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Reliability of symptoms to determine use of bone scans to identify bone metastases in lung cancer: prospective study

BMJ 2004; 328 doi: (Published 29 April 2004) Cite this as: BMJ 2004;328:1051
  1. Martin Hetzel (, consultant physician1,
  2. Juergen Hetzel, specialist in internal medicine1,
  3. Coskun Arslandemir, physician2,
  4. Karin Nüssle, radiologist3,
  5. Holger Schirrmeister, consultant in nuclear medicine2
  1. 1 Department of Internal Medicine II, University of Ulm, D-89081 Ulm, Germany
  2. 2Department of Nuclear Medicine, University of Ulm
  3. 3Department of Diagnostic Radiology, University of Ulm
  1. Correspondence to: M Hetzel
  • Accepted 11 November 2003


Based on the hypotheses that most skeletal metastases in lung cancer are clinically symptomatic, that the incidence of bony metastases in early stages is low, and that bone scintigraphy has a sensitivity of nearly 100%, leading professional societies recommend diagnostic skeletal imaging depending on clinical symptoms.1 2 No study has assessed the significance of skeletal symptoms as a criterion for skeletal imaging in patients with lung cancer since 1991.3 But in the intervening period gamma camera technology has been considerably refined and more sensitive methods such as magnetic resonance imaging have become available for skeletal imaging.

We redetermine the role of symptoms and serum concentrations in detecting bony metastases in lung cancer and reassess the accuracy of bone scans for screening.

Participants, methods, and results

From September 1999 to September 2001 we recruited 153 consecutive patients at University Hospital Ulm. We included patients based on cytological or histological evidence of lung cancer returned no more than …

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