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NCCN Guidelines for Patients


Breast Cancer - Early-Stage


, Version 1.2016


Breast cancer recurrence

Treatment planning


Instead of a bone scan, another way to image

bones is by the use of both PET (






omography) and CT scans. 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 sites 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 imaging test that is used to see if breast

cancer has spread is FDG (






lucose) PET/

CT. FDG PET/CT is most helpful when other imaging

tests are unclear. It may be helpful with finding breast

cancer that has spread to lymph nodes or distant sites.

FDG is a radiotracer that is made of fluoride and a

simple form of sugar called 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.

Bone x-rays

X-rays of bones that hurt are advised. 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.

Chart 8.1 Health care before recurrence treatment

Main tests and services

Other care based on signs and symptoms

• Medical history

• MRI scan if CNS symptoms start

• Physical exam

• X-rays of bones that hurt

• Chest diagnostic CT

• X-rays of long or weight-bearing bones that

are abnormal on bone scan

• Abdominal ± pelvic diagnostic CT or MRI

• Bone scan or sodium fluoride PET/CT

• FDG PET/CT is an option

• Complete blood count

• Liver function tests

• Biopsy of recurrence site

• Hormone and HER2 receptor tests on

metastatic sites

• Genetic counseling if hereditary breast

cancer is likely