Skeletal scintigraphy in breast cancer management

Since its introduction in 1971 bone scintigraphy has become the classical p rocedure to confirm or exclude metastatic spread of breast cancer to skelet on. Recent developments in tomographic imaging (CT, MRI) as well as a more critical attitude towards technical diagnostic tests have raised the questi on about the present role of scintigraphy in staging and follow-up of breas t cancer patients, Based upon systematic retrospective analyses bone scinti graphy is recommended for the initial staging of high risk patients (node-p ositive). In the follow-up of symptom-free patients bone scintigraphy did n ot prove to be necessary while it should be used in symptomatic patients to confirm and demonstrate the extent of metastatic disease. The bone scan is also useful for treatment control, However, due to similar findings in cas e of response (flare phenomenon) as well as tumor progression clinical rele vance appears to be limited, In future increasing competition with CT and/o r MRI will probably occur, Since MRI was proven to be more sensitive as wel l as specific in direct comparison, all efforts should be made to improve i mage quality and to reduce costs of skeletal scintigraphy, PET using F-18 f luoride might be an interesting alternative, if it becomes available for re asonable prices.