Is there a diagnostic role for bone scanning of patients with a high pretest probability for metastatic renal cell carcinoma?

BACKGROUND. The utility of performing whole-body bone scintigraphy (BS) as part of a routine staging workup for patients with renal cell carcinoma (RC C) is currently being debated. This study investigated the diagnostic perfo rmance of BS in 36 patients with a high pretest probability for bone metast ases due to abnormal laboratory tests, pain, or confirmed nonosseous metast ases. METHODS. Planar whole-body BS was performed in all patients 3 hours after t he intravenous injection of 555 MBq (15 mCi) of technetium-99m-3,3-diphosph ono-1,2-propane dicarboxylic acid tetrasodium salt). RESULTS. In 14 of 36 patients, bone metastases could be confirmed either du e to computed tomography or magnetic resonance imaging (n = 11) or open sit e directed biopsy (n = 3), respectively. The sensitivity ranged from 10% to 60%, depending on the applied visual threshold. The extent of the metastat ic involvement was underestimated in all cases. No diagnostic pattern of tr acer accumulation, clinical features, or laboratory tests was identified as enhancing the sensitivity for the detection of bone metastases in this pop ulation. CONCLUSIONS. The authors concluded that, even among preselected patients, B S has no diagnostic role in RCC and should therefore be omitted from the cl inical workup. Cancer 1999;85:153-5. (C) 1999 American Cancer Society.