European Journal of Nuclear Medicine

, Volume 21, Issue 11, pp 1198–1205 | Cite as

The value of thallium and three-phase bone scans in the evaluation of bone and soft tissue sarcomas

  • Calin I. Caluser
  • Hussein M. Abdel-Dayem
  • Homer A. Macapinlac
  • Andrew Scott
  • John H. Healey
  • Andrew Huvos
  • Hovanes Kalaigian
  • Samuel D. J. Yeh
  • Steven M. Larson
Original Article

Abstract

Thirty-seven patients with newly diagnosed or treated sarcomas had 47 sets of sequential thallium scans (TS) followed by three-phase bone scan (TPBS) on the same day. The diagnosis in all patients was verified by biopsy (n=40) or long-term follow-up studies (n=7). The sensitivity, specificity, and accuracy of TS and TPBS in detecting sarcomatous lesions was calculated: TS sensitivity was 88%, specificity 69%, and accuracy 83%; blood flow (BF) and blood pool (BP) sensitivity was 91%, specificity 54%, and accuracy 81 %; delayed bone scan (DB) sensitivity was 88%, specificity 38%, and accuracy 74%. In 17 studies the flow and blood pool parts of the TPBS and TS demonstrated the soft tissue component of sarcomas, which would have been missed if only the delayed bone scan had been performed. The TS lesion to normal tissue ratio alone was not very helpful in differentiating sarcomas from benign conditions because some benign lesions are highly cellular and vascular while some malignant lesions, such as chondrosarcoma, have poor vascularity and a less cellular chondroid matrix. However, when the thallium ratio was correlated with similar ratios calculated from yhe BP image, it was found that if the TS lesion to normal tissue ratio exceeded the BP lesion to normal tissue ratio (12 patients), the specificity for detecting sarcomatous lesions was 100%. Nevertheless, the reverse was not true. The positive predictive value of this observation was 100% and the negative predictive value was 37%.

