Detection of bone metastases in routine follow-up after treatment for primary breast cancer

[An investigation of the effect of gamma rays emitted by patients undergoing radionuclide bone scintigraphy in computed radiography during X-ray mammography examination]

For convenience of outpatients, mammographies of outpatients are often taken after the injection of a radionuclide. In this study, we investigated the effects of gamma rays emitted by a patient onto imaging plates (IPs). We used a flat container filled with (99m)Tc solution as a planar source to irradiate gamma rays onto IPs. We changed irradiation times on each IP, and took radiographies of an ACR-specified 156 model phantom and AGH-D210F phantom. We evaluated radiography images, using visual evaluation, and profile curves, histograms, and CNR and RMS granularities analyses. The results indicated that the depiction ability of a fibrous part began to fall when the irradiation time exceeded 3 minutes. With an increase in irradiation time, an increase in pixel value and RMS granularity value and a decrease in CNR value were observed. In conclusion, IP exposed by gamma rays influenced the evaluation of phantom images.

Radiological staging in breast cancer: which asymptomatic patients to image and how

BACKGROUND

Approximately 4% of patients diagnosed with early breast cancer have occult metastases at presentation. Current national and international guidelines lack consensus on whom to image and how.

METHODS

We assessed practice in baseline radiological staging against local guidelines for asymptomatic newly diagnosed breast cancer patients presenting to the Cambridge Breast Unit over a 9-year period.

RESULTS

A total of 2612 patients were eligible for analysis; 91.7% were appropriately investigated. However in the subset of lymph node negative stage II patients, only 269 out of 354 (76.0%) investigations were appropriate. No patients with stage 0 or I disease had metastases; only two patients (0.3%) with stage II and < or =3 positive lymph nodes had metastases. Conversely, 2.2, 2.6 and 3.8% of these groups had false-positive results. The incidence of occult metastases increased by stage, being present in 6, 13.9 and 57% of patients with stage II (> or =4 positive lymph nodes), III and IV disease, respectively.

CONCLUSION

These results prompted us to propose new local guidelines for staging asymptomatic breast cancer patients: only clinical stage III or IV patients require baseline investigation. The high specificity and convenience of computed tomography (chest, abdomen and pelvis) led us to recommend this as the investigation of choice in breast cancer patients requiring radiological staging.

Metastatic breast carcinoma confined to bone: portrait of a clinical entity

BACKGROUND

The current study was performed to study metastatic breast carcinoma that remains confined to bone.

METHODS

The medical notes of 2514 breast carcinoma patients who were treated in 2 academic units over a 20-year period were screened and patients who fulfilled the following criteria were selected: 1) clinical manifestation and imaging confirmation of bone metastases, and 2) metastatic disease remaining confined to bone for a minimum of 24 months. Available clinical and pathologic data were recorded and analyzed. The objective of the current study was to describe this clinical entity and investigate possible correlations between clinicopathologic parameters and clinical outcome.

RESULTS

A total of 104 patients (4% of the total screened patient population) fulfilled the study criteria. The majority of patients were postmenopausal, with a median age of 58 years; 44 of the patients were found to have metastases at the time of presentation (M1) and 60 patients developed metastases at a median of 38 months (range, 8-160 months) after surgery for the primary tumor. Metastases remained confined to bone for a median of 50 months. Survival after the diagnosis of bony metastases was 72 months and was similar in the 2 groups (66 months vs. 78 months). Of the patients treated, 80% responded to hormonal therapy, and 76.5% responded to chemotherapy. There was no association noted between survival and tumor grade, anatomic distribution, or disease extension.

CONCLUSIONS

Bone-confined metastatic breast carcinoma has an indolent clinical course that alleviates the need for vigorous follow-up and calls into question aggressive therapeutic approaches in these patients. Translational studies are warranted to map the molecular profile, leading to the development of targeted therapies in this group of patients.