New guidelines are out for appropriate use of bone scintigraphy, scans for bone metastases.
On April 6, the Society of Nuclear Medicine & Molecular Imaging (SNMMI) published appropriate use criteria for implementation with patients who have breast or prostate cancer.
The guidelines are designed to hep referring physicians and other ordering professionals abide by the requirements set forth in the 2014 Protecting Access to Medicine Act (PAMA). In 2018, PAMA will require referring physicians to consult appropriate use criteria.
According to the guidelines bone scintigraphy is appropriate for prostate cancer:
-initial screening in patients with intermediate-risk disease (stage T2, PSA level >10 ng/mL, Gleason score ≥7)
-initial evaluation of patients with high-risk disease (stage T3, PSA level >20 ng/mL, Gleason score >8)
-evaluation of patients with symptoms referable to bones regardless of stage or risk
-evaluation of patient in which change of treatment is anticipated
-patients presenting with pathological fracture
-evaluation of patients who undergo radium or other radionuclide bone therapy
Use is not appropriate for initial staging in prostate cancer patients with low-risk of metastatic disease (PSA level ≤10 ng/mL, Gleason score <6, no other clinical signs or symptoms).
Guidelines for breast cancer include:
-initial stage with node-positive disease
-patient in any stage or risk who have symptoms referable to bones
-patients who undergo bone-directed radionuclide therapy
-patients who present with pathological fractures
-patients who require a chance in treatment plans
-patients suspected of having nonosseous or osseous disease progression
Use is not appropriate for initial staging in breast cancer patients with low-risk disease (clinical stage 0 or 1) or with no other clinical signs or symptoms.
The guidelines were designed by SNMMI, the European Association of Nuclear Medicine, and the American Society of Clinical Oncology.