The influence of bone pain on the results of bone scans

The diagnostic value of bone pain in 227 consecutive patients with known primary tumor was investigated and bone scans were obtained. Eighty-two of 130 patients with bone pain had metastases with positive scans. In contrast, 80 of 97 patients without pain did not have metastases and the scans were negative; 13, however, did have metastases and positive scans, and in 10 of these the lesions were osteoblastic. Osteoblastic metastases may not produce pain. In a group of 70 patients with bone pain of unknown origin or elevated phosphatase levels, bone scans were also obtained and evaluated. Only one had metastatic disease, 40 were negative, and 29 had positive scans due to benign disease. It is concluded that in the assessment of malignancies, bone pain is a good indication for bone scintigraphy, except in those patients with osteoblastic lesions. However, when malignant disease has not yet been established, bone pain is not a reliable indication for scanning and radiographic examination is the initial examination of choice.