No benefit found to radionuclide bone scans for cartilaginous tumors in the humerus
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Radionuclide bone scans may not correlate with other radiographic and clinical findings and are not warranted for the diagnosis of enchondromas of the humerus, according to published results.
While radionuclide bone scans are reliable for differentiating between benign enchondromas and malignant well-differentiated chondrosarcomas, their reliability for differentiating enchondromas is unknown, according to researchers from Hospital for Special Surgery and Yale University School of Medicine.
To determine the utility of bone scans, researchers retrospectively reviewed information on 25 patients (mean age of 50 years), with an eventual diagnosis of enchondroma, who underwent radionuclide bone scanning at one academic medical center between January 2004 and December 2010.
According to the study, radiographs and MRIs were used to find evidence of aggressive features such as soft tissue involvement, endosteal scalloping and periosteal involvement. Researchers performed bivariate logistic regression to determine the association of bone scan results with endosteal scalloping on the radiographs and MRIs.
During an average of 69 weeks of follow-up, no lesions showed progression. Researchers determined “no statistically significant association” between positive findings of the bone scans and aggressive features on radiographs or MRIs. Bone scanning showed 72% of patients (n = 18) had positive findings at the site of the enchondroma, 20% (n = 5) had weakly positive findings and 8% (n = 2) had negative findings. Endosteal scalloping was shown on 8% (n = 2) of radiographs and 18% (n = 4) of MRIs, according to the study.
“When treating patients with low-grade cartilaginous lesions, differentiating between benign and malignant lesions is critical,” the researchers wrote in the study. “In the humerus, imaging may be especially important because pain from concurrent rotator cuff pathology may be difficult to differentiate from a painful, metabolically active chondrosarcoma,” they wrote.
“Based on the current findings and given the utility of patient presentation, plain radiographs and MRI scans in the diagnosis of these lesions, regular use of radionuclide bone scans for workup of well-differentiated cartilaginous lesions is not warranted,” they added. “Physicians who have experience in the diagnosis of musculoskeletal tumors may rely instead on the clinical and radiographic findings, with regular observation over time to ensure that there is no disease progression.”
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