renal dysfunction resulting from chronic pyelonephritis. Whether the accumulation of the radiopharmaceutical agent in the pleural effusion was malignant or benign could not readily be distinguished.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Female; Humans; Pleural Effusion; Radionuclide Imaging; Technetium Tc 99m Medronate; Thoracic Neoplasms

A retrospective review of 2,851 bone scans done at a cancer center over a period of 4 yr revealed 41 patients having a single abnormality in a rib as their first abnormal scintigraphic finding. The scan findings in these cases were correlated with clinical, scintigraphic, and radiographic follow-up to ascertain their etiology and course. Four lesions (9.8%) were due to malignant disease, 16 (39%) were associated with benign fractures demonstrated on x-ray, 11 (27%) were associated with primary or postoperative radiation therapy. The remaining ten patients (24.2%) with normal x-rays and no association with radiation therapy or subsequent development of metastasis were assigned to benign etiology. This experience suggests that solitary rib lesions in cancer patients are uncommon and are most frequently (90%) associated with benign etiology.

Topics: Bone Diseases; Bone Neoplasms; Breast Neoplasms; Humans; Lung Neoplasms; Neoplasm Invasiveness; Neoplasms; Radionuclide Imaging; Radiotherapy; Retrospective Studies; Rib Fractures; Ribs; Technetium Tc 99m Medronate

After radiation therapy regional 99mTc-MDP clearance by 17 metastatic lesions was determined repeatedly in 13 patients. 99mTc-MDP clearance rates decreased within 14 weeks after irradiation of osteoblastic metastases, but were normalized in only one lesion. In osteolytic lesions 99mTc-MDP clearance increased 4 weeks after completion of radiation therapy indicating reossifications evident from X-ray examinations subsequently. 99mTc-MDP clearance decreased subsequently and returned to normal after 28-50 weeks in 6 out of 11 metastases demonstrating reossification on X-ray. Monitoring of radiation therapy of bone metastases should be adapted to these complex variations of tracer kinetics. The initial increase of tracer accumulation in osteolytic metastases due to bone repair should not be misinterpreted as a local progression of metastatic bone disease.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

In a retrospective study of 254 women with carcinoma of the breast (mean age 55.4 years) the occurrence of bone pain was compared with results of skeletal scanning, skeletal X-ray examinations and routine biochemical findings. Typical signs of skeletal metastases were found in bone scans of 119 patients, 88 (74%) of whom had bone pain. Alkaline phosphatase was elevated in 54 (45%), LDH in 32 (27%), and gamma-GT in 69 patients (58%). There was a statistical correlation between the number of affected skeletal parts and the absolute level of alkaline phosphatase (P less than 0.001) and of LDH (P less than 0.05). Skeletal scans gave no evidence of bone metastases in 36 patients who had bone pains. In this group of patients alkaline phosphatase was elevated in 4, LDH in 1 and gamma-GT in 12 patients. Routine scanning of 254 patients revealed skeletal metastases in 12% without any clinical symptoms. Bone pain and (or) increased activity of alkaline phosphatase occurred in 91% of patients with skeletal metastases. In our view, bone scan in the postoperative control of breast cancer is justified only after onset of clinical symptoms and (or) if there is an abnormally raised alkaline phosphatase activity.

Topics: Adult; Aged; Alkaline Phosphatase; Bone Neoplasms; Breast Neoplasms; Clinical Enzyme Tests; Diphosphonates; Female; gamma-Glutamyltransferase; Humans; L-Lactate Dehydrogenase; Middle Aged; Pain; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Medronate

Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Bone and Bones; Breast Neoplasms; Cisplatin; Diphosphonates; Esophageal Neoplasms; Humans; Kidney; Kidney Neoplasms; Radionuclide Imaging; Tamoxifen; Technetium; Technetium Tc 99m Medronate

In 87 patients with proved diagnosis and a normal or pathologic bone scan (BS) in addition a bone marrow scan (BMS) was performed using a 99mtechnetium-labelled microcolloid. The analysis of scintigraphic findings included those obtained by other investigations shows that in these selected patients a false normal or false positive interpretation would have been resulted in 18% performing the BS only. Both methods BS and BMS were capable of diagnosing the correct stage of disease in all patients. The results indicate an augmentation of diagnostic facilities by the BMS in diseases affecting bone or bone marrow.

