title: Is bone scintigraphy indicated in surgical work-up for hepatocellular carcinoma patients?
abstract: BACKGROUND
  Patients with hepatocellular carcinoma (HCC) undergo extensive staging investigations when being assessed for surgical resection. The aim of this study was to assess the use and yield of baseline bone scintigraphy in patients with HCC necessitating high-risk surgical resection.
  
  
  METHODS
  All patients diagnosed with HCC between 2000 and 2010 within a tertiary referral center were reviewed. Recurrence and survival rates were compared between patients with and without bone scintigraphy in their preoperative work-up.
  
  
  RESULTS
  A total of 366 patients were diagnosed with resectable HCC. In the work-up for resection 137 HCC patients (41%) underwent bone scintigraphy, which showed bone metastases in 3 (2%). There was no significant difference in long-term survival between patients with and without bone scintigraphy. None of the patients with a positive bone scintigraphy died due to skeletal bone metastases. Only one patient had an indication for bone scintigraphy based on clinical suspicion. Two patients were found to have asymptomatic skeletal metastases prior to surgery. Symptomatic skeletal metastases were identified at an estimated cost of €27,008 per case.
  
  
  CONCLUSIONS
  Clinically unsuspicious bone lesions turned out to be metastases in two patients, with an estimated cost of €27,008 per case. Recurrence rate and disease-free and overall survival showed no significant difference between patients with and without preoperative baseline bone scintigraphy. There is no justification for routine preoperative bone scintigraphy to detect asymptomatic skeletal metastases in patients with resectable HCC.
authors: Department of Hepatobiliary and Transplantation Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands. c.witjes@erasmusmc.nl
authors: Caroline D M
authors: CD
authors: Witjes
authors: Cornelis
authors: C
authors: Verhoef
authors: Dik J
authors: DJ
authors: Kwekkeboom
authors: Roy S
authors: RS
authors: Dwarkasing
authors: Robert A
authors: RA
authors: de Man
authors: Jan N M
authors: JN
authors: Ijzermans
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics / Q000401:mortality / Q000556:secondary*; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000191:economics / Q000401:mortality / Q000556:secondary*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006498:Hepatectomy; D006801:Humans; D007223:Infant; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009426:Netherlands; D011300:Preoperative Care / Q000379:methods*; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult