Limites de la scintigraphie osseuse dans le suivi des métastases osseuses du carcinome mammaire : étude du centre tunisien

Bone metastases, a relatively frequent complication of breast carcinoma, are more and more associated with better survival. This in part through a specific detection and monitoring. In Sousse (Tunisia), bone scan is the exam most frequently performed for monitoring bone metastases, which is also the only functional exam available until December 2011. We studied the place of bone scan in the monitoring of these bone metastases. We followed 115 patients between 2000 and 2004 with a follow-up of 7 to 11 years. We used Measurable Criteria Disease response of Anderson (MDA) scintigraphic criteria. Complete remission was rare. Partial remission rate decreased gradually over time. Partial remission rate was 22.6% at the first evaluation and became equal to 10% at the fourth assessment. Stability is a false reassuring category since among the 27 cases judged to be stable after the first evaluation, only nine continued to be stable at the fourth evaluation and one at the sixth. In conclusion, bone scan is reliable only in cases of complete or partial remission. For other stages bone scintigraphy had many limitations since this examination informs about the osteoblastic reaction around metastases and not the tumour itself. 18F-FDG-PET/CT (18Fluoro-deoxy-glucose) indeed shows the metastasis metabolism itself, so is better positioned to evaluate the therapeutic response.