NCCN Guidelines for Patients
Stage IV Breast Cancer, Version 1.2014
Sodium fluoride PET/CT
Instead of a bone scan, PET (
omography) and CT scans can be used to image
bones. However, PET/CT is recommended only when
other tests don’t clearly show if cancer is present in
the bones. Some cancer centers have an imaging
machine that does both scans. At other centers, the
scans are done with two machines.
Like a bone scan, PET also uses a radiotracer to see
the activity of cells. The radiotracer used to image
bone with PET is sodium fluoride. Sodium fluoride
PET/CT is a costly test but shows areas of bone
damage and repair better than a bone scan. It also
has a shorter waiting time of 40 to 60 minutes for the
radiotracer to be seen and a shorter scanning time of
15 to 20 minutes than a bone scan.
Another type of PET used to see if breast cancer has
spread is FDG (
lucose) PET/CT. FDG
is a radiotracer that is made of fluoride and a simple
form of sugar (glucose). Cancer cells use more FDG
than normal cells and thus show up as bright spots
on pictures. For this test, you must fast for 4 hours
or more. FDG PET/CT is most helpful when other
imaging tests are unclear and may be helpful with
finding breast cancer that has spread to lymph nodes
or distant sites.
X-rays of bones that hurt are recommended. Long and
weight-bearing bones that aren’t normal on bone scan
or PET/CT should also be x-rayed. During an x-ray,
you must lie still on a table while the x-ray machine
sends small amounts of radiation into your body.
Images made from the x-rays are seen on a screen.
A biopsy removes small samples of tissue or fluid
from the body for testing. The methods used to
remove samples will depend on where the cancer
has spread. A biopsy is recommended to confirm if
the distant site has cancer, test for the type of cancer,
and perform the receptor tests described next. If your
doctor does not suggest a biopsy, ask why.
Tissue from the breast tumor was likely tested before
if you have been treated for early stage-breast cancer.
Expect that your doctor will want to biopsy your
metastatic breast cancer. In a small number of cases,
the biology of the tumor changes. Such changes can
greatly impact your treatment options and response to