Background
Data about early detection of ONJ by Bone Scan (99mTc-MDP scintigraphy) (BS) have been occasionally published1,2. Following data are in favour: a) BS is an imaging technique with high sensitivity; b) sporadic cases of early jawbone (maxilla or mandible) uptake have been reported, occasionally even months or years before clinical evidence of ONJ (bone exposure); c) the BS is performed periodically in patients with skeletal metastases to check out the status of disease activity and the response to specific treatments; consequently the research for early ONJ does not involve additional costs. Potential limitations include: a) maxilla or mandibular uptake could be due to metastatic lesions; b) BS is a technique with low specificity: beside neoplastic one, bone traumatic, inflammatory, degenerative lesions can determine an uptake; c) an undefined proportion of patients (even without any active tumor disease) shows jaw uptakes, due to dental diseases widely seen in the general population (abscesses, denture ulcers, periodontal disease, etc.); c) even in BP-related ONJ suspected cases, jaw uptake may be due to infections that are not necessarily connected to the osteomyelitis component of ONJ.
Methods
We conducted a retrospective study of routine BS performed in 12 ONJ patients treated with BPs (8 with breast cancer, 4 prostate cancer); BS was performed 6–12 months prior to definitive ONJ diagnosis. Two Nuclear Medicine specialists reviewed images.
Results
6–12 months prior to diagnosis, 8/12 BS were positive (evident jaw uptakes in ONJ sites), 3/12 were doubtful (moderate uptake) and 1 negative.
Conclusions
These preliminary data are interesting and challenging. A case-control study has been designed with different patient groups, including: ONJ cases; patients treated with BP and not suffering from ONJ; cancer patients not receiving BPs.
References
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