Dr. Schuster on Detecting Bone Metastases in Breast Cancer

David M. Schuster, MD, director, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, compares the efficacy of bone scans and FDG-PET/CT scans for detecting bone metastases in patients with breast cancer.

Schuster notes that some controversy exists regarding the most specific and sensitive method for detecting bone metastases in breast cancer. He feels this controversy has been resolved in favor of FDG-PET/CT scans instead of bone scans.

In general, trials report that if metastases are purely sclerotic or osteoblastic a bone scan is more sensitive than FDG-PET. However, Schuster adds that a traditional PET scan may still be able to detect these types of lesions. For mixed, osteolytic, and silent or invisible lesions an FDG-PET scan appears superior to a bone scan, Schuster believes.

Overall, Schuster recommends starting with an FDG-PET/CT scan. If results from this scan return negative and bone metastases are suspected, he recommends completing a bone scan as well.