Should bone scintigraphy be performed to determine if patients with hepatocellular carcinoma (HCC) awaiting liver transplants have bone metastases? New research suggests the answer is no.
A multispecialty, multi-organizational team of physicians in Australia recommend that bone scintigraphy be eliminated, explaining their rationale in a November 23, 2018, article in Transplantation Direct.
Current clinical practice guidelines in both Europe and the U.S. recommend that bone scintigraphy be performed to eliminate patients with bone metastases from eligibility for a new liver. Because metastases in patients with early stage liver tumors --- who are good candidates for liver transplants -- is low, the authors wanted to determine if and how much diagnostic value bone scans provide. The authors analyzed 360 bone scans of 186 patients between January 2010 and May 2017. The only metastases---three cases---identified by the bone scans proved to be false positives. None of the patients were removed from the liver transplant waiting list as a result.
Within the cohort, 92 patients had one bone scan and 94 had two or more. Of these, eight bone scans were performed using single-photon emission computed tomography (SPECT) and 46 were performed with SPECT/CT. Besides the three false-positive studies, 14 studies were equivocal. These patients had CT, MRI, and additional bone scans that concluded the findings were benign.
Lead author Numan Kutaiba, MBChB, a radiologist at Austin Health, and co-authors determined that the average cost for a bone scan and related workup for the patients in this study was approximately U.S. $950. Total estimated costs for all participants were over U.S. $175,000.
In addition to potential cost savings of eliminating the bone scans, the authors said targeted cross-sectional imaging will identify most metastatic activity. They noted that liver transplant candidates with hepatocellular carcinoma who receive a new liver may benefit from reduced radiation exposure, and live longer, as a result
Bone scans unnecessary for assessment of patients awaiting liver transplants . Appl Radiol.