Topics: Adult; Bone and Bones; Bone Diseases; Bone Marrow; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Hodgkin Disease; Humans; Lung Neoplasms; Male; Middle Aged; Myeloproliferative Disorders; Osteomyelitis; Osteosarcoma; Plasmacytoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Breast Neoplasms; Chondroma; Diphosphonates; Female; Humans; Humerus; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Serial bone scans, x-rays and records of bone pain were reviewed in order to determine the relative contributions of these parameters in the assessment of response of bone metastases to treatment. Twenty-seven patients with abnormal bone scans due to metastatic breast cancer were studied. Ten of the patients showed an early temporary flare on bone scan including five with apparent new lesions. Confirmation that such new lesions did not denote progressive disease was provided by subsequent improvement in symptoms and reduction in intensity and number of lesions on a follow-up bone scan, without any change in systemic therapy. Serial x-rays were found to be unreliable as a sole method for assessing response to therapy or disease progression, as in only seven of the 27 patients could a definitive radiological assessment of response be made. In only one patient did x-rays improve the accuracy of the scan by distinguishing between a healing flare and progressive disease. In contrast, this distinction was made in seven of the 10 patients on the basis of improvement in bone pain at the time of the flare. The other 3 patients had no bone pain prior to therapy or at the time of the flare. Tentative response criteria incorporating bone scan, x-ray and symptoms are suggested. The criteria incorporate recognition of the fact that new lesions appearing on a bone scan within six months of initiation of therapy may comprise part of a healing flare response.

Topics: Antineoplastic Agents; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Prognosis; Radiography; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Medronate; Time Factors

The bone-imaging agents MDP, DPD and HDP were compared radiochemically (only minor differences were found) in 12 patients with prostatic and 12 patients with breast carcinoma. Each patient received both MDP and either DPD or HDP. The scintigraphic examinations were compared visually and quantitatively. The uptake ratio normal bone/soft tissue was higher for DPD and HDP than for MDP. The ratio pathologic bone/normal bone was highest for MDP, particularly for prostatic carcinoma. The differences in this ratio for breast carcinoma were in general non-significant. The observed differences were minor and of little practical importance.

Topics: Aged; Bone and Bones; Breast Neoplasms; Chromatography, Gel; Diphosphonates; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Prostatic Neoplasms; Quality Control; Radiochemistry; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

We describe a patient with osteosarcoma of the breast with intense uptake by the primary tumour of 99m Tc-methylene diphosphonate on bone scan. This appearance on bone scan strongly suggests a diagnosis of osteosarcoma, and has diagnostic and therapeutic implications which are discussed.

Topics: Breast Neoplasms; Diphosphonates; Female; Humans; Middle Aged; Osteosarcoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Immune-deprived mice bearing HX99 human breast carcinoma xenografts were injected with a radiolabelled monoclonal antibody, LICR-LON-M8 (M8), to investigate the dependence of tumour localization on (i) tumour site and (ii) antibody radiolabel. No significant difference was found in the degree of localization of radio-iodinated M8 in subcutaneous, renal or intracranial xenografts, but a highly significant improvement in HX99 localization by M8 was recorded using an 111indium-DTPA conjugate of the antibody (111In-DTPA-M8), related to its rapid tumour uptake and blood pool clearance. Radio-iodinated or 111In-labelled M8 was given to 29 patients with breast cancer, 7 with primary tumours and 22 with metastases. Tumour localization was assessed by (i) examination of surgical specimens and (ii) antibody scans, which were compared with conventional X-rays and 99mTc-methylene diphosphonate (MDP) bone scans. Radiolabelled M8 localized preferentially in all primary tumours (radioactivity tumour: normal breast = 6.2 +/- 1.4 [mean +/- s.e.]). All ten patients with skeletal metastases had positive 111In-DTPA-M8 scans, but the correlation with X-rays and MDP scans showed a regional variation. Radio-iodinated M8 failed to identify metastases in any site. The favourable biodistribution of 111In-DTPA-M8 has led to the clear localization of breast carcinomas in patients and mice. In future such reagents may rationalize the clinical management of breast cancer.

Topics: Animals; Antibodies, Monoclonal; Breast Neoplasms; Diphosphonates; Evaluation Studies as Topic; Female; Humans; Indium; Iodine Radioisotopes; Mice; Mice, Inbred BALB C; Mice, Inbred CBA; Neoplasm Metastasis; Neoplasm Transplantation; Organ Specificity; Pentetic Acid; Radiography; Radioisotopes; Radionuclide Imaging; Scintillation Counting; Technetium; Technetium Tc 99m Medronate; Transplantation, Heterologous

Technetium-99m phosphate compounds may occasionally accumulate in malignant pleural effusions. A case of metastatic pleural effusion first diagnosed by bone scan, prior to its clinical or roentgenographic detection, is reported.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Pleural Effusion; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Indium is generally presumed to localize in the bone marrow within the erythroid cell line. Fibrosis, inflammation, lymphoma, extended field radiation, chemotherapy, or combinations of both treatment modalities generally depress the uptake of indium by the marrow a complex fashion. We report a case of metastatic breast carcinoma and pancytopenia in which the In-111 scan appeared qualitatively similar to a Tc-99m MDP bone scan. Findings were confirmed by bone marrow biopsy.

