title: Technetium-99m bone scan and panoramic radiography in detection of bone invasion by oral carcinoma.
abstract: OBJECTIVE
  The correct extension of cancer in the bone usually remains undetected on static imaging which may lead to inadequate or over excision. The conventional radiography as well as other anatomical imaging modalities like computed tomography, magnetic resonance imaging often fails to detect functional changes in the bone. However, bone scinitigraphy is highly sensitive in detecting earlier changes in the bone but lack anatomical definition. The purpose of the study was to evaluate the accuracy of combining technetium-99m bone scan and panoramic radiography (Tc scan/PR) over using single diagnostic modality in detection of jaw bone invasion by oral carcinomas. The accuracy of these imaging modalities either alone or in combination were determined by comparing with the histopathological findings.
  
  
  METHODS
  Twenty patients with biopsy-proven oral malignant tumors were randomly selected from Oral Medicine and Radiology department over a period of two years. All patients were investigated preoperatively by Tc scan and PR. Lewis - Jones's designed diagnostic criterion was applied on Tc scan/PR to evaluate bone involvement by cancer. To test the accuracy of Tc scan, PR and Tc scan/PR, their results were compared with the histopathological findings of resected specimen.
  
  
  RESULTS
  Hybrid Tc scan/PR had higher specificity, accuracy and positive predictive value (83.3%, 94.7%, 92.8%) than Tc scan alone (50%, 84.2%, 81.2%) and higher sensitivity and negative predictive value (100%, 100%) than PR (69.2%, 55.5%).
  
  
  CONCLUSIONS
  Combination of Tc scan and PR was more accurate in detecting jaw bone invasion by oral squamous cell carcinoma than Tc scan and PR alone.
authors.affiliation: Professor, Department of Oral Medicine and Radiology, Mahatma Gandhi Dental College & Hospital , Jaipur, India .
authors.forename: Anshuman Suresh
authors.initials: AS
authors.lastname: Jamdade
authors.affiliation: EX-Professor and Head, Department of Oral Medicine and Radiology, Government Dental College & Hospital , Mumbai, India .
authors.forename: Ani
authors.initials: A
authors.lastname: John
keywords: Bone invasion; Oral cancer; Oral squamous cell carcinoma; Panoramic radiography; Technetium-99m bone scan