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The purpose of the present work is to "quantify" bone scanning, in order to calculate indices of localized uptake that will make it possible to differentiate between normal and pathological uptake, and approach an etiologicial diagnosis. The authors use an Elscint dual head whole body scanner and an offline video display calculator. The patient is given 8 mc technetium 99m pyrophosphate 4 hours prior to scanning. The whole body count is expressed in thousands of counts multipled by two so that the knee to whole body ratio is close to one, to facilitate comparison of the indices. Results show that the presence of metastases is demonstrated more clearly by using a ratio bone segment to whole body. Quantitative scanning with 99mTc-pyrophosphate makes it possible to: 1) detect bone metastases easily, 2) follow the metastases during treatment, 3) avoid the gross errors that can be made in nomquantitative scanning.

A group of 135 patients with osseous metastases from breast cancer were treated with hydroxy-9-methyl-2-ellipticinium (100 mg/m2 weekly). Although it was impossible to grade the response precisely, because only indirect criteria are available for assessing the course of bone metastases (radiographs, quantified 99mTc pyrophosphate scintigrams, CEA), it was considered that an objective response was obtained in 44 cases. These responses lasted from 3 to 17 months. The main characteristic of the compound is its lack of marrow toxicity, a valuable property in osseous lesions, where frequent marrow involvement makes it difficult to use conventional drugs. The major and most unpleasant side effect was an inhibition of salivary secretion, which causes other complications such as tongue mycosis, anorexia, and asthenia. Immunologic disorders were less frequent, and four patients developed severe tubular renal insufficiency.

In 96 patients (95 women--1 man) with osseous metastases from breast cancer suitable for analysis an objective remission was obtained with hydroxy-9-methyl-2-ellipticinium (100 mg/m2 weekly) in 31 cases. These responses lasted from 3 to 17 months. The main characteristic of this compound is its lack of marrow toxicity, a property of value in osseous lesions where marrow is so frequently involved, making difficult the use of conventional chemical drugs. The principal unpleasant drawback is an inhibition of the salivary secretion which causes other side effects such as tongue mycosis, anorexia, and asthenia. Less frequently immunologic disorders and a few cases of renal insufficiency were observed.

Since 1976 to 1978 inclusive, 465 patients with primary breast cancers underwent whole body analogical scintiscans, 456 numerical scans, and 453 were X-rayed. Ninety per cent received axillary node ablation, 62% presented adenopathies of which a third were capsular ruptures and 54% were T3 and T4. In 53 patients, the presence of metastasis was estimated by clinical evaluation. In 38 patients, metastasis were confirmed. Probability for the patient to present metastasis when the test is positive, is: P (M/T +) = Se.p/(Se.p) + (1-p) + (1-p) (1-Spe) Probability when the test is negative is: P (M/T -) = p(1-Spe)/p(1-Se) + (1-p)Spe p = prevalence Se = sensibility Spe = specificity Performance of the test is the probability of obtaining a correct result is: P = (f1) - (f2) = (f3) The (f3) curves were plotted for each of the three tests. For a prevalence of 11% (clinical estimate) the X-ray or analogical scintiscans tests achieve the same performance, but that for a prevalence of 8% (exact number) the radiological examination yields the best. In two cases, numerical scan is better.