Staging Bone Scan Research Articles

2197 BONE SCAN IN PATIENTS WITH NEWLY DIAGNOSED PROSTATE CANCER; TO PERFORM OR NOT?: EXTERNAL VALIDATION OF THE CURRENTLY AVAILABLE GUIDELINES FOR JAPANESE PATIENTS

INTRODUCTION AND OBJECTIVES: The indication for a bone scan to evaluate bone metastases in patients with newly diagnosed prostate cancer (PCa) differs among current guidelines. Furthermore, these guideline recommendations have not yet been fully validated. The aim of the study was to externally validate these current guideline recommendations regarding the need for a staging bone scan in patients with newly diagnosed PCa, and to extract which patients in Japan should undergo such a bone scan. METHODS: The study included 508 consecutive patients with newly diagnosed PCa from January, 2005 to December, 2008 at Keio University Hospital. All patients prospectively underwent a bone scan using technetium Tc 99m methylene diphosphonate at diagnosis. We assessed the association between the results of the bone scan and clinicopathological factors, such as PSA, clinical stage, and biopsy Gleason score. The accuracy of the most updated EAU, AUA, NCCN, American Joint Committee on Cancer (AJCC), American College of Radiology (ACR), and Japanese Urological Association (JUA) guidelines indicating the need for a baseline staging bone scan was evaluated with area under the curve (AUC) estimates. RESULTS: A positive bone scan was detected in 18 patients (3.5%). PSA level (p 0.002), clinical stage (p 0.001), Gleason score (p 0.001), and positive biopsy scores (p 0.002) were higher in patients with a positive bone scan than in patients with a negative bone scan. Serum TP (p 0.006) level was far lower and the CRP (p 0.011), ALP (p 0.001), and FNG (p 0.007) levels were much higher in the bone scan positive group. In multivariate analysis, PSA 20 (p 0.001, HR 12.58) and Gleason sum 8 (p 0.025, HR 3.91) were independent predictors for a positive bone scan. The sensitivity was determined to evaluate the validity of each guideline and the values were as follows: EAU 72.2%, AUA/AJCC 77.8%, NCCN 88.9%, JUA 88.9%, and ACR 94.4%. The overall accuracy values were EAU 79.6%, AUA/AJCC 75.6%, NCCN 77.9%, JUA 74.9%, and ACR 65.6%. CONCLUSIONS: This is the first study aimed at externally validating the current guideline recommendations addressing the need for staging bone scans in Japanese patients with newly diagnosed PCa. The frequency of a positive bone scan was 3.5%, and PSA 20 and Gleason sum 8 independently predicted a positive bone scan. We believe the indication for a bone scan should be modified and updated, taking into consideration racial differences.

An evaluation of [F‐18]‐fluorodeoxy‐D‐glucose positron emission tomography, bone scan, and bone marrow aspiration/biopsy as staging investigations in Ewing Sarcoma

Staging investigations following the diagnosis of Ewing sarcoma may include chest computerized tomography (CT), technetium bone scintigraphy (bone scan), [F-18]-fluorodeoxy-D-glucose positron emission tomography (FDG-PET) scan, and bone marrow biopsy and aspiration (BMA/Bx). Each of these staging investigations provides complementary prognostic information, however the optimal combination of staging investigations is not clear. We conducted a retrospective study of 91 patients diagnosed with Ewing sarcoma and consecutively treated at our medical facilities between January 1, 2001 and December 31, 2011. We compared the radiologist's interpretations of staging FDG-PET and bone scans. We additionally compared the results of imaging evaluations to bilateral and unilateral BMA/Bx. We found FDG-PET and bone scan to have an examination-based concordance rate of 98% (one discordant case with a positive FDG-PET and negative bone scan). The region-based concordance rate for the imaging modalities was 97% for all cases and 63% for metastatic cases. The ipsilateral concordance rate for BMA/Bx was 98% with BMBx detecting metastases in seven cases and BMA detecting metastases in four cases. The left versus right concordance rates for BMBx and BMA were 98% and 97%, respectively. In all cases where bone marrow metastases were detected by BMA or BMBx, FDG-PET and bone scan detected osseous metastases. Our study indicates FDG-PET may be sufficient for initial screening for osseous metastases and identified all patients who also have bone marrow metastases. If osseous metastases are detected, a bone scan can detect additional osseous lesions and BMBx may indicate prognostic bone marrow metastases.

