Bone pain as a primary predictor of bone metastasis: A retrospective review

Objectives FDG-PET scans are often not performed unless cancer pts have a specific complaint such as pain. The purpose of the study was to retrospectively evaluate pain levels in patients presenting with FDG-PET positive metastatic disease to bone.

Methods Retrospective evaluation of 100 FDG-PET scans in patients with known metastatic disease to bone. Pain was evaluated on a scale from 0-2 with 0 being no pain, 1 being pain not requiring daily medication, and 2 being pain requiring daily medication use. This was evaluated through direct consultation with the primary care physician as well as a comprehensive review of electronic medical records. Studies were reviewed by 2 board certified nuclear medicine physicians. A study was considered positive if a discrete focal abnormality was present above the normal bone/marrow background.

Results 71% (71/100) of patients with PET positive metastatic disease to bone did not experience bone pain. The majority of findings were found in the lytic or trabecular metastatic sites. Table 1 illustrates pain scale percentages in 100 retrospectively reviewed PET positive patients. Table 2 is a complete summary of all 100 patients with corresponding pain scale listings by primary malignancy.

Conclusions FDG-PET detects osseous metastatic disease prior to pts developing pain. Bone pain is not an accurate predictor of metastatic disease to bone in patients with known primary malignancy. FDG-PET imaging should therefore not be deferred until the onset of symptoms but should be used to accurately assess staging.