Bone Scan Indications for Cancer Patients

Primary Indications for Bone Scan

The National Comprehensive Cancer Network recommends bone scintigraphy for detecting skeletal metastases in high-risk prostate cancer patients with T1 disease and PSA ≥20 ng/mL, T2 disease and PSA ≥10 ng/mL, Gleason score ≥8, or T3/T4 disease 1, 2
The National Comprehensive Cancer Network suggests bone scintigraphy for breast cancer patients with signs or symptoms of bone metastases, advanced breast cancer for staging, patients with persistent or localized bone pain, or large tumors with aggressive biology 3, 4
Bone scintigraphy is indicated for lung cancer patients with locally advanced disease, patients with signs or symptoms of bone metastases, or advanced NSCLC staging 3, 4
For renal cell carcinoma, bone scintigraphy is only recommended in patients with suspected bone metastases based on symptoms or biochemical markers 3, 4

The National Comprehensive Cancer Network recommends bone scintigraphy after radical prostatectomy if PSA fails to fall to undetectable levels post-operatively, or if undetectable PSA becomes detectable and increases on 2 subsequent determinations 1, 2
After radiation therapy, bone scintigraphy is recommended if PSA is rising or if the patient has a positive digital rectal examination and is a candidate for additional local therapy 1, 2

Bone scintigraphy has low specificity, and equivocal findings or small number of hot spots require confirmation with other imaging modalities (MRI, CT, or PET/CT) 3, 4
MRI is more sensitive than bone scintigraphy and is preferred for early detection of spinal cord metastases 3, 4
PET/CT may be used as an alternative to bone scintigraphy in some guidelines for breast cancer and NSCLC, and shows comparable or superior diagnostic accuracy to bone scan 3, 4

The frequency of imaging should be based on individual risk factors, including age, PSA doubling time, Gleason score, and overall health 1, 2
Elevated bone-specific alkaline phosphatase (B-ALP) is an indicator for bone metastases and may warrant bone imaging 3, 4, 5
Any patient with localized bone pain, suspected pathologic fracture, or neurologic symptoms should undergo bone imaging regardless of other risk factors 1, 2, 3, 4