Conclusions

In a patient with a known or suspected malignancy, the finding of an asymptomatic area of increased uptake on bone scintigraphy images but with normal plain bone radiographs does not necessarily indicate that a bone metastasis is present. In fact, such a hot spot represents a benign lesion in as many as 78% of patients. Open biopsy for histological confirmation is mandatory in this setting. Until recently, accurately locating a bone lesion for open biopsy with only the bone scan image as a guide greatly challenged the surgeon. The technique of methylene-

blue "tattooing" of the target bone appears to be effective it is somewhat cumbersome and time consuming [11,12]. The recently described intraoperative gamma-probe technique of locating bone scan lesions offers real advantages in terms of decreased surgery time, minimal interdepartmental coordination, and 100% sensitivity [3]. With the widespread use of the gamma probe in melanoma and breast cancer surgery as well as other applications described in earlier chapters of this book, this instrument is becoming a common fixture in most active surgery rooms. As a result, the gamma probe will be readily available to guide surgeons in performing open bone biopsies.

In our study, the hand-held gamma probe was successfully used intraopera-tively to guide the surgeon in locating asymptomatic rib and sternal lesions to biopsy. This same technique could no doubt be easily adapted by orthopedic surgeons to biopsy subtle lesions in other bones in the appendicular skeleton. In addition, the gamma probe could obviously be used to aid in the biopsy of symptomatic or radiographically visible bone lesions in patients whose body habitus or location of the bone lesion might make precise conventional intraoperative localization difficult. This technique is easy to learn and apply, has no apparent side effects, and should be considered for use by the surgeon in guiding the open biopsy of suspected asymptomatic bone metastases.

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