Value of routine 99mTc-MDP bone scintigraphy in the detection of occult skeletal metastases in women with primary breast cancer.

Baseline staging bone scans in 208 women with primary breast cancer in University Hospital Kuala Lumpur from January 1993 to December 1995 were reviewed. A positive bone scan was found in 14.7% of women aged below 50 years, and 9.1% of women aged 50 years and above. No patient with T0/T1, 4.7% with T2, 6.6% with T3 and 35.8% with T4 tumours had a positive scan caused by bone metastases. No patient with clinical Stage 0/1, 4% with Stage 2, 9.5% with Stage 3 and 63% with Stage 4 disease had a positive bone scan. Clinical staging alone was inaccurate in 20.2% of patients. Forty per cent of patients with a positive bone scan did not have bone pain. The false positive rate was 0.5% and the false negative rate was 0.96%. We conclude that a routine bone scan is not required in Stage 1 disease or T1 tumours, is indicated in Stage 3 and 4 disease, or T3 and T4 tumours, and should only be performed in selected women with Stage 2 or T2 cancers.