In a prospective study of forty-five patients, we evaluated the
usefulness of bone and gallium scintigraphy prior to definitive surgery for
a soft-tissue sarcoma in an extremity. Bone scintigraphy provides a
baseline for staging and often reveals periosteal invasion that is not
detected by routine radiographs. Blood-pool scintigraphy with bone tracers
is very sensitive for a diagnosis of malignant disease. Gallium
scintigraphy appeared to be a reliable preoperative indicator of malignant
disease of soft tissue (sensitivity, 85 per cent; specificity, 92 per cent)
and was useful for detecting the infrequent occult, non-pulmonary
metastasis. Combined gallium and bone scintigraphy with blood-pool imaging
provided a reliable prediction of the presence or absence of a malignant
lesion in patients with a soft-tissue mass in an extremity. We recommend
that bone and gallium scintigraphy be routinely used in the initial
clinical staging of soft-tissue sarcomas.