NCCN Guidelines for Patients
Breast Cancer – Locally Advanced (STAGE III)
A bone scan may be used to see if the cancer has
spread to your bones. For this scan, a radiotracer will
be injected into your bloodstream. The most common
radiotracer used for bone scans is technetium. You
will need to wait about 3 hours for the radiotracer to
enter your bones.
A special camera will be used to take pictures while
you lie still on a table. It takes 45 to 60 minutes to
complete the pictures. Areas of bone damage use
more radiotracer than healthy bone and thus appear
as bright spots in the pictures. Bone damage can
be caused by cancer as well as by other health
Sometimes CT is combined with PET (
omography). When used to together, they
are called a PET/CT scan. Some cancer centers
have one machine that does both scans. At other
centers, the scans are done with two machines.
For PET, a radiotracer will first be injected into your
body. The radiotracer is detected with a special
camera during the scan. Cancer cells appear brighter
than normal cells because they use the radiotracer
more quickly. PET can show even small amounts of
Sodium fluoride PET/CT
Instead of a bone scan, images of bones can be
made with PET/CT. The radiotracer used to image
bones is sodium fluoride. This scan is costly.
However, it 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
This scan also detects cancer. FDG
(fluorodeoxyglucose) is a radiotracer that is made of
fluoride and a simple form of sugar called glucose.
You must fast for 4 hours or more before the scan.
FDG PET/CT can be done at the same time as
FDG PET/CT is most helpful when other imaging
tests are unclear. It may also be helpful with finding
breast cancer that has spread to lymph nodes or
distant sites. If the scan detects cancer spread to the
bone, a bone scan or sodium fluoride PET/CT may
not be needed.
Treatment given before surgery can cause tumors to
shrink a lot. Thus, biopsies may be done while the
cancer can still be found. A biopsy is a procedure that
removes tissue or fluid samples for testing. Numbing
medicine may be injected into the site before the
If not done before, a core needle biopsy of the breast
tumor is needed. Mammography may be used to
guide the needle into the tumor. This procedure is
called a stereotactic needle biopsy. Needles can also
be guided with ultrasound images. You may also
have small metal clips placed in your breast near the
tumor. The clips will help your surgeon find the area
Lymph node biopsy
If not done before, you may receive an ultrasound
of axillary lymph nodes. If cancer may be present,
a needle biopsy is often done with ultrasound
guidance. An FNA (
a small group of cells.
See Figure 7
. A core needle
biopsy removes a solid tissue sample. Like breast
tumors, lymph nodes with possible cancer may be
marked with a tattoo or clip.