Whole-Body Bone Scanning Helpful in Staging Non-Small Cell Lung Cancer

Whole-Body Bone Scanning Helpful in Staging Non-Small Cell Lung Cancer

According to the results of a study recently published in Chest, whole body bone scans (WBBS) may be useful in staging patients with non-small cell lung cancer (NSCLC).

Lung cancer is the leading cause of cancer related deaths in the United States and Europe. NSCLC is the most common type of lung cancer and arises from the tissues of the lung. Under most circumstances, NSCLC is not curable. Current treatments include surgery, chemotherapy and radiation in an attempt to destroy tumor cells or prevent further tumor growth. At the time of diagnosis, various tests will be performed to determine the extent of the disease, and based on how the disease has spread, the stage of the disease will be determined. These tests may include CT scans and bone scans to determine if the cancer has invaded other parts of the body such as the bones. These tests are important because the stage of the disease is often the basis for determining the appropriate treatment. Patients with undiagnosed metastatic disease may be subjected to unneeded surgery.

Bone scans are considered an integral part of staging patients with potentially operable NSCLC. A bone scan is a nuclear scanning test that identifies new areas of bone growth or breakdown. It is frequently performed to detect cancer that has spread (metastasized) to the bones. A bone scan can detect cancer in bones not detected by X-ray or CT scan. To perform a bone scan, a radioactive tracer (radioactive technetium diphosphonate) is injected into a vein in the arm. The tracer then travels through the bloodstream and into the bones. Areas of rapid bone growth or repair absorb increased amounts of the tracer and show up as bright or “hot” spots in the pictures. Hot spots may indicate the presence of a tumor. A bone scan may be done on the entire body (WBBS) or just a part of it.

In this recent study, 125 patients diagnosed with 1 of the 4 types of NSCLC were enrolled (squamous cell 54.4%, adenocarcinoma 32.8%, non-small cell carcinoma 8.8%, large cell carcinoma 4%). Each patient was evaluated for clinical findings, such as laboratory results or physical symptoms, that may indicate the possibility of bone metastases. Signs and symptoms of bone metastases include pain in the bones, elevated alkaline phosphatase, and an elevated blood calcium level. Whole body bone scans were performed on all patients and 10 received an additional MRI because clinical factors did not correlate with WBBS findings.

Overall, bone metastases were detected in 20.8% of patients in this study. Bone metastases were detected in 53% of 39 patients who had suspected bone metastases based on clinical findings. Bone metastases were also found in 5.8% of patients with no clinical findings. . Among the different cell types, adenocarcinoma was the most common type of NSCLC found in patients with bone metastasis (39%).

These researchers concluded that WBBS was helpful, as it detected most cancers thought to be present by signs and symptoms and also detected a significant number of unsuspected cancers. Detecting unsuspected cancers is important since these patients have metastatic disease and may not benefit from surgery to remove the primary cancer.

Reference: Erturan S, Yaman M, Aydin G, et al. The Role of Whole Body Bone Scanning and Clinical Factors in Detecting Bone Metastases in Patients With Non-Small Cell Lung Cancer. Chest. 2005;127: 449-454.

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