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Two foci with minimal uptake in BONE SCAN. Something serious?

Resolved Question:

You explained to me that 2 small foci with minimal uptake on a bone scan is nothing to worry about. If bone turnover is a normal part of life, wouldn't there be LOTS of foci with minimal uptake??

It seems that if there are only 2 foci with minimal uptake that this indicates something serious. The 2 foci are in the middle of the femur, so it is not arthritis. And I had not had any trauma to that femur.

I hope that you still think these foci are unimportant.

Category: Oncologist

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Category: Hematologist
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Patient replied :

Main question: Are you saying that the 2 minimal uptake foci in my right femur are background activiity, and not to be worrried about? Or are they specific lesions with abnormality and asymmetry to be evaluated?? I am hoping that you mean that they are background noise, because that would calm my fears.

I did have a totally negative bone scan 3 months after the one with the foci. I just don't trust it, because it didn't show the arthritis in my knee either, so I think it just wasn't showing anything. (the first bone scan also showed arthritis in the knee--but the foci were too far up the femur to be connected to the arthritis. also the 2 foci were probably 6 inches apart). I am currently having radiation, and will be rescanned after that is over.

Did you have CT or MRI of that area after the first bone scan ?? Can you forward me those reports.. If the second scan is negative, I could not understand why you should be worried, when your oncologist feels normal about the scans.
Can you forward all the previous investigations please ?/
Kind regards.

Patient replied :

I probably shouldn't have bothered you about this again, because last time you said you weren't worried about those 2 spots at all, but now you sound worried. (you have the bone scan I sent you last time)

no mri or ct of that area (well, the ct/pet cut off somewhere in the femur--and the pet was negative--it may have included one of the foci--but the report said nothing about it)

1. I thought you were telling me that minimal uptake foci were background activity, is that true? And that to be cancer it had to be significant uptake. I was just wondering if people with just 2 foci can call it background activity???

2. The other question, is would those areas have hurt back when the scan was taken, if they were mets??

3. The reason I don't trust the 2nd (negative) bone scan is because it didn't show my arthritis in the knee, either (which had been on the other scan). Is that a reason to NOT trust the scan?

4. I've heard that bone scans on lobular cancer give false negatives 30 percent of the time. Is that true?

False negatives , true positives , true negatives , false positives are all statistics and for routine clinical application needs a lot of corroborative evidence.
1. Background activity can be picked up in a bone scan based on threshold levels set during imaging. Lot of factors are involved during interpretation of a bone scan.
2. Pain is one of the symptoms in bone metastases. It can be non specific, based on extent of bone destruction.
3 & 4. PET scan is more appropriate than bone scan with better sensitivity and specificity.

Patient replied :

So, do you agree with your previous answer that for a bone scan to be positive you need significant uptake? And for it to be negative it can be minimal of no uptake? You said you were not worried at all about my scan.

Then I wouldn't have to worry.

Yes for a bone scan to be positive you need significant uptake.
So i am not worried about you at all.

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.
Dr. Prasad Eswaran and 4 other Medical Specialists are ready to help you

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