Skeletal scintigraphy in breast cancer management

Since its introduction in 1971 bone scintigraphy has become the classical procedure to confirm or exclude metastatic spread of breast cancer to skeleton. Recent developments in tomographic imaging (CT, MRI) as well as a more critical attitude towards technical diagnostic tests have raised the question about the present role of scintigraphy in staging and follow-up of breast cancer patients. Based upon systematic retrospective analyses bone scintigraphy is recommended for the initial staging of high risk patients (node-positive). In the follow-up of symptom-free patients bone scintigraphy did not prove to be necessary while it should be used in symptomatic patients to confirm and demonstrate the extent of metastatic disease. The bone scan is also useful for treatment control. However, due to similar findings in case of response (flare phenomenon) as well as tumor progression clinical relevance appears to be limited. In future increasing competition with CT and/or MRI will probably occur. Since MRI was proven to be more sensitive as well as specific in direct comparison, all efforts should be made to improve image quality and to reduce costs of skeletal scintigraphy. PET using F-18 fluoride might be an interesting alternative, if it becomes available for reasonable prices.