Endobronchial Mucosa Invasion Predicts Survival in Patients with Small Cell Lung Cancer

BackgroundCurrent staging system for small cell lung cancer (SCLC) categorizes patients into limited- or extensive-stage disease groups according to anatomical localizations. Even so, a wide-range of survival times has been observed among patients in the same staging system. This study aimed to identify whether endobronchial mucosa invasion is an independent predictor for poor survival in patients with SCLC, and to compare the survival time between patients with and without endobronchial mucosa invasion.MethodsWe studied 432 consecutive patients with SCLC based on histological examination of biopsy specimens or on fine-needle aspiration cytology, and received computed tomography and bone scan for staging. All the enrolled patients were assessed for endobronchial mucosa invasion by bronchoscopic and histological examination. Survival days were compared between patients with or without endobronchial mucosa invasion and the predictors of decreased survival days were investigated.Results84% (364/432) of SCLC patients had endobronchial mucosal invasion by cancer cells at initial diagnosis. Endobronchial mucosal involvement (Hazard ratio [HR], 2.01; 95% Confidence Interval [CI], 1.30–3.10), age (HR, 1.04; 95% CI, 1.03–1.06), and extensive stage (HR, 1.39; 95% CI, 1.06–1.84) were independent contributing factors for shorter survival time, while received chemotherapy (HR, 0.32; 95% CI, 0.25–0.42) was an independent contributing factor better outcome. The survival days of SCLC patients with endobronchial involvement were markedly decreased compared with patients without (median 145 vs. 290, p<0.0001). Among SCLC patients of either limited (median 180 vs. 460, p<0.0001) or extensive (median 125 vs. 207, p<0.0001) stages, the median survival duration for patients with endobronchial mucosal invasion was shorter than those with intact endobronchial mucosa, respectively.ConclusionEndobronchial mucosal involvement is an independent prognostic factor for SCLC patients and associated with decreased survival days.

Widespread osseous metastasis of signet ring type bladder cancer detected by NaF18-PET/CT bone scan

We present a case of a 70 year old black male with innumerable small osseous metastases which were not visible on FDG-PET/CT or CT and were only detected by NaF18-PET/CT bone scan. To our knowledge, this is the first case in the literature reporting the use of NaF18-PET/CT bone scan in the initial staging of signet ring cell bladder carcinoma. Metastatic bone disease was widely spread throughout the skeleton. Some bladder cancers are detected in late stages and have occult distant metastases. Signet ring type adenocarcinomas of the bladder are very rare and they have a very aggressive nature. Proper staging can save the patients from undue surgical procedures. NaF-PET/CT may be a necessary tool in the diagnostic staging of aggressive bladder cancers.

Is there a role of whole-body bone scan in patients with esophageal squamous cell carcinoma

BackgroundCorrect detection of bone metastases in patients with esophageal squamous cell carcinoma is pivotal for prognosis and selection of an appropriate treatment regimen. Whole-body bone scan for staging is not routinely recommended in patients with esophageal squamous cell carcinoma. The aim of this study was to investigate the role of bone scan in detecting bone metastases in patients with esophageal squamous cell carcinoma.MethodsWe retrospectively evaluated the radiographic and scintigraphic images of 360 esophageal squamous cell carcinoma patients between 1999 and 2008. Of these 360 patients, 288 patients received bone scan during pretreatment staging, and sensitivity, specificity, positive predictive value, and negative predictive value of bone scan were determined. Of these 360 patients, surgery was performed in 161 patients including 119 patients with preoperative bone scan and 42 patients without preoperative bone scan. Among these 161 patients receiving surgery, 133 patients had stages II + III disease, including 99 patients with preoperative bone scan and 34 patients without preoperative bone scan. Bone recurrence-free survival and overall survival were compared in all 161 patients and 133 stages II + III patients, respectively.ResultsThe diagnostic performance for bone metastasis was as follows: sensitivity, 80%; specificity, 90.1%; positive predictive value, 43.5%; and negative predictive value, 97.9%. In all 161 patients receiving surgery, absence of preoperative bone scan was significantly associated with inferior bone recurrence-free survival (P = 0.009, univariately). In multivariate comparison, absence of preoperative bone scan (P = 0.012, odds ratio: 5.053) represented the independent adverse prognosticator for bone recurrence-free survival. In 133 stages II + III patients receiving surgery, absence of preoperative bone scan was significantly associated with inferior bone recurrence-free survival (P = 0.003, univariately) and overall survival (P = 0.037, univariately). In multivariate comparison, absence of preoperative bone scan was independently associated with inferior bone recurrence-free survival (P = 0.009, odds ratio: 5.832) and overall survival (P = 0.029, odds ratio: 1.603).ConclusionsAbsence of preoperative bone scan was significantly associated with inferior bone recurrence-free survival, suggesting that whole-body bone scan should be performed before esophagectomy in patients with esophageal squamous cell carcinoma, especially in patients with advanced stages.

