Follow-up bone scan in breast cancer patients: what is the appropriate interpretation of purely rib uptake?

Abstract:

AIM:Although rib uptake is frequently detected in follow-up bone scans of breast cancer patients, few studies have assessed its clinical significance. PATIENTS AND METHODS:Among 1208 breast cancer patients who underwent a bone scan between 2011 and 2014, 157 patients presented with newly detected rib uptake at follow-up. Patients who had underlying bone metastases (n=8) or had simultaneous new uptake in sites other than the rib (n=13) were excluded. The patients enrolled finally were those who had purely rib uptakes. The location, intensity, and final diagnosis of the uptake were evaluated by nuclear medicine physicians. RESULTS:A total of 275 new instances of rib uptake were detected in follow-up bone scans of 136 patients. These were more frequently located on the ipsilateral side of the breast cancer (61.1%) and the anterior arc (65.1%), and they presented as moderate to intense (93.1%) uptakes. Among these, 265 lesions in 130 patients turned out to be benign fractures (96.4%), whereas only 10 lesions in six patients were metastases. The proportion of metastases was significantly higher if the uptake was linear or if the patient had recurrence. It was marginally higher if the uptake was located in the posterior arc. The proportion of metastases within the radiation field was significantly lower in patients with a history of irradiation. CONCLUSION:Newly detected purely rib uptake on a follow-up bone scan in patients who have been treated for breast cancer is mostly because of fractures and rarely signals metastasis. However, if the patient has disease recurrence, metastasis should strongly be suspected, particularly when uptake is linear or located in the posterior arc.

journal_name

Nucl Med Commun

authors

Seo M,Ko BK,Tae SY,Koh SJ,Noh YJ,Choi HJ,Bae K,Bang M,Jun S,Park SH

doi

10.1097/MNM.0000000000000597

subject

Has Abstract

pub_date

2016-12-01 00:00:00

pages

1318-1324

issue

12

eissn

0143-3636

issn

1473-5628

journal_volume

37

pub_type

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