Between ethics and utility of 99MTC HDP bone scan in cancer - a retrospective study on 5670 patients

Abstract

Aim: This paper aims to emphasize the importance of nuclear imaging for cancer patients evolution and personalized treatment. Material and method: A retrospective study comprising 5,670 patients, who performed bone scans, between 2003-2015, at the “Sf. Spiridon” County Clinical Emergency Hospital Iași Nuclear Medicine Laboratory. Studied parameters were demographic data, referral diagnosis, staging, tumor markers, bone metastases and patient follow-up. Results: Of all, 3,960 were oncological patients. They performed in evolution 3,846 bone scans, between two (21.01%) and 11 (0.05%) explorations. Patients’ age varied between 2 and 97 years (with two peaks, at 55 and 65). Gender distribution showed female (61.73%) over male (38.27%) predominance, especially in multiple scans (73.32%). For half of the patients the bone scan showed evolution (worsening), meaning the treatment was only partially effective and required modifications. Ethically, for these patients bone scan was irreplaceable. Its absence would have meant undergoing a partially/inefficient treatment, a reserved prognosis and a shorter survival period. The benefits outweigh the risks in terms of radiation exposure. Conclusions: Ethics in oncological nuclear medicine is complex, following the balance between risk and benefit, in the interest of a personalized management. As a result, ethically it is equivalent to maximizing the benefits of this minimally invasive functional investigation, scintigraphy, which is essential for treatment modulation, in order to improve the disease prognosis and increase the patients’ survival rate, for precision medicine in cancer.