Bone scanning in management of metastatic osteogenic sarcoma

Bone scan findings are presented from five consecutive cases of metastatic osteogenic sarcoma. Every patient had pulmonary metastases which concentrated the bone imaging radiopharmaceutical to some degree. In one patient, the diagnosis of pulmonary metastasis was made prior to our seeing any radiographic abnormalities. The mechanism by which skeletal imaging agents localize in pulmonary lesions is not clear. Unsuspected skeletal metastases were also discovered on scans in two patients, both of whom had normal radiographs. Diagnosis of hypertrophic pulmonary osteoarthropathy was made in one patient with normal radiographs. These findings indicate that bone scans as well as radiographs should be performed routinely in preoperative staging and followup of patients with osteogenic sarcoma.