When to perform bone scan in patients with newly diagnosed prostate cancer: external validation of a novel risk stratification tool

To externally validate the performance characteristics of the Briganti's risk stratification tool for baseline staging bone scan in patients with newly diagnosed prostate cancer (PCa). From 2009 onwards, a consecutive series of patients with PCa were enrolled. All patients were staged to evaluate the presence of bone metastasis (BM) with a conventional total-body Tc 99m MDP scintigraphy performed regardless of baseline PCa characteristics. The area under the curve (AUC) estimates were used to test the accuracy of the Briganti's risk stratification tool that recommended staging baseline bone scan for patients with a biopsy Gleason score>7 or with a prostate-specific antigen (PSA) >10ng/ml and palpable disease (cT2/T3). The new tool was compared to the European Association of Urology (EAU) guideline. A total of 313 patients were consecutively enrolled. Median age was 68 (range 49-95years), and median PSA was 7ng/ml (range 0.81-2,670). Twenty (6.4%) patients presented BMs. Patients with BMs were significantly older, with higher PSA and a higher Gleason score (p=0.001). The novel Briganti's model was significantly (p=0.001) more accurate (AUC: 0.75; CI: 0.632-0.859) than the EAU guideline (AUC: 0.64; CI: 0.52-0.761) for the prediction of BMs. Our study validated in a group of patients with PCa the novel risk stratification tool proposed by Briganti, which presented a higher accuracy for baseline staging bone scan when compared with the EAU guideline. In our experience, this approach would further reduce (about 60%) the use of staging baseline bone scan without compromising the ability to detect BMs in patients with PCa.

Not Everything That Is Hot on a Staging Bone Scan Is Malignant: A Pictorial Review of Benign Causes of Increased Isotope Uptake

Poster: ECR 2010 / C-2190 / Not everything that’s hot on a bone scan is malignant: A pictorial review of benign causes of increased isotope uptake by: D. E. Moran , A. O'Neill, E. J. Heffernan, S. Skehan; Dublin/IE

Searching for bone metastases—how, when and why?

Bone metastases from prostate cancer are detected with staging bone scans. New research supports existing guidelines on the appropriate referral criteria for bone scans and shows that a specific subgroup of patients with prostate cancer who are at low risk of bone metastases do not require a staging bone scan.

303 WHEN TO PERFORM BONE SCAN IN PATIENTS WITH NEWLY DIAGNOSED PROSTATE CANCER: EXTERNAL VALIDATION OF A NOVEL RISK STRATIFICATION TOOL

