Bone Scans: Assessing Pain and Cancer Metastasis Risks

BONE SCAN

Hello Director Wu, I would like to ask about my mother's sudden shoulder pain.
After X-ray and MRI examinations, the doctor found abnormalities and inquired about the possibility of a biopsy.
Since my mother is due for a routine follow-up for her breast cancer and will undergo a bone scan, the doctor suggested waiting for the bone scan results before proceeding.
The bone scan results indicated that trauma should be the primary consideration (with no significant changes compared to the previous bone scan).
Is there still a possibility of metastasis? Are there any other tests that can be done, such as Ga-67? Thank you very much.

Xiao Hui, 30~39 year old female. Ask Date: 2005/05/14

Dr. Wu Bin'an reply Radiology

Dear Xiaohui,
First, I would like to clarify that I am a radiologist, not a nuclear medicine physician.
I will answer your questions based on my knowledge:
Generally speaking, various malignant tumors can spread to the bones through the bloodstream, with lung cancer, breast cancer, and prostate cancer having the highest rates of bone metastasis.
Often, metastasis occurs even in the absence of bone pain symptoms.
If a patient with a malignant tumor shows multiple hot spots on a whole-body bone scan, the likelihood of bone metastasis is extremely high.
Bone scans can typically reveal changes 3 to 6 months earlier than X-rays, so among those with positive bone scans, about 30% may have normal X-ray results.
If only a single hot spot is present, the probability of bone metastasis is low, with research indicating only a 6-8% chance; however, if the X-ray is also negative, there may still be a high suspicion of a bone metastasis, and follow-up observation is warranted.
Regarding your question about your mother experiencing sudden shoulder pain, and after X-ray and MRI examinations, the physician found abnormalities and inquired about a biopsy, while also suggesting to wait for the results of a bone scan due to her routine follow-up for breast cancer: I personally believe it is essential to first ask if your mother has a history of trauma to the shoulder bones.
Based on your description, the physician found abnormalities in the X-ray and MRI, which may indicate an old trauma to the shoulder bones, but the possibility of bone metastasis cannot be ruled out.
As for whether other tests, such as Gallium-67 scans, are necessary, I personally do not think they are required at this time, but continued follow-up examinations should be conducted in the future.

Reply Date: 2005/05/14

More Info

When it comes to assessing the risk of bone metastasis in cancer patients, particularly those with a history of breast cancer, bone scans are a crucial diagnostic tool. In your mother's case, the recent bone scan results indicated that the primary consideration is trauma rather than metastatic disease, which is a reassuring sign. However, it is understandable to have concerns about the potential for metastasis, especially given her medical history.

Bone scans, particularly those using Technetium-99m (Tc-99m), are effective in detecting areas of increased bone metabolism, which can indicate various conditions, including trauma, infection, and cancer metastasis. In your mother's case, the previous bone scan showed no significant changes, and the current results suggest that the abnormalities observed may be related to trauma rather than cancer spread. This is further supported by the absence of osteolytic or osteoblastic lesions in the imaging studies, which are typically indicative of metastatic disease.

The fact that the bone scan results suggest trauma as the primary consideration is a positive outcome. It implies that there are no new lesions or significant changes that would typically raise suspicion for metastatic activity. However, it is essential to remain vigilant and continue monitoring her condition, especially since she has a history of breast cancer.

Regarding the possibility of metastasis, while the bone scan results are reassuring, it is important to note that no diagnostic test is infallible. If there are ongoing symptoms, such as shoulder pain, further evaluation may be warranted. Additional imaging studies, such as MRI or CT scans, can provide more detailed information about specific areas of concern. These modalities can help visualize soft tissue structures and may be more sensitive in detecting subtle changes that a bone scan might miss.

As for the suggestion of a Ga-67 scan, this is a type of nuclear medicine scan that can be used to evaluate certain types of tumors and infections. However, it is not commonly used as a first-line investigation for suspected bone metastasis. The decision to perform additional imaging should be based on clinical judgment, the specific symptoms your mother is experiencing, and the results of her current evaluations.

In summary, while the bone scan results suggest that trauma is the primary concern, it is essential to continue monitoring her symptoms and consider further imaging if necessary. Engaging in a thorough discussion with her oncologist about her symptoms, the need for additional tests, and the overall management plan will help ensure that she receives the best possible care. Regular follow-ups and open communication with her healthcare team are vital in managing her health and addressing any concerns that may arise.

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