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Thank you for your last answer.  A two part question for you:

1.  I am wondering if on a bone scan, the bones actually have to be turning over DURING the scan to make it show a positive?

I found this article on wikipedia that says this:
The nuclear medicine scan technique is sensitive to areas of unusual bone-rebuilding activity because the radiopharmaceutical is taken up by osteoblast cells that build bone. The technique therefore is sensitive to fractures and bone reaction to infections and bone tumors, including tumor metastases to bones, because all these pathologies trigger osteoblast activity.

It would seem, that just the presence of extra osteoblastic cells would make the tracer show a positive scan. And then the bones wouldn't have to be turning over DURING the scan.

Is this true?

2.  I also read ( NOT on wiki)  that lobular cancer, since it grows slowly, might not make the osteoblasts active enough, and that would give a false negative?  Does that make sense?  It would seem to me that if you have osteoblastic cancer, and extra osteoblasts around it, that the slow-growing part wouldn't matter?  Does that make sense?

Category: Oncologist

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Category: Hematologist
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Patient replied :

Do you believe that the bone scan works worse on mets for lobular cancer?

Yes. If there is evidence of bone destruction and the process of remodeling is going on !

Patient replied :

Did you mean to say that bone scan works badly for lobular cancer? I'm confused because you said yes, but the rest of your answer doesn't seem to fit with that--the rest of your answer sounds like you think it works fine for lobular.
Also, one more question: do you think that osteoblastic cancer will show up on a plain ct (with no pet)? I heard that there is cortical destruction around an osteoblastic cancer, that helps it show up on ct scans. Is it true that blastic cancers can cause cortical destruction?

I hope you read completely about the articles I sent you on PET and Bone Scan. These two radionuclide investigations have different mechanisms of interpreting the disease.

Bone scan will be positive in case of active bone remodelling taking place at the site of destruction by tumor mediated osteoclasts.

PET CT correlates with glucose uptake mechanisms in cancer cells. May act differently in lobular cancer. Hence chances of varied sensitivity and specificity in these scans.

Hope your doubt is cleared. I apologise if I was misunderstood.


Dr. Prasad Eswaran
Category: Hematologist
Doctorate in Medicine (Fellowship in Oncology), DM,  Madras Medical College & Govt. General Hospital, Chennai, India.

Doctor of Medicine (Residency in Radiation Oncology) , MD, Christian Medical College, Vellore, Tamilnadu, India, 2004-06.

Diploma in Medical Radiology & Therapy (Residency in Radiation Oncology), D.M.R.T, Madras Medical College & Govt. General Hospital, Chennai, India, 2004-06.

Bachelor of Medicine & Bachelor of Surgery - M.B.B.S, Govt. Stanley Medical College & Hospital, Chennai, India, 1998-2004.
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