DrVirgo
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Lung sends lytic mets and prostate sends blastic mets to the vertebrae...
So how do we differentiate between the two in terms of presentation and symptoms of back pain?
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| sprint123
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I think we could not differentiate the two mets by clinical features alone--
I think both will manifest as constant dull aching back pain WITHOUT neurological symptoms , WITHOUT tenderness over the vertebra and NOT relieved by rest
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| cirus
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but put in mind there is hypercalcemia, the source is breast or lung
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| dr in trouble
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I think in lytic mets there can be history of fracture.
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| ssrpk
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if we suspect bone mets?
wht is the first step in diagnosis?
also wht is the most specific for any type of bone mets?
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| elitoki
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first step is X-ray and then bone scan for specific???
I'm not sure, let me know if I'm wrong. 
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| dratish
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X-RAY is USELESS. BONE SCAN is the best test in suspected bony metastases. Confirmatory test is bone biopsy but thats usually not required as the presentation is classical with multiple hot spots on bone scan in patient with known CA.
Do not forget Multiple Myeloma for lytic lesions and hypercalcemia
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| Justice
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dratish wrote:
X-RAY is USELESS. BONE SCAN is the best test in suspected bony metastases.
Disagree...
Whereas the test of choice is MRI (not bone scan, colleague), x-ray (L-spine) may also reveal lytic or (+)-bone lesions if appropriate positioning is executed.
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| dr in trouble
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I read somewhere that first we have to do bone scan and then xray to confirm about the lesions lighten up on bone scan.
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| dr19
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radionuclide bone scanning is widely regarded as the most cost-effective and available whole-body screening test for the assessment of bone metastases.
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| ssrpk
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so wht to do first?
xray or bone scan???
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| dr in trouble
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First Bone scan and then Xray
Screening for bone metastases is generally thought to be unnecessary if the primary tumor is at an early stage. Once clinical justification is made for screening (pain, biomarker elevation), bone scan is the first imaging modality for screening most tumor types (except MM) because it offers whole-body scanning and is cost-effective. Positive bone scan can manifest as multiple focal, randomly distributed lesions, multiple atypical lesions, or infarction, solitary, or photon-deficient lesions ("cold spots") and diffuse involvement. If bone scan is positive for metastatic disease, x-ray examination can be performed to assess the degree of bone loss and risk of pathologic fracture. Standard radiography is also important to establish a baseline for comparison with future assessments. Symptomatic patients should undergo x-ray examination even if bone scan is negative. If x-ray examination demonstrates metastases, assessment with a baseline CT (especially for lesions in weight-bearing bones or the chest wall) and/or MRI (especially for spinal lesions) is justified. MRI can provide detailed images of bone and bone marrow. MRI has better contrast resolution than CT for visualizing soft tissue and spinal cord and thus is particularly useful for distinguishing benign from malignant causes of vertebral compression fracture and in detecting spinal cord compression. Bone biopsy confirms the presence or absence of metastatic disease, as indicated by these imaging modalities.
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| ssrpk
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hey thanks....that was helpful 
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| DrVirgo
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Also, mets from prostate are blastic, and mets from lung and breast are lytic, so prostate won't cause compression fractures. But both can cause back pain.
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