Planar Bone Scan Versus Computerized Tomography in Staging Locally Advanced Breast Cancer in Asymptomatic Patients: Does Bone Scan Change Patient Management Over Computerized Tomography?

AIM: The Royal College of Radiologists guidelines from 2013 recommend that contrast-enhanced computerized tomography of chest, abdomen and pelvis (CT TAP) for breast cancer patients with suspected metastasis could obviate the need for bone scan in asymptomatic patients. The purpose of this study was to perform a head-to-head comparison of bone scan and CT scan in locally advanced breast cancer patients. The aim of this study was to evaluate the utility of planar bone scan in changing the stage or management of locally advanced breast cancer patients. METHODS: Between June 2006 and January 2016, 156 breast cancer patients had staging investigations (either CT and bone scans, bone scans only, or CT only). All images and reports on picture archiving and communication system were evaluated retrospectively. RESULTS: One hundred five of 156 patients had both CT TAP and bone scan within 10 days of each other. Of the total of 105 patients, 33 (31.4%) had concordant normal results on CT TAP and bone scan. There were 18/105 (17.1%) patients with extraosseous metastasis on CT with negative or inconclusive bone scan. Bone scans diagnosed peripheral osseous metastasis in 5/105 (4.7%), which were either skull or extremity metastasis outside CT TAP field of view. All of these 5 patients had other metastatic lesions within axial skeleton or soft tissues on CT and led to no change in patient management. CONCLUSIONS: Our findings suggest routine use of bone scan in asymptomatic patients with locally advanced breast cancer did not change patient management.

Serum and cerebrospinal fluid biomarker profiles in acute SARS-CoV-2-associated neurological syndromes.

Preliminary pathological and biomarker data suggest that SARS-CoV-2 infection can damage the nervous system. To understand what, where and how damage occurs, we collected serum and CSF from patients with COVID-19 and characterized neurological syndromes involving the PNS and CNS (n = 34). We measured biomarkers of neuronal damage and neuroinflammation, and compared these with non-neurological control groups, which included patients with (n = 94) and without (n = 24) COVID-19. We detected increased concentrations of neurofilament light, a dynamic biomarker of neuronal damage, in the CSF of those with CNS inflammation (encephalitis and acute disseminated encephalomyelitis) [14 800 pg/ml (400, 32 400)], compared to those with encephalopathy [1410 pg/ml (756, 1446)], peripheral syndromes (Guillain-Barré syndrome) [740 pg/ml (507, 881)] and controls [872 pg/ml (654, 1200)]. Serum neurofilament light levels were elevated across patients hospitalized with COVID-19, irrespective of neurological manifestations. There was not the usual close correlation between CSF and serum neurofilament light, suggesting serum neurofilament light elevation in the non-neurological patients may reflect peripheral nerve damage in response to severe illness. We did not find significantly elevated levels of serum neurofilament light in community cases of COVID-19 arguing against significant neurological damage. Glial fibrillary acidic protein, a marker of astrocytic activation, was not elevated in the CSF or serum of any group, suggesting astrocytic activation is not a major mediator of neuronal damage in COVID-19.