NUCLEAR MEDICINE APPLICATIONS FOR BONE METASTASES 

The Quarterly Journal of Nuclear Medicine 2001 March;45(1):38-46

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Radio-guided surgical biopsy for the diagnosis of suspected osseous metastases

Robinson L. A.

From the Division of Cardiovascular and Thoracic Surgery Thoracic Oncology Program H. Lee Moffitt Cancer Center and Research Institute University of South Florida College of Medicine Tampa, Florida, USA

Radioisotope ­bone scan­ning is fre­quent­ly ­employed in stag­ing malig­nan­cies. However, ­false pos­i­tive ­results are com­mon, and biop­sy is usu­al­ly ­required. In the ­absence of ­plain radio­graph­ic abnor­mal­ities or ­local symp­toms, local­iza­tion of the ­area of abnor­mal trac­er activ­ity at the ­time of ­open rib or ster­num biop­sy may be dif­fi­cult. It ­often ­requires resec­tion of a ­large por­tion of one or ­more ­ribs or oth­er ­bones to ­assure ­that the tar­get ­area was biop­sied, and ­still the ­area in ques­tion is com­mon­ly ­missed. In ­this set­ting, the new­ly-devel­oped, ­small gam­ma ­probe is now ­used as a ­tool to ­allow pre­cise intra­op­er­a­tive local­iza­tion of ­increased trac­er activ­ity in the tar­get ­bone. The use of gam­ma count­ing is an ­easy, high­ly accu­rate aid (100% sen­si­tiv­ity) to local­ize are­as of abnor­mal radio­iso­tope ­uptake in sus­pect­ed asymp­to­mat­ic ­osseous metas­ta­ses, usu­al­ly for ­open biop­sy of a rib. The use of ­this tech­nique obvi­ates the ­need to ­obtain intra­op­er­a­tive local­iz­ing radio­graphs to con­firm accu­rate rib iden­tifi­ca­tion, there­by sub­stan­tial­ly decreas­ing oper­a­tive ­time.