Editor—Hetzel et al discuss the reliability of symptoms in indicating the use of bone scanning in patients with lung cancer.1 They reported a low sensitivity of 53% in detecting bone metastases when bone scanning is restricted to patients with skeletal complaints.
This value seems unacceptably low and is in contrast with the guidelines of leading professional societies that recommend bone scanning only in patients with clinical symptoms indicating bone involvement. However, Hetzel et al do not state the stage of disease at the time of scanning, which is crucial to understand the value of their results. Prevalence (or pretest probability) of bone metastases and reliability of symptoms in driving use of bone scanning is expected to vary according to disease stage.2
Competing interests: None declared.
References
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- 2.Jaeschke R, Guyatt GH, Sackett DL. Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA 1994;271: 703-7. [DOI] [PubMed] [Google Scholar]