Technetium-labeled methylene diphosphonate bone scan (BS) is the most commonly used imaging test to screen for skeletal metastases in patients with breast cancer. Since its introduction into clinical practice, a large number of studies have been conducted to explore the role of BS in the baseline staging work-up at the time of breast cancer diagnosis. Even though the policy of offering preoperative or perioperative BS is still widely diffuse, a lot of evidence in the literature suggests that routine BS examinations are not cost-effective and should be recommended in selected cases only. Based on current guidelines, the use of BS as a staging procedure is considered appropriate in patients with a high pre-test probability (prevalence) of bone metastases. This category is represented by patients with newly diagnosed high-risk breast cancer (i.e. pN2 or T4/pT4) or with symptoms or laboratory signs suspicious for bone involvement
