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February 14, 1977

Bone Scanning in Screening for Metastatic Disease

JAMA. 1977;237(7):644. doi:10.1001/jama.1977.03270340030013

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To the Editor.—  Bone scanning with use of technetium Tc 99m etidronate (formerly diphosphonate) has achieved widespread acceptance as a method for detecting metastasis in the face of negative roentgenograms. Recently, in an article entitled "Screening for Bone Metastasis: Are Only Scans Necessary?" by D. A. Pistenma et al (231:46, 1975), bone scanning of patients with proved primary carcinoma is advocated as the primary approach to the metastatic survey. A similar conclusion is drawn in an article entitled "Bone Scanning in Osseous Metastatic Diseases" by Robert O'Mara, MD (229:1915, 1974). Obviously, no test is perfect and a small percentage of patients with roentgenographically demonstrable metastases will have a normal-appearing scan.We believe the study is overused, and recently ran a prospective bone scintigraphic study in an effort to correlate bone scan findings with clinical symptoms of pain and the ability to elicit pain on physical examination by the physician in