Bristow et al. (2008)

Bristow et al. (2008)
Design: Prospective comparative study (Diagnostic), evidence level 3.
Country: UK
Inclusion criteria:
None stated
Exclusion criteria:
None stated
Number of patients = 77 (incl 1 male). Range: 35–90 years. Mean: 63 years.
Consecutive patients presenting with suspected or confirmed MBC underwent CT of the thorax, abdomen and pelvis and bone scan. The two imaging modalities were given between four days and two weeks apart and were reviewed and discussed at MDT meetings. Diagnoses were made by consensus and additional information obtained, if necessary, from radiology and serum tumour markers.

CT: multi-slice technique with oral and i.v. contrast. Images were reviewed by a team of radiologists who were blinded to the findings by bone scan.

Bone scan: using i.v. Tc99m HDP at 500 MBq. Scans were reviewed independently by radiologists with a particular interest in nuclear medicine.
To determine whether bone scans could be avoided if the pelvis was included in a CT scan of thorax, abdomen to detect bone metastases from breast cancer.

Sensitivity and specificity (calculated from published data).
Follow up:
The following calculations were made from data within the paper:

CT scan:
Sensitivity = 97.5%
Specificity = 100%
Accuracy = 98.5%

Bone scan = 100%
Specificity = 67.5%
Accuracy = 85.5%
General comments:
This paper present the results of a small prospective but non-randomised comparative study matching CT scans of thorax, abdomen and pelvis with a full skeleton bone scan. The aim of the study was to determine whether, if the CT field was extended to include the proximal femur, any additional information gained on the number of bone metastases could obviate the necessity to use bone scans for this purpose.

The authors highlighted a potential saving to UK hospitals in imaging costs which might result by performing an extended CT scan rather than using both imaging methods to identify bone metastases as a routine staging procedure. They stated that metastases occurring outside the CT field of view were rare and that identifying extra bone metastases tended not to influence management of these patients.

From: Chapter 2, Presentation and diagnosis

Cover of Advanced Breast Cancer
Advanced Breast Cancer: Diagnosis and Treatment.
NICE Clinical Guidelines, No. 81.
National Collaborating Centre for Cancer (UK).
Copyright © 2009, National Collaborating Centre for Cancer.

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