NCCN Guidelines for Patients
Breast Cancer – Metastatic (STAGE IV), Version 2.2017
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.
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.
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