Topics: Bone Marrow; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Indium; Middle Aged; Pancytopenia; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

Increased accumulation of radioactivity was observed in malignant pleural and ascitic effusion as to a patient with stomach cancer and in malignant pleural effusions as to 2 patients (1 with breast cancer and another with lung cancer) during the performance of routine whole-body bone scans with 99mTc methylene diphosphonate. This finding should strongly suggest malignancy.

Topics: Adult; Ascites; Bone and Bones; Breast Neoplasms; Diphosphonates; Female; Humans; Lung Neoplasms; Male; Middle Aged; Pleural Effusion; Stomach Neoplasms; Technetium; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Of 1116 patients receiving primary treatment for breast carcinoma at the Royal Marsden Hospital since 1976, 651 had an abnormal bone scintigram either at primary diagnosis (378) or on subsequent follow-up (273) and 167 developed radiographically detectable bone metastases (21 at the time of primary diagnosis). Comparison of bone scintigrams and X-rays showed that scintigraphy was an inaccurate localiser of existing radiographic detectable metastases. If X-rays alone are used to detect bone metastases a limited examination with five plates will detect metastases with 92% accuracy. After primary surgery, routine X-ray screening for bone metastases is not necessary since it is possible to identify patients at risk on the basis of clinical examination, chest X-ray, and serum alkaline phosphatase and gamma-glutamyl transpeptidase levels.

Topics: Alkaline Phosphatase; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Follow-Up Studies; gamma-Glutamyltransferase; Humans; Radiography, Thoracic; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors

Our experiences with more than 2000 bone scintigrams in 803 tumour patients underline the high ranking of skeletal scintigraphy in oncology. Among our patients--who, as a matter of fact, represented a selected material--the rate of false negative scintigraphs was less than 1%. The incidence mentioned in literature is between 1 and 3% (6, 11, 38, 41). By balanced and differentiated assessment of bone scintigrams and analogous x-ray films (plain radiographs, spot-film radiographs, if necessary x-ray tomograms), taking into consideration storage anomalies in respect of localization, form and storage intensity, false-positive results can be reduced to a minimum; as a matter of fact, we believe that in oncology patients the quota of false-positive results can be reduced to less than 3%. In tumour patients, the question as to whether there are any bone metastases, can be correctly answered with a probability of about 96% by means of skeletal scintigraphic imaging and the analogous x-ray film as a complementary examination. The bone scintigram is excellently suited for effecting malignoma staging. It is, in fact, superior to all other methods. Skeletal scintigraphic imaging enables the identification of metastases earlier than any other method. It is the most sensitive primary search method which can be utilized for on-target application of x-ray diagnostic methods. Both solitary and multiple osseous metastases can be accurately localized by scintigraphy. The early identification of skeletal metastases in skeletal regions with endangered stability, is particularly important, since an impending spontaneous fracture can be prevented by osteosynthesis or local radiation therapy. Changes in the growth of metastases under radiation and/or chemotherapy can be reliably observed by scintigraphic follow-ups, and can be assessed to determine whether there is a continued growth or a remission. If scintigram and x-ray film are employed side by side--a procedure which is imperative during first examination and later with specific courses of the disease, the low grade specificity of scintigraphy is largely compensated by the x-ray method.

Topics: Bone Neoplasms; Breast Neoplasms; Diagnosis, Differential; Diphosphonates; Female; Fractures, Spontaneous; Hodgkin Disease; Humans; Lung Neoplasms; Male; Plasmacytoma; Prostatic Neoplasms; Radionuclide Imaging; Ribs; Sarcoma; Skull Neoplasms; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Adult; Aged; Bone and Bones; Breast Neoplasms; Diphosphonates; Female; Humans; Lung Neoplasms; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Bone and Bones; Breast Neoplasms; Diagnosis, Differential; Diphosphonates; Female; Fibrous Dysplasia of Bone; Humans; Middle Aged; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Aged; Bone Neoplasms; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Diphosphonates; Female; Humans; Radionuclide Imaging; Sternum; Technetium; Technetium Tc 99m Medronate

Topics: Adenocarcinoma, Mucinous; Bone and Bones; Breast; Breast Neoplasms; Diphosphonates; Female; Humans; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Two case reports of malignant pleural effusion from breast carcinoma, with scans showing a striking accumulation of Tc-99m MDP, are presented. The Tc-99m MDP was in the pleural fluid and not in the pleura as demonstrated by shift with gravity. Possible mechanisms of malignant effusion accumulation of Tc-99m MDP are suggested. The scant literature on the subject is reviewed.

