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NCCN Guidelines for Patients



Breast Cancer – Locally Advanced (STAGE III)

Version 1.2017

Bone scan

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

diagnostic CT.

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


Breast biopsy

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

with cancer.

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 (






spiration) removes

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.


Treatment planning