You have accessJournal of UrologyProstate Cancer: Staging1 Apr 2011303 WHEN TO PERFORM BONE SCAN IN PATIENTS WITH NEWLY DIAGNOSED PROSTATE CANCER: EXTERNAL VALIDATION OF A NOVEL RISK STRATIFICATION TOOL Cosimo De Nunzio, Costantino Leonardo, Andrea Cantiani, Alfonso Carluccini, Carlo De Dominicis, and Andrea Tubaro Cosimo De NunzioCosimo De Nunzio Rome, Italy More articles by this author , Costantino LeonardoCostantino Leonardo Rome, Italy More articles by this author , Andrea CantianiAndrea Cantiani Rome, Italy More articles by this author , Alfonso CarlucciniAlfonso Carluccini Rome, Italy More articles by this author , Carlo De DominicisCarlo De Dominicis Rome, Italy More articles by this author , and Andrea TubaroAndrea Tubaro Rome, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.396AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To externally validate the performance characteristics of a novel risk stratification tool recently proposed by Briganti et al. on the need for baseline staging bone scans in patients with newly diagnosed prostate cancer. METHODS From 2009 onwards, a consecutive series of patients with prostate cancer were enrolled. Indications for prostatic biopsy were a PSA > 4 ng/ml and/or a positive DRE. Patients were staged with total-body Tc 99m MDP scintigraphy performed regardless of baseline prostate cancer characteristics. The presence of skeletal metastasis (BM) on bone scan was defined when either solitary or multiple asymmetric areas of tracer increased uptake occurred. Patients with positive or equivocal bone scan findings also underwent CT or MRI to confirm the scintigraphy findings. No patient was on hormonal therapy at the time of the staging imaging. The AUC estimates were used to test the accuracy of the novel risk stratification tool (the regression tree (CART)) proposed by Briganti which recommended staging baseline bone scan for patients with a biopsy Gleason score >7 or with a PSA >10 ng/ml and palpable disease (cT2/T3) prior to treatment. The new tool was compared to the EAU guideline. The specificity, sensitivity, positive and negative predictive values of each model were also calculated. RESULTS A total of 313 patients were consecutively enrolled. Median age was 68 (range 49–95 years), median PSA was 7 ng/ml (range 0.81–2670); median prostatic volume was 40 cc (range 10–189). 20 (6.4%) patients presented a BM at the bone scan. Out of them, all patients presented at least a PSA > 30 ng/ml; 8 pts (40%) a Gleason score 7 and 12 (60%) a Gleason score >7; 10 pts (50%) presented a palpable disease. The AUC for the EAU guidelines was 0.64 (CI: 0.52–0.761). However, the novel CART model, was significantly more accurate (AUC: 0.75; CI: 0.632–0.859, p=0.001) than the EAU guideline (p<0.001). Table 1 reported the performance characteristics of CART and EAU guideline. Bone scans performed using the EAU and CART, No. (%) Rate of BM within the recommended patient group% (No) Overall accuracy% Sensitivity% Specificity% NPV% PPV% EAU 151/313(48%) 9.9%(815/151) 64% 75% 54% 97% 11% CART 90/313(29%) 16.6%(15/90) 75% 74% 74% 98% 16% CONCLUSIONS Our study validated the novel risk stratification tool recently proposed by Briganti and we confirmed as it presented a higher accuracy for baseline staging bone scan when compared to the EAU guideline. Furthermore, with this highly accurate approach we would further reduce (about 60%) the use of staging baseline bone scans. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e123 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cosimo De Nunzio Rome, Italy More articles by this author Costantino Leonardo Rome, Italy More articles by this author Andrea Cantiani Rome, Italy More articles by this author Alfonso Carluccini Rome, Italy More articles by this author Carlo De Dominicis Rome, Italy More articles by this author Andrea Tubaro Rome, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Changing the referral criteria for bone scan in newly diagnosed prostate cancer patients

The aim of this study was to correlate the prostate-specific antigen (PSA) level and Gleason score with staging bone scan result in patients with a new diagnosis of prostate cancer in order to establish the feasibility of implementing the European Association Urology guidelines, which state that a bone scan may not be indicated when PSA <20 in well-moderately differentiated tumours. We identified 633 patients retrospectively and 186 patients prospectively with a new diagnosis of prostate cancer undergoing a staging bone scan between March 2005 and January 2010. Patients were excluded if there was no Gleason score available or if the PSA level was checked over 3 months prior to bone scan. Bone scan results were analysed with respect to age, PSA level and Gleason score. In the case of an equivocal result, subsequent imaging was taken into consideration or the initial bone scan was re-reviewed. In persistently equivocal cases, all relevant imaging was assessed by a blinded panel of radiologists to allow a final decision to be made. Of 672 patients aged 39-93 years (median 71 years), who fulfilled the inclusion criteria, 54 (8%) had evidence of bony metastases. PSA level and Gleason score were both independent predictors of bone scan positivity and their predictive value was additive p<0.01. None of the 357 patients with a PSA level of <20 and a Gleason score of <8 had a positive bone scan. Staging bone scans in newly diagnosed prostate cancer patients with a PSA level of <20 and a Gleason score of <8 can be safely omitted, with these criteria having a negative predictive value of 100% in our series.