Topics: Aged; Bone and Bones; Breast Neoplasms; Diphosphonates; Female; Humans; Middle Aged; Phosphates; Pleural Effusion; Posture; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Tc-99m labeled dimethyl-amino-diphosphonate (DMAD) was compared with methylene diphosphonate (MDP) in five healthy volunteers and 28 patients with a variety of bony afflictions. Although the normal bone uptake of DMAD is less than MDP, the lesion-to-normal bone ratio is significantly higher with DMAD. All 71 lesions detected with MDP were also seen with DMAD. However, 10 lesions were disclosed with DMAD that were not seen with MDP. These lesions tended to have low grade concentrations of the radiopharmaceutical and were detected with DMAD by virtue of the lower normal bone uptake rather than higher lesion uptake.

Topics: Adult; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Humans; Kidney Neoplasms; Lung Neoplasms; Middle Aged; Multiple Myeloma; Organotechnetium Compounds; Osteitis Deformans; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Breast; Breast Neoplasms; Calcinosis; Diagnosis, Differential; Diphosphonates; Female; Humans; Mammography; Mastectomy; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Animals; Arthritis, Rheumatoid; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Male; Radioisotope Renography; Rats; Rats, Inbred Strains; Technetium; Technetium Tc 99m Medronate; Tissue Distribution

Topics: Adult; Aged; Bone Neoplasms; Breast; Breast Neoplasms; Diphosphonates; Female; Humans; Mastectomy; Middle Aged; Postoperative Period; Radionuclide Imaging; Ribs; Technetium; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Bone and Bones; Breast Neoplasms; Calcinosis; Diphosphonates; Female; Humans; Lung; Lung Neoplasms; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Various methods have been evaluated for their ability to detect bone metastases in patients with breast cancer. Bone scanning and hydroxyproline measurements are insensitive and showed metastases in few patients with primary breast cancer despite the fact that most will develop bone metastases. We have therefore investigated the value of examining the bone marrow with immunocytochemical staining for breast carcinoma cells. Initial results in 68 patients with no evidence of bone metastases by conventional means indicated (a) that some patients have breast cancer cells in bone marrow despite having no evidence of dissemination using other tests, and (b) that patients with micrometastases relapse sooner than those patients with normal bone marrows.

Topics: Biopsy, Needle; Bone and Bones; Bone Marrow Examination; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Follow-Up Studies; Humans; Hydroxyproline; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors

Myocardioscintigraphy with 99mTc MDP is patients undergoing protracted treatment with adriblastin led to the discovery that accumulation of the isotope was infrequent in subjects protected with strophanthin and vitamin E, contrary to the position in an earlier series for whom no treatment designed to reduce the cardiotoxic effect of the antiblastic drug had been provided.

Topics: Breast Neoplasms; Diphosphonates; Doxorubicin; Female; Heart; Humans; Male; Middle Aged; Radionuclide Imaging; Strophanthins; Technetium; Technetium Tc 99m Medronate; Vitamin E

Topics: Breast Neoplasms; Diphosphonates; False Positive Reactions; Female; Humans; Injections; Lymph Nodes; Lymphatic Metastasis; Mastectomy; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Bone and Bones; Breast Neoplasms; Diphosphonates; Evaluation Studies as Topic; Female; Humans; Lung Neoplasms; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Aged; Animals; Bone and Bones; Breast Neoplasms; Diphosphonates; Female; Humans; Lung Neoplasms; Male; Middle Aged; Prostatic Neoplasms; Rabbits; Radionuclide Imaging; Rats; Technetium; Technetium Tc 99m Medronate

Topics: Adult; Aged; Breast Neoplasms; Diphosphonates; Female; Humans; Manubrium; Mastectomy; Middle Aged; Postoperative Period; Radionuclide Imaging; Sternum; Technetium; Technetium Tc 99m Medronate

Over the last decade, bone scans have played an increasingly important role in the management of patients with breast carcinoma; by detecting both occult and symptomatic bony metastases. 234 bone scans carried out in this hospital in 1978/79 on patients with breast cancer, at considerable cost to the NHS, are reviewed.

Topics: Bone Neoplasms; Breast Neoplasms; Diphosphonates; Neoplasm Staging; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate