We are grateful to Rodríguez S et al. for their interest in our study. The findings of their research [1] and other studies we cited [2,3] reinforce the conclusion that routine bone scans for staging patients with hepatocellular carcinoma (HCC) are neither clinically indicated nor cost-effective, even in the context of patients with early-stage HCC undergoing evaluation for liver transplantation, as per the Barcelona Clinic Liver Cancer (BCLC) staging system.
At this point, we cannot specify any particular threshold beyond conventional criteria where the pre-test probability of extrahepatic spread would justify a bone scan. However, given the established association between the prevalence of bone metastases and disease stage [4,5], we believe further investigation is warranted. Notably, in our study, all patients with bone metastases had already been diagnosed with advanced disease [6].
Future studies could explore the utility of bone scans in patients with vascular invasion and/or extrahepatic spread (i.e., BCLC stage C) who demonstrate adequate responses to systemic therapy and are subsequently considered for liver transplantation [7]. Such an effort would require a multicenter research collaboration to achieve an adequate sample size.
FundingThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