Do all patients with newly diagnosed prostate cancer need staging radionuclide bone scan? a retrospective study

Define a group of patients with newly diagnosed prostate cancer, whose risk of bone metastasis is low enough to omit a bone scan staging study. From 2003 to 2009, the medical records of patients who were newly diagnosed with prostate cancer were retrospectively reviewed. The data collected included: age, digital rectal examination, serum prostate specific antigen (PSA), Gleason score, clinical T stage, and bone isotope scan. Patients were divided into two groups according to the results of bone isotope scan; positive group and negative group. A univariate and multivariate binary logistic regression was used to analyze the results. Of the 106 patients, 98 had a complete data collection and were entered into the study. The median age of the patients was 70.5 years and patients with a positive bone scan was 74 years, significantly higher than for patients with negative scans (69 years) (p=0.02). Bone metastasis was detected in 39 cases (39.7%). In all patients with clinical T1-2 stage, a Gleason score of <8 and PSA≤20 ng/mL, the bone isotope scans were negative. In univariate analysis, PSA (>20 ng/mL) and Gleason score (>7) were independently predictive of positive bone scan, while clinical stage was not. Staging bone scans can be omitted in patients with a PSA level of ≤20 ng/mL, and Gleason score<8. Our results suggest that by considering the Gleason score and PSA, a larger proportion of patients with prostate cancer could avoid a staging bone scan.

ACR Appropriateness Criteria® on Metastatic Bone Disease

Appropriate imaging modalities for screening, staging, and surveillance of patients with suspected and documented metastatic disease to bone include (99m)Tc bone scanning, MRI, CT, radiography, and 2-[(18)F]fluoro-2-deoxyglucose-PET. Clinical scenarios reviewed include asymptomatic stage 1 breast carcinoma, symptomatic stage 2 breast carcinoma, abnormal bone scan results with breast carcinoma, pathologic fracture with known metastatic breast carcinoma, asymptomatic well-differentiated and poorly differentiated prostate carcinoma, vertebral fracture with history of malignancy, non-small-cell lung carcinoma staging, symptomatic multiple myeloma, osteosarcoma staging and surveillance, and suspected bone metastasis in a pregnant patient. No single imaging modality is consistently best for the assessment of metastatic bone disease across all tumor types and clinical situations. In some cases, no imaging is indicated. The recommendations contained herein are the result of evidence-based consensus by the ACR Appropriateness Criteria((R)) Expert Panel on Musculoskeletal Radiology.

When to Perform Bone Scan in Patients with Newly Diagnosed Prostate Cancer: External Validation of the Currently Available Guidelines and Proposal of a Novel Risk Stratification Tool

BackgroundSeveral guidelines have indicated that in patients with well-differentiated or moderately well-differentiated prostate cancer (PCa), a staging bone scan may be omitted. However, the guidelines recommendations have not yet been externally validated. ObjectiveThe aim of the study was to externally validate the available guidelines regarding the need for a staging bone scan in patients with newly diagnosed PCa. Moreover, we developed a novel risk stratification tool aimed at improving the accuracy of these guidelines. Design, setting, and participantsThe study included 853 consecutive patients diagnosed with PCa between January 2003 and June 2008 at a single centre. All patients underwent bone scan using technetium Tc 99m methylene diphosphonate at diagnosis. MeasurementsThe area under the curve (AUC) of the criteria suggested by the guidelines (European Association of Urology, American Urological Association, National Comprehensive Cancer Network, and American Joint Committee on Cancer) to perform a baseline bone scan was assessed and compared with the accuracy of a classification and regression tree (CART) including prostate-specific antigen (PSA), clinical stage, and biopsy Gleason sum as covariates. Results and limitationsThe AUC of the guidelines ranged between 79.7% and 82.6%. However, the novel CART model, which stratified patients into low risk (biopsy Gleason ≤7, cT1–T3, and PSA <10 ng/ml), intermediate risk (biopsy Gleason ≤7, cT2/T3, and PSA >10 ng/ml), and high risk (biopsy Gleason >7) was significantly more accurate (AUC: 88.0%) than all the guidelines (all p≤0.002). The limitation of this study resides in its retrospective design. Moreover, the proposed risk stratification tool can be considered only for patients who are candidates for radical prostatectomy until validated in other clinical settings. ConclusionsThis is the first study aimed at externally validating the available guidelines addressing the need for staging baseline bone scans in PCa patients. All guidelines showed high accuracy. However, their accuracy was significantly lower compared with the accuracy of the novel risk stratification tool. According to this tool, staging bone scans might be considered only for patients with a biopsy Gleason score >7 or with a PSA >10 ng/ml and palpable disease (cT2/T3) prior to treatment. However, before recommending its use in clinical practice, our model needs to be externally validated.

