Hypertrophic osteoarthropathy in staging skeletal scintigraphy for lung cancer

Aim: To assess the prognostic significance of hypertropic osteoarthropathy (HOA) discovered on routine staging bone scintigraphy in patients with lung cancer. Patients and methods: Between 1989 and 1992 all Tc-99m-MDP bone scintigrams performed for the staging of bronchogenic carcinoma were reviewed. HOA was diagnosed by the observation of cortical/periosteal increased uptake in the extremities of the long bones. Follow-up and confirmation of the diagnosis nas obtained by hospital computer, histology records, operative records, patient notes and radiological data where available. Results: 164 staging scintigrams for lung cancer were identified. Twenty-eight patients (17%) were observed to have HOA. Patients with and without HO were well matched for age and sex. There was little difference in the distribution of cell type but the HOA groups has a greater incidence of peripheral tumours. There was no significant difference in survival between the two groups. Two of three long-term survivors had clinically overt HOA and one presented with arthralgia. Conclusion: HOA is often seen on skeletal scintigraphy for staging of lung cancer and has no prognostic significance. The data also support current teaching that a high index of suspicion for HOA, as a cause of arthralgia may lead to early diagnosis of a potentially resectable lung carcinoma.