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A series of 315 patients with histologically proven breast cancer had skeletal scintigraphy performed for defined reasons other than initial staging. Of these, 173 (55%) were found to be abnormal. The yield of abnormalities was highest (83%) in patients with bone pain or tenderness and radiographic evidence of metastases: 38% in those with bone pain or tenderness alone, 37% in asymptomatic patients with local or regional recurrence and 54% in those with non-bony metastases. The overall actuarial survival over a maximum follow-up of 9 years was significantly worse for those with abnormal scintigraphy. Non-staging skeletal scintigraphy is useful in detecting asymptomatic bone metastases at the time of local or regional recurrence or in the presence of non-bony metastases.

The results of skeletal scintigraphy performed at presentation in 465 women with histologically confirmed carcinoma of the breast were correlated with tumour size, node status, clinical course and survival during a follow-up of at least 2 years and up to 9 years. Skeletal metastases were eventually confirmed in 17.6% of the population under study, but were identified at presentation by scintigraphy in only half of these. The incidence of significant scintigraphic abnormalities ranged from 1.5% in patients with T0 and T1 node negative tumours to 20.3% in T4 node positive tumours. Patients with scintigraphic evidence of metastases had a significantly shorter survival than those without; 13.6% of the patients with an abnormality considered to be significant on the criteria employed in this study failed to develop confirmatory evidence of skeletal metastases during the period of follow-up. Alternative criteria are proposed which would substantially decrease the incidence of false positives without increasing the incidence of false negatives. Even so, it is concluded that there is no evidence that routine skeletal scintigraphy affects management of newly diagnosed patients with carcinoma of the breast. Unless an algorithm can be defined which requires the information provided by skeletal scintigraphy in order to determine clinical management, this investigation is not justified as a routine staging procedure and should be reserved for patients in whom there is a clinical suspicion of metastases and for clinical trials.