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Is the assessment of the central skeleton sufficient for osseous staging in breast cancer patients? A retrospective approach using bone scans

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Abstract

Objective

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.

Materials and methods

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.

Results

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).

Conclusions

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.

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Conflicts of interest

The authors declare that there are no conflicts of interest.

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Authors and Affiliations

  1. Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Julia Krammer, Dorothee Engel, Andreas Schnitzer, Clemens G. Kaiser, Dietmar J. Dinter, Stefan O. Schoenberg & Klaus Wasser

  2. Institute of Medical Statistics, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Ludolf-Krehl-Straße 13-17, 68167, Mannheim, Germany

    Joachim Brade

Authors
  1. Julia Krammer
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  2. Dorothee Engel
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  3. Andreas Schnitzer
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  4. Clemens G. Kaiser
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  5. Dietmar J. Dinter
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  6. Joachim Brade
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  7. Stefan O. Schoenberg
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  8. Klaus Wasser
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Correspondence to Julia Krammer.

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Krammer, J., Engel, D., Schnitzer, A. et al. Is the assessment of the central skeleton sufficient for osseous staging in breast cancer patients? A retrospective approach using bone scans. Skeletal Radiol 42, 787–791 (2013). https://doi.org/10.1007/s00256-012-1562-7

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  • DOI: https://doi.org/10.1007/s00256-012-1562-7

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