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Bone Imaging in Metastatic Breast Cancer

From the Breast Cancer Research Program and the Departments of Blood and Marrow Transplantation, Diagnostic Radiology, Nuclear Medicine, and Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX

Address reprint requests to N.T. Ueno, MD, PhD, Breast Cancer Research Program, Department of Blood and Marrow Transplantation, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 448, Houston, TX 77030; e-mail: nueno{at}mdanderson.org

Bone is the most common site to which breast cancer metastasizes. Imaging—by skeletal scintigraphy, plain radiography, computed tomography, or magnetic resonance imaging—is an essential part, and positron emission tomography or single-photon emission computed tomography have a potential of evaluating bone metastases, but no consensus exists as to the best modality for diagnosing the lesion and for assessing its response to treatment. Imaging bone metastases is problematic because the lesions can be osteolytic, osteoblastic, or mixed, and imaging modalities are based on either direct anatomic visualization of the bone or tumor or indirect measurements of bone or tumor metabolism. Although bone metastases can be treated, their response to treatment is considered "unmeasurable" according to existing response criteria. Therefore, the process by which oncologists and radiologists diagnose and monitor the response of bone metastases needs revision, and the current inability to assess the response of bone metastases excludes patients with breast cancer and bone disease from participating in clinical trials of new treatments for breast cancer. In this review of the MEDLINE literature, we discuss the pros and cons of each modality for diagnosing bone metastases and for assessing their response to treatment and we present a practical approach for diagnosis and assessment of bone metastasis.

Supported by the Public Health Research Foundation's Comprehensive Support Project for Oncology Research in Breast Cancer in Japan.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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