Incidence of Bone metastasis and Necessity of Preoperative Bone Scanning in Breast Cancer Patient

Lee, Un Sook; Song, Tae Jin; Jung, Ki Hoon; Choi, Won Jun; Kim, Sun Han; Whang, Cheung Wung; Koo, Bum Hwan

Abstract

The bone scanning has been routinely used for initial report in 1970s showed a high incidence of positive-up to 45%-results in preoperative assessment of these patients. But recent reports have questioned the routine use of bone scanning in preoperative basis by the result of much lower positive result as rate less than 1%. On this point, we analyzed 224 cases of breast cancer, which were operatively managed in the period from January 1990 to January 1995 at the department of surgery, Korea university medical center. All the cases were performed bone scanning preoperatively and followed up more than 3 months. The analytic evaluation was done about age, stage of disease, serum alkaline phosphatase level according to menopausal status and its correlation to the result of bone scanning. The result was 14 positive cases(6.3%) from bone scanning in 224 breast cancer cases, but only 8 cases(3.6%) were true positive with bone metastasis. While 35 stage I cases and 69 stage IIa ones had no true positive, 1 among 63 stage IIb cases(1.6%), 5 among 46 stage IIIa cases(10.9%) and 2 among 11 of stage IIIb ones(18.2%) had true positive. There were high bone metastasis rate in premenopausal patients(5/108 cases, 4.6%) than postmenopausal patients(3/116, 2.6%) (p<0.05). The alkaline phosphatase level shows no significant differences between true positive and other groups(p>0.05). All true positive patients' alkaline phosphatase level shows within normal limits. According to this result, we think that preoperative bone scanning is unnecessary as a routine procedure in Stage I and IIa breast cancer patients. Stage IIb needs more and further study for confirming the indication of bone scanning as combinations with other predictive indicator or symptoms. About Stage III disease, we conclude the bone scanning is absolutely helpful.