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 (RCC) is currently being debated. This study investigated the diagnostic performance of BS in 36 patients with a high pretest probability for bone metastases due to abnormal laboratory tests, pain, or confirmed nonosseous metastases.

METHODS

Planar whole-body BS was performed in all patients 3 hours after the intravenous injection of 555 MBq (15 mCi) of technetium-99m-3,3-diphosphono-1,2-propane dicarboxylic acid tetrasodium salt).

RESULTS

In 14 of 36 patients, bone metastases could be confirmed either due to computed tomography or magnetic resonance imaging (n=11) or open site directed biopsy (n=3), respectively. The sensitivity ranged from 10% to 60%, depending on the applied visual threshold. The extent of the metastatic involvement was underestimated in all cases. No diagnostic pattern of tracer accumulation, clinical features, or laboratory tests was identified as enhancing the sensitivity for the detection of bone metastases in this population.

CONCLUSIONS

The authors concluded that, even among preselected patients, BS has no diagnostic role in RCC and should therefore be omitted from the clinical workup.