To the Editor.—
The article "Evaluation of Bone Pain in Carcinoma of the Lung: Role of the Localized False-Negative Scan" by Covelli et al (1980; 244:2625) describes finding gross tumor in vertebral bodies on postmortem examination in ten of 43 patients, all of whom had bone scans and roentgenograms with normal vertebral area interpretations. Because of this high false-negative rate (23%), the authors concluded that radiation therapy should be considered for patients with back pain and carcinoma of the lung, despite normal vertebral bone scans and roentgenograms.However, radiation therapy is not devoid of risks, and back pain is fairly common and has numerous benign causes, even in patients with bronchogenic carcinoma. Therefore, the bone scan is often used to help decide whether to administer radiation therapy to symptomatic vertebral or pelvic regions. Confidence in this technique is based not only on the high sensitivity of bone scans but also
Gorten RJ. False-Negative Bone Scans. JAMA. 1981;246(24):2807–2808. doi:10.1001/jama.1981.03320240017011
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