Role of skeletal scintigraphy in soft tissue sarcoma: Improving the diagnostic yield.
BACKGROUND
The presence of skeletal metastases significantly influences the therapeutic strategy adopted for soft tissue sarcoma. However, literature on the prevalence of skeletal metastases in soft tissue sarcoma is limited and none of the available data is based on the Indian patient population.


OBJECTIVE
To determine the prevalence of skeletal metastases at presentation in patients of soft tissue sarcoma and to rationalise the use of preoperative skeletal scintigraphy in such patients.


METHODS
Preoperative bone scans were evaluated in 122 patients with soft tissue sarcoma (median age, 34 years; range, 4-83). The scans were classified into 3 grades: Grade 1: metastases very likely; Grade 2: equivocal; Grade 3: normal or benign lesion. In all the patients studied, the ability of the patient to localize the site or sites of pain was recorded and that was correlated with the site of metastases in scintigraphy.


RESULTS
Seventeen (13.9%) patients had Grade 1 scan; 16 of them had bony pain that was not readily explainable by trauma or other local factors. Ten ( 8.1%) patients had Grade 2 scan, five of them had bony pain which was not readily explainable by trauma or other local factors. Ninety-five patients (77.8%) had Grade 3 scan. Of these, 9 had localised bone pain which could be definitely associated with trauma or joint degeneration.


CONCLUSIONS
The prevalence of skeletal metastases at presentation in patients with soft tissue sarcoma is low (13.9%). The low rates of skeletal metastases in bone pain-free patients (0.9%) versus the high rate in symptomatic patients (76.1%) supports the use of bone scanning in symptomatic patients only.
Barai
S
S
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India. danzig@rediffmail.com
Bandopadhayaya
G P
GP
Chumber
S
S
Gupta
D K
DK
Patel
C D
CD
Dhanpati
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012509:Sarcoma / Q000000981:diagnostic imaging* / Q000473:pathology*; D013669:Technetium Tc 99m Medronate
D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate