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January 6, 1975, Vol 231, No. 1 >
ARTICLE | January 6, 1975

Screening for Bone Metastases: Title and subTitle BreakAre Only Scans Necessary? FREE

David A. Pistenma, MD; I. Ross McDougall, MD, PhD; Joseph P. Kriss, MD
[+] Author Affiliations

Reprint requests to Division of Nuclear Medicine, Stanford University School of Medicine, Stanford, CA 94305 (Dr. Pistenma).


JAMA. 1975;231(1):46-50. doi:10.1001/jama.1975.03240130028020
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References

The results of total skeletal scintigraphy with technetium 99m-labeled diphosphonate in 200 patients with biopsy-proven primary cancer demonstrated abnormalities in 114; 57 had normal roentgenograms. In 32 of the 57 patients, the abnormalities were ascribed to malignant lesions. This is a false-negative rate of 17% for the roentgenographic examinations.

Only three patients had abnormal roentgenograms but normal scans, a yield of 1.6% false-negative scans. In a comparison of scan and roentgenographic findings with the skeleton divided into 12 regions, 119 of 160 abnormalities seen on scans but not on roentgenograms were attributed to tumor. Only five of 17 regions that were abnormal on roentgenogram but not on scans were unexplained false-negative findings. Thus, on a regional basis, the yields of false-negative roentgenograms and scans were 9.1% and 0.4%, respectively.

(JAMA 231:46-50, 1975)

REFERENCES

1 +
Subramanian G, McAfee JG, Bell EG, et al:  99mTc-labeled polyphosphate as a skeletal imaging agent . Radiology 102:701-706, 1972;.
2 +
Subramanian G, McAfee JG, Blair RJ, et al:  99mEHDP: A potential radiopharmaceutical for skeletal imaging . J Nucl Med 13:947-950, 1972;.
3 +
Castronovo FP, Callahan RT:  New bone scanning agent: 99mTc-labeled 1-hydroxy-ethylidene-1, 1-disodium phosphonate . J Nucl Med 13:823-827, 1972;.
4 +
Pendergrass HP, Potsaid MS, Castronovo FP Jr:  The clinical use of 99mTc-diphosphonate (HEDSPA) . Radiology 107:557-562, 1973;.
5 +
Silberstein EB, Saenger EL, Tofe AJ, et al:  Imaging of bone metastases with 99mTc-SnEHDP (diphosphonate), 18F and skeletal radiography . Radiology 107:551-555, 1973;.
6 +
Merrick MV:  Bone scans or skeletal surveys? Lancet 2:382-383, 1973;.
7 +
Edeiken J:  Radiologic approach to diagnosis of bone disease , in Goswitz FA, Andrews GA, Viamonte M (eds): Clinical Use of Radionuclides: Critical Comparison With Other Techniques . United States Atomic Energy Commission 27, 1972;, pp 90-100.
8 +
Charkes ND, Valentine G, Cravitz B:  Interpretation of the normal 99mTc-polyphosphate rectilinear bone scan . Radiology 107:563-570, 1973;.
9 +
Berg GR, Kalisher L, Osmond JD, et al:  99mTc-diphosphonate concentration in primary breast carcinoma . Radiology 109:393-394, 1973;.
10 +
McDougall IR, Pistenma DA:  Concentration of 99mTc-diphosphonate in breast tissue . Radiology 112:655-657, 1974;.
11 +
Milner TH, Maynard CD, Cowan RJ:  Evaluation of strontium-85 bone scans and roentgenograms in 100 patients . Arch Surg 103:371-372, 1971;.
12 +
Brand WN:  Clinical value of bone scanning with fluorine-18 , in Goswitz FA, Andrews GA, Viamonte M (eds): Clinical Uses of Radio-nuclides: Critical Comparison With Other Techniques USAEC 27, 1972;, pp 156-161.
13 +
McDougall IR, Pistenma DA:  Rib abnormality hidden by breast prosthesis . J Nucl Med 15:379-380, 1974;.
14 +
Michall WR, King WR, Wakim JM:  Metabolism of disodium ethane-1-hydroxy-1, 1-diphosphonate (disodium etidronate) in the rat, rabbit, dog and monkey . Toxicol Appl Pharmacol 21:503-515, 1972;.
15 +
Russell RGG, Smith R:  Diphosphonates: Experimental and clinical aspects . J Bone Joint Surg 55B:66-86, 1973;.
16 +
Cram RI, Barmada R, Geho WB, et al:  Diphosphonate treatment of calcinosis universalis . N Engl J Med 265:1012-1013, 1971;.
17 +
Weiss IW, Fisher L, Phang JM:  Diphosphonate therapy in a patient with myositis ossificans progressiva . Ann Intern Med 74:933-936, 1971;.
18 +
Altman RD, Johnston CC, Khairi MRA, et al:  Influence of disodium etidronate on clinical and laboratory manifestations of Paget's disease of bone (osteitis deformans) . N Engl J Med 2:31-37, 1972;.

