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Focal Uptakes on Planar Scintigraphy in Breast Cancer Patient: Always a Bone Metastases? | OMICS International
ISSN: 2168-9784
Journal of Medical Diagnostic Methods
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Focal Uptakes on Planar Scintigraphy in Breast Cancer Patient: Always a Bone Metastases?

Mapelli P, Canevari C*, Spinapolice EG and Gianolli L
Nuclear Medicine Department, San Raffaele Scientific Institute, Milan, Italy
Corresponding Author : Carla canevari
Nuclear Medicine Department
San Raffaele Scientific Institute, Milan, Italy
E-mail: [email protected]
Received April 30, 2013; Accepted May 16, 2013; Published May 18, 2013
Citation: Mapelli P, Canevari C, Spinapolice EG, Gianolli L (2013) Focal Uptakes on Planar Scintigraphy in Breast Cancer Patient: Always a Bone Metastases? J Med Diagn Meth 2:111. doi:10.4172/2168-9784.1000111
Copyright: © 2013 Mapelli P, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

A 55 years-old patient was treated in 2007 with left mastectomy, chemotherapy and hormonal therapy for breast cancer, achieving complete response. Three years later, hepatic recurrence was detected and a planar 99Tc-MDP bone scintigraphy was performed to restage the disease and assess the presence of bone metastases.

Keywords
Bone scan; Breast cancer; SPECT/CT; Pitfalls
A 55 years-old patient was treated in 2007 with left mastectomy, chemotherapy and hormonal therapy for breast cancer, achieving complete response.
Three years later, hepatic recurrence was detected and a planar 99Tc-MDP bone scintigraphy was performed to restage the disease and assess the presence of bone metastases.
Bone scan planar images showed two focal uptakes in correspondence of the skull in left frontal region and at the right hipbone (Figure 1a, red arrows).
To better characterize the morphological features of these findings, tomographic acquisitions at hips and skull level were subsequently performed.
Single photon emission computed tomography/CT (SPECT/CT) image (Figure 1b, yellow arrow) showed a correspondence between the uptake seen on planar image and an intestinal loop so that the presence of hip metastases was excluded. Transaxial tomographic acquisition of the skull confirmed the absence of structural bony lesion as well (Figure 1c, red cross-arrow).
The present case demonstrates the possible pitfalls that can occur in the interpretation of planar scintigraphy. It has been largely reported that different physiological conditions can lead to a misinterpretation of bone scan images [1].
Tomographic acquisition or further examination should be always considered when equivocal findings are detected on bone planar scintigraphy especially in oncologic patients for whom the precise definition of bone involvement has a significant impact on patient management [2,3].
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