Indication of bone scans in early breast cancer staging

Objective Evaluate the indication for bone scanning during initial staging of early breast cancer in the light of scientific evidence to assess the need to modify practices with scant effectiveness. Material and methods The bone scans carried out in our Nuclear Medicine Department in 2007 on patients with primary breast cancer were reviewed retrospectively.Results were analyzed in relation to the clinical and histopathologic findings for each tumor. Bone scan results of tumors >2 cm and ≤5 cm (T2) were analyzed in two groups stratified by tumor size, ≤3 cm or >3 cm, and pre-treatment clinical stage. Results Out of 245 bone scans of patients with breast cancer, 237 (97%) were negative for metastatic disease and 8 (3%) were positive. Lesions <2 cm (Tis and T1) were diagnosed in 131 patients (53.5%), none of which had bone metastasis at time of diagnosis. Lesions >2 cm and ≤5 cm (T2) were diagnosed in 84 patients (34%), of which 3.6% had bone metastasis. There were no differences in the rate of bone metastases in patients with stage T2 disease and lesions ≤3 cm vs. >3 cm. The bone scan findings did not modify staging in any of the 66 patients with T2 tumors stage IIA, but it did modify staging in 2 of 12 patients with stage IIB tumors. Twenty percent of 15 patients with T3 tumors and 13% of patients with T4 tumors had bone metastasis at time of diagnosis. Conclusions : Ineffective practices should be modified and bone scanning should not be indicated in patients with early breast cancer Tis, T1 and T2 with tumor ≤2 cm, clinical stage IIA. Pre-treatment bone scanning is still indicated in T2 IIB, T3 and T4 disease.

前立腺癌病期診断における画像検査の有用性の検討

Staging for prostate cancer often includes computed tomography (CT) and bone scan in Japan. We examined the criteria of avoiding unnecessary CT and bone scan for the prostate cancer patients at Matsusaka Chuo General Hospital. 211 patients were newly diagnosed at our institution between 1998 September and 2004 April. We reviewed data from 208 patients who had a staging CT and bone scan. The data was analysed using Gleason score, clinical T-stage and serum prostatic specific antigen (PSA) level. CT detected lymphadenopathy in 19 patients (9.1%), Bone scan detected bone metastasis in 31 patients (14.9%). However there was no lymphadenopathy detected by CT in the patients with 20 ng/ml or less. In the analysis using PSA and Gleason score, there was no bone metastasis detected by bone scan in the patients with PSA level of 20 ng/ml or less and Gleason sum 7 or less. In the analysis using PSA and clinical local stage there was no bone metastasis detected by bone scan in the patients with PSA level of 20 ng/ml or less and localized lesion (cT1-2). In a new proatate cancer patient CT and bone scan can be avoidable by PSA level of 20 ng/ml or less and cT1-2 or less and Gleason sum 7 or less.

Are prostatic biopsies necessary in men aged ≥80 years?

To examine whether prostatic biopsies are necessary in all men aged > or =80 years, as men found to have prostate cancer are frequently treated with a 'watch and wait' policy or with hormonal withdrawal alone, and biopsies are associated with a small but significant complication rate. The findings on a digital rectal examination (DRE), the prostate-specific antigen (PSA) level, the biopsy and staging bone scan results for all men aged > or = 80 years who had prostatic biopsies over a 3-year period were reviewed, together with those in a group of men aged <80 years for comparison. All biopsy samples had been examined in one of three histopathology units, and 33 consultant urological surgeons contributed. In all, 210 biopsies from 205 men aged > or = 80 years were identified, of whom 163 (79%) had biopsy-confirmed prostate cancer. All 29 men with a PSA level of > or = 100 ng/mL, 98% of 47 with > or = 50 ng/mL, 97% of 76 with > or = 30 ng/mL and 92% of 101 with > or = 20 ng/mL had biopsy cores containing cancer; 63% of men with a PSA level of <20 ng/mL had cancer on biopsy. In men with cancer and a PSA level of > or = 30 ng/mL, 92% had Gleason grade > or = 7 and 93% were treated with hormonal withdrawal alone. In all men with cancer the DRE was abnormal in 91%, the mean number of positive cores was 59% and the bone scan was positive in 18%. The DRE was abnormal in 77% of men with benign biopsies. In men aged > or = 80 years with a PSA level of > or = 30 ng/mL, at least 97% had prostate cancer, >90% of whom had high-grade disease, and nearly all with cancer received active pharmacological treatment. In the vast majority of these men prostate biopsies did not alter their cancer management. The value of prostatic biopsy in this age group, with a PSA level of > or = 30 ng/mL, is questionable.