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1 +
Subramanian G, McAfee JG, Bell EG, et al:  99mTc-labeled polyphosphate as a skeletal imaging agent . Radiology 102:701-706, 1972;.
2 +
Subramanian G, McAfee JG, Blair RJ, et al:  99mEHDP: A potential radiopharmaceutical for skeletal imaging . J Nucl Med 13:947-950, 1972;.
3 +
Castronovo FP, Callahan RT:  New bone scanning agent: 99mTc-labeled 1-hydroxy-ethylidene-1, 1-disodium phosphonate . J Nucl Med 13:823-827, 1972;.
4 +
Pendergrass HP, Potsaid MS, Castronovo FP Jr:  The clinical use of 99mTc-diphosphonate (HEDSPA) . Radiology 107:557-562, 1973;.
5 +
Silberstein EB, Saenger EL, Tofe AJ, et al:  Imaging of bone metastases with 99mTc-SnEHDP (diphosphonate), 18F and skeletal radiography . Radiology 107:551-555, 1973;.
6 +
Merrick MV:  Bone scans or skeletal surveys? Lancet 2:382-383, 1973;.
7 +
Edeiken J:  Radiologic approach to diagnosis of bone disease , in Goswitz FA, Andrews GA, Viamonte M (eds): Clinical Use of Radionuclides: Critical Comparison With Other Techniques . United States Atomic Energy Commission 27, 1972;, pp 90-100.
8 +
Charkes ND, Valentine G, Cravitz B:  Interpretation of the normal 99mTc-polyphosphate rectilinear bone scan . Radiology 107:563-570, 1973;.
9 +
Berg GR, Kalisher L, Osmond JD, et al:  99mTc-diphosphonate concentration in primary breast carcinoma . Radiology 109:393-394, 1973;.
10 +
McDougall IR, Pistenma DA:  Concentration of 99mTc-diphosphonate in breast tissue . Radiology 112:655-657, 1974;.
11 +
Milner TH, Maynard CD, Cowan RJ:  Evaluation of strontium-85 bone scans and roentgenograms in 100 patients . Arch Surg 103:371-372, 1971;.
12 +
Brand WN:  Clinical value of bone scanning with fluorine-18 , in Goswitz FA, Andrews GA, Viamonte M (eds): Clinical Uses of Radio-nuclides: Critical Comparison With Other Techniques USAEC 27, 1972;, pp 156-161.
13 +
McDougall IR, Pistenma DA:  Rib abnormality hidden by breast prosthesis . J Nucl Med 15:379-380, 1974;.
14 +
Michall WR, King WR, Wakim JM:  Metabolism of disodium ethane-1-hydroxy-1, 1-diphosphonate (disodium etidronate) in the rat, rabbit, dog and monkey . Toxicol Appl Pharmacol 21:503-515, 1972;.
15 +
Russell RGG, Smith R:  Diphosphonates: Experimental and clinical aspects . J Bone Joint Surg 55B:66-86, 1973;.
16 +
Cram RI, Barmada R, Geho WB, et al:  Diphosphonate treatment of calcinosis universalis . N Engl J Med 265:1012-1013, 1971;.
17 +
Weiss IW, Fisher L, Phang JM:  Diphosphonate therapy in a patient with myositis ossificans progressiva . Ann Intern Med 74:933-936, 1971;.
18 +
Altman RD, Johnston CC, Khairi MRA, et al:  Influence of disodium etidronate on clinical and laboratory manifestations of Paget's disease of bone (osteitis deformans) . N Engl J Med 2:31-37, 1972;.

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