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NCCN Guidelines for Patients



Breast Cancer – Metastatic (STAGE IV), Version 2.2017


Treatment planning

Imaging tests

may be fitted with coil devices that emit radio waves.

Straps may be used to help you stay in place.

During MRI, you will be inside the machine. An

open MRI scanner may be an option at some health

centers. The machine makes loud noises but you

can wear earplugs. The part of your body that was

scanned may feel a bit warm afterward. You will be

able to resume your activities right away unless you

took a sedative.

Spine and brain MRI

Breast cancer can spread to your spine or brain.

Cancer spread to the brain is much less common

than to the spine. MRI is very useful for viewing

these sites. MRI is advised if your symptoms suggest

cancer is present. Contrast will be used. For a brain

MRI, a device will be placed around your head that

sends and receives radio waves. For spinal MRI, no

device is worn.

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 minutes.


. This scan also detects cancer. FDG







lucose) is a radiotracer that is made of

fluoride and a simple form of sugar called glucose.

For this test, you must fast for 4 hours or more.

FDG PET/CT can be done at the same time as

diagnostic CT. If the scan detects cancer spread to

the bone, a bone scan or sodium fluoride PET/CT

may not be needed. FDG PET/CT is most helpful

when other imaging tests are unclear. It may help

find breast cancer that has spread to nearby lymph

nodes or distant sites.

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