Key words

Thallium-201 chloride Bone scan Soft tissue sarcoma 

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References

  1. 1.
    Enneking WG, Chew FC, Springfield DS, Hudson TM, Spanier SS. The role of radionuclide bone-scanning in determining the resectability of soft-tissue sarcomas. J Bone Joint Surg [Am] 1981; 63: 249–257.Google Scholar
  2. 2.
    Hortobagyi GN, Libshitz HI, Seabold JE. Osseous metastases of breast cancer. Cancer 1984; 53: 577–582.Google Scholar
  3. 3.
    McNeil BJ. Rationale for the use of bone scans in selected metastatic and primary bone tumors. Semin Nucl Med 1978; 8: 336–345.Google Scholar
  4. 4.
    McKillop JH, Etcubanas E, Goris ML. The indications for and limitations of bone scintigraphy in osteogenic sarcoma: review of 55 patients. Cancer 1981; 48: 1133–1138.Google Scholar
  5. 5.
    Tonami N, Hisada K. Clinical experience of tumor imaging with T1–201 chloride. Clin Nucl Med 1977; 2: 75–81.Google Scholar
  6. 6.
    Tonami N; Michigishi T, Banko H, et al. Clinical tumor scanning with T1–201 chloride [abstract]. J Nucl Med 1977; 18: 617.Google Scholar
  7. 7.
    Salvatore M, Carrati L, Porta E. Thallium-201 as a positive indicator for lung neoplasms: preliminary experiments. Radiology 1976; 167: 487–488.Google Scholar
  8. 8.
    Cox PH, Belfer AJ, Van der Pompe WB. T1–201 chloride uptake in tumours: a possible complication in heart scintigraphy. Br J Radiol 1976; 49: 767–768.Google Scholar
  9. 9.
    Sehweil AM. An evaluation of thallium-201 as a tumor imaging agent. PhD thesis. Glasgow University. 1988.Google Scholar
  10. 10.
    Sehweil A, El Sayed M, Ziada G, et al. Thallium 201 kinetics in malignant tumors [abstract]. J Nucl Med 1986; 27: 1033.Google Scholar
  11. 11.
    Sehweil A, McKillop JH, Ziada C, Abdel-Dayem HM. The optimum time for tumor imaging with T1–201. Eur J Nucl Med 1988;13:527–529.Google Scholar
  12. 12.
    Sehweil A, Mckillip JH, Milroy R, et al. Mechanism of T1–201 uptake in tumours. Eur J Nucl Med 1989; 15: 376–379.Google Scholar
  13. 13.
    Kaplan WD, Takuorian T, Morris JH, et al. T1–201 brain tumor imaging: a comparative study with pathologic correlation. J Nucl Med 1987; 29: 47–52.Google Scholar
  14. 14.
    Gruber ML, Hockberg FH. Systemic evaluation of primary brain tumors (editorial). J Nucl Med 1990; 31: 969–971.Google Scholar
  15. 15.
    Hoefnagel CA, Delprat CC, Zanin D, van der Schoot JB. New radionuclide tracers for the diagnosis and therapy of medullary thyroid carcinoma. Clin Nucl Med 1988; 13: 159–165.Google Scholar
  16. 16.
    Ramanna L, Waxman AD, Brachman MB, Tanasescu DE, Bernstein G. Thallium-201 scintigraphy in differentiated thyroid cancer: comparison with radioiodine scintigraphy and serum alupoglobulin determinations. J Nucl Med 1991; 32: 441–446.Google Scholar
  17. 17.
    Eisenberg B, Velchik MG, De Vries DF Thallium-201 chloride uptake in a lung tumor during a routine stress thallium examination. Clin Nucl Med 1988; 13: 214–215.Google Scholar
  18. 18.
    Klier S, Heo J, Iskandrian AS. Massive extracardiac thallium accumulation in pulmonary carcinoma [letter]. Clin Nucl Med 1988;93:672.Google Scholar
  19. 19.
    Tagawa T, Sujuki A, Kato K. Relation between T1–201 to Ga-67 uptake ratio and histological type in primary lung cancer. Eur J Cancer Clin Oncol 1977; 4: 487–488.Google Scholar
  20. 20.
    El-Gazzar AH, Malki AA, Abdel-Dayem HM, et al. Role of thallium-201 in the diagnosis of solitary bone lesions. Nucl Med Commun 1989; 10: 477–485.Google Scholar
  21. 21.
    Terui S, Oyamada H, Nishikawa K, Beppu Y, Fukama H. T1–201 chloride scintigraphy for bone tumors and soft part sarcomas [abstract]. J Nucl Med 1984; 25: P114.Google Scholar
  22. 22.
    Waxman AD, McKee D, Siesem JK, Singer FR. Gallium scanning in Paget's disease of bone. AJR 1980; 134: 303–306.Google Scholar
  23. 22.
    Ramanna L, Waxman AD, Waxman S, et al. TI-201 scintigraphy in bone and soft-tissue sarcoma: evaluation of tumor mass and viability [abstract]. J Nucl Med 1988; 29: 854.Google Scholar
  24. 23.
    Ramanna L, Waxman AD, Binney G. Thallium-201 scintigraphy in bone sarcoma: comparison with gallium-67 and technetium-MDP in the evaluation of chemotherapeutic response. J Nucl Med 1988; 31: 567–572.Google Scholar
  25. 24.
    Ramanna L, Waxman AD, Rosen G. Evaluation of T1–201 (T1) uptake pattern in bone lesions: differentiation of benign from malignant processes [abstract]. J Nucl Med 1992; 33: 869.Google Scholar
  26. 25.
    Caluser C, Macapinlac HA, Healey J, et al. The relationship between thallium uptake, blood flow, and blood pool activity in bone and soft tissue tumors. Clin Nucl Med 1992; 17: 565–571.Google Scholar
  27. 26.
    Rosen G, Capparos G, Nirenberg A, et al. Ewing's sarcoma: a ten year experience with adjuvant chemotherapy. Cancer 1981;47:2204–2213.Google Scholar
  28. 27.
    Rosen G, Capparos B, Huvos AG, et al. Preoperative chemotherapy for osteogenic sarcoma: selection of postoperative adjuvant chemotherapy based upon the response of the primary tumor to preoperative chemotherapy. Cancer 1982; 49: 1221–1230.Google Scholar
  29. 28.
    Chaudary MA, Maisey MN, Shaw PJ, Rubens RD, Hayard JL. Sequential bone scans and chest radiographs in the postoperative management of early breast cancer. Br J Surg 1983; 70: 517–518.Google Scholar
  30. 29.
    Levenson RM, Sauerbrunn BJ, Bates HR, Newman RD, Eddy JL, Ihde DC. Comparative value of bone scintigraphy and radiography in monitoring tumor response in systemically treated prostatic carcinoma. Radiology 1983; 146: 513–518.Google Scholar
  31. 30.
    Rossleigh MA, Lovegrove FTA, Reynolds PM, Byrne MJ. Serial bone scans in the assessment of response to therapy in advanced breast carcinoma. Clin Nucl Med 1982; 7: 397–402.Google Scholar
  32. 31.
    Pollen JJ, Witztum KF, Asburn WL. The flare phenomenon on radionuclide bone scan in metastatic prostate cancer. AJR 1984;142:773–776.Google Scholar
  33. 32.
    Sessler M, Manol FD, Geck P, et al. Kinetics and mechanism of T1 uptake in malignant tumours in vivo and in vitro. Nuclear medicine and biology proceedings, 3rd world congress of nuclear medicine and biology. Paris: Pergamon Press; 1982: 2281–2284.Google Scholar
  34. 33.
    Ando AA, Ando I, Katayama M, et al. Biodistribution of T1–201 in tumor bearing animals and inflammatory lesion induced animals. Semin Nucl Med 1987; 12: 567.Google Scholar
  35. 34.
    Britten JS, Blank M. Thallium activation of the (Na+K+) activated ATP-ase of the rabbit kidney. Biochem Biophys Acta 1968;159:160.Google Scholar
  36. 35.
    Caluser C, Healey T, Macapinlac H, Abdel-Dayem H, et al. T1–201 uptake in recurrent pigmented villonodular synovitis. Correlation with three phase bone imaging. Clin Nucl Med 1992;17:751–753.Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • Calin I. Caluser
    • 1
  • Hussein M. Abdel-Dayem
    • 1
  • Homer A. Macapinlac
    • 1
  • Andrew Scott
    • 1
  • John H. Healey
    • 2
  • Andrew Huvos
    • 3
  • Hovanes Kalaigian
    • 1
  • Samuel D. J. Yeh
    • 1
  • Steven M. Larson
    • 1
  1. 1.Nuclear Medicine ServiceMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Orthopaedic Surgery ServiceMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Pathology DepartmentMemorial Sloan Kettering Cancer CenterNew YorkUSA

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