Bone Scan and Liver Ultrasound Scan in the Preoperative Staging for Primary Breast Cancer

The aim of the present study was to investigate the value of preoperative staging in primary operable breast cancer. This retrospective study included patients presenting between May 1999 and February 2004 with operable primary breast cancer. Of the 221 patients 189 had normal and 32 suspicious or positive bone scans (BS). Of the 189 patients with normal BS 182 had normal liver ultrasound (US), whereas the remaining seven patients underwent computed tomography scan which was normal in five and two confirmed liver metastases (one with abnormal LFTs). Of the 32 patients with suspicious or positive BS 26 were false positive on further investigations and the remaining six patients were confirmed to have bony metastasis (one abnormal bone profile). BS and liver US truly altered treatment in 3% of patients. False-positive results caused delay, psychological upset, and costly investigations in 14% of cases. Preoperative staging with liver US and BS should be reserved for high-risk patients.

Routine staging radiology is not needed for all breast cancer patients

10648 Background: Early stage breast carcinoma is unlikely to have undergone metastatic spread at the time of presentation. The utility of routine staging liver ultrasound (LUS) and bone scan (BS) in early stage disease is unclear. We postulate that early stage breast cancer patients do not need routine radiological staging. Methods: We studied 200 patients with a diagnosis of invasive breast carcinoma. 100 with symptomatic breast cancer (SBC) and 100 with screen detected (SD). Patients’ histology, tumour markers (CEA, CA 15.3), hormone receptor status, CXR, LUS and BS results were reviewed. Results: All patients underwent curative surgery for early stage invasive breast cancer. 3 patients had liver metastases diagnosed by LUS. Two of these patients were from the SBC and one from SD (grade ≥2, mean tumour size 2.2 cm). 4 patients had bony metastases diagnosed by BS. Three of these were from the SBC and one from SD (grade ≥2, mean tumour size 3.2 cm.). No patients with low-grade T1 tumours had signs of metastasis on BS or US. Conclusions: The incidence of metastatic disease is very low in newly diagnosed early stage breast carcinoma. Our results suggest that patients with low-grade T1 tumours do not need staging BS or US. No significant financial relationships to disclose.

A Study on Staging Bone Scans in Newly Diagnosed Prostate Cancer

Objective: This study aimed to evaluate the role of bone scan as a staging investigation in newly diagnosed untreated prostate cancers. Materials and Methods: Bone scan results in patients with newly diagnosed prostate cancer were reviewed and correlated with clinical stage, prostate-specific antigen (PSA) and Gleason scores from the biopsy specimen. Results: In all, 124 patients fulfilled inclusion criteria with an age range of 51–94 (mean 72.3) years. Pre-biopsy PSA ranged from 2.2 to 5,864 with a median of 21.1 ng/ml. Clinical stage was T0-T1c 14.5%, T2a 41.9%, T2b 17.7%, T3 16.9%, and T4 9%. A Gleason score of 7 was found in 31%. Four patients’ samples were not suitable for Gleason scoring. Twenty patients (16.1%) had a positive bone scan with a mean age of 79.4 years (median 83). Two patients with PSA <20 ng/ml were positive. Of the 44 scans performed in the patients with PSA ≤20 ng/ml, clinical stage <T4 and Gleason sum ≤7 (with the major Gleason <4), none was positive. The above criteria give a 100% negative predictive value for avoiding bone scans as a staging investigation. Conclusions: Staging bone scan can be safely omitted in patients with a clinical stage of <T4, PSA level of ≤20 ng/ml and a Gleason score of ≤7 (with major Gleason pattern <4) unless the symptoms are suggestive of metastasis.

1652: Bone Scan in Staging of Prostate Cancer - Criteria Re-Evaluated

1652: Bone Scan in Staging of Prostate Cancer - Criteria Re-Evaluated