Clinical impact of SPECT-CT on bone scintigraphy in oncology: Pattern approach.

PURPOSE: The recent addition of single photon emission computed tomography (SPECT)-CT into bone scintigraphy (BS), increased the accuracy of the test. The objective of this study was to define the main problematic scintigraphic patterns that were solved with the contribution of SPECT-CT and serve as a guide to the medical oncologist who will refer their patients to BS. METHODS: Two hundred and ten patients (median age 62 years, range 12-80, F/M:122/ 88) with diagnosis of cancer (breast 109;52%, prostate 63;30%, lung 15;7% and others 20;11%) were referred for BS. Subsequent SPECT-CT images (231 images from 210 patients) were obtained from the related body regions where suspicious skeletal radioactivity uptake had been observed. BS and SPECT-CT images were classified into groups according to the BS, clinical history and other imaging results in consideration with the role of SPECT-CT for more accurate diagnosis. RESULTS: SPECT-CT studies resulted in the emergence of 6 main patterns that helped improve the interpretation of the whole-body BS for more accurate diagnosis. Pattern 1: Extraskeletal uptake and/or incidental findings (14/231;6%); Pattern 2: Identification of skeletal trauma and degenerative osteoarthritic diseases (147/231;64%); Pattern 3: Benign bone tumors and reactions (12/231;5%); Pattern 4: Sclerotic-mixed type metastases (32;14%); Pattern 5: Lytic/ bone marrow metastases (12/231;5%); Pattern 6: Metabolically inactive metastases (14/231;6%). CONCLUSION: SPECT-CT is a revolutionary technique that improved the interpretation of BS. Recognition of patterns of disease that may be resolved with SPECT-CT will help significantly to better understanding the patient's bone disease.

Comparison of wire-guided localization and radio-guided occult lesionlocalization in preoperative localization of nonpalpable breast lesions.

BACKGROUND/AIM: Breast lesions that are not palpable on physical examination but considered suspicious for malignancy on mammography or ultrasonography should be marked before surgery. Wire-guided localization (WGL) is the most frequently used method for preoperative marking of nonpalpable breast lesions (NPBLs). An alternative is marking by a radioactive agent (radio-guided occult lesion localization; ROLL). The present study aimed to compare WGL and ROLL for preoperative marking. MATERIALS AND METHODS: The study included 25 patients marked by ROLL and 11 patients marked by WGL. The groups were compared in terms of patient and lesion characteristics, method-related characteristics, hospital stay duration, complications, cosmetic outcomes, and rate of correct marking. RESULTS: Suspicious lesions were marked with a success rate of 95.6% by ROLL and 100% by WGL. Complications and pain sensation rates were found significantly lower in the ROLL group compared to WGL. Although ROLL was considered more advantageous in terms of hospital stay duration, positive surgical margins, cosmetic outcomes, and excision duration, the differences between the groups were not statistically significant. CONCLUSION: ROLL, which is a simple, comfortable, and reliable method, could be used as an alternative to the WGL in preoperative marking of NPBLs.