Diagnostic Value of Technetium-99m Bone Scintigraphy in the Detection of Cervical Spine Metastases in Oncological Patients.

MINI: Bone scan remains the modality of choice for the screening of bone metastases. This study demonstrated the diagnostic value of bone scan in detecting bone metastases limited to the cervical spine in oncological patients remains uncertain due to the moderately high false-negative diagnostic rate.

STUDY DESIGN: A retrospective cohort, radiographic study.

OBJECTIVE: To assess the diagnostic accuracy of bone scintigraphy (BS) for the detection of cervical spine metastases in oncological patients.

SUMMARY OF BACKGROUND DATA: BS remains the modality of choice for the screening of bone metastases, because of its feasibility in whole-body scanning and its widespread availability at low cost. Current practice guidelines for patients with malignant diseases recommend BS imaging as the primary screening method for detecting both axial and appendicular skeletal metastases.

METHODS: Of 481 patients, 242 were diagnosed with cervical spinal metastases from a primary cancer. The BS findings of these patients, evaluated by nuclear medicine physicians, were assessed with respect to their usefulness for detecting cervical spine metastases. Magnetic resonance imaging findings, evaluated by radiologists, were used as the reference standards. The diagnostic value of BS was compared between subgroups according to the order in which the diagnostic procedures (magnetic resonance imaging and BS) were completed, the presence of pathological fractures, the location of the primary malignancy, and the number of cervical metastases.

RESULTS: The sensitivity of BS in the detection of cervical spine metastases was 59.1%, with a 40.9% rate of false-negative diagnoses; the specificity was 94.6%, with a 5.4% rate of false-positive diagnoses. The sensitivity tended to be higher in the presence of pathological fractures (72.1% in cases with a fracture vs. 3% in cases without a fracture) and a greater number of lesions (r = 0.921). Neither the order in which the diagnostic examinations were performed nor the location of the primary cancer, except for those in the stomach and liver, appeared to affect the diagnostic accuracy of BS.

CONCLUSION: Considering the moderately high false-negative diagnostic rate obtained in the present study, BS alone cannot accurately diagnose metastases in the cervical spine in oncological patients.

LEVEL OF EVIDENCE: 3.