Can tumour marker assays be a guide in the prescription of bone scan for breast and lung cancers? (original) (raw)
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Value of bone scanning in neoplastic disease
Seminars in Nuclear Medicine, 1984
This article reviews recent literature on a variety of primary and secondary bone tumors in an attempt to indicate the use of bone scans in the peri-and posttreatment phases. The data indicate that the yields and value of bone scans are tumor specific and that for some tumors (particularly breast and pros-T HE DETECTION of malignant bone disease has been of interest and concern to physicians for nearly 100 years. More recently, the concern has heightened because of the rising incidence of cancer in this country. In 1983 there will be an estimated 855,000 new cancers and 440,000 deaths from cancer] New cancers of the breast, colon/rectum, and uterus are the most common in women, and cancers of the lung, colon/rectum, and prostate are the most common in men. This fact coupled with increasing financial pressures to optimize the use of diagnostic resources has led third party payers to scrutinize the use of many radiologic procedures and radiologists and oncologists to look systematically at the benefits of a variety of staging procedures. Much information has been obtained since Treadwell and coworkers first explored the use of radiotracers for studying the metabolism of metastatic bone disease, 2 and since Lusted proposed the first formalism for evaluating the information content and the impact of diagnostic tests) This article will review briefly basic facts about bone metastases and will then summarize data on the usefulness of bone scans in several tumors. It is based, in part, on three previous review articles. 4 6 DISTRIBUTION OF METASTASES The maximum percentage of patients having bone metastases that can be detected either initially or during the follow-up of a malignancy is generally no greater than the percentage found at autopsy. For the most common tumors, the percentage of patients with metastases at autopsy is high (Table 1).7-9 Nearly 80% of all metastatic lesions discovered during life are in the central skeleton, 28% in the ribs and sternum, 39% in the vertebrae, and 12% in the pelvis] ~ Only 10% are in the cranium, and a similar percentage is in the long tate) interpretation of studies on patients undergoing hormonal or chemotherapy can be complicated by the "flare phenomenon," Data are still needed on the rate of development of bone metastases in the follow-up period on a stage-specific and therapyspecific basis.
Usefulness of bone markers for detection of bone metastases in lung cancer patients
Clinical Biochemistry, 2002
Objectives: Lung cancer commonly causes destructive bone metastases. The aim of this study was to compare efficiency of biochemical bone markers in the detection of bone metastases in lung cancer patients. Design and methods: We measured serum calcium (Ca), alkaline phosphatase (ALP), bone isoenzyme of alkaline phosphatase (BALP), osteocalcin (OC) and urine deoxypyridinoline crosslinks (DPD) levels in 52 lung cancer patients; 27 patients with the evidence of bone metastases, 25 without metastases in bone when they were first diagnosed. BALP, OC and DPD were measured by specific immunoassays. ALP, Ca and urine creatinine levels were determined by colorimetric methods. Results: Ca, ALP, BALP, OC and DPD levels were significantly higher in the patients with bone metastases than those without bone metastases (p Ͻ 0.01 for BALP and OC, p Ͻ 0.001 for Ca, ALP and DPD). The sensitivity and specificities of all markers as follows: 89%-44% for BALP, 52%-88% for OC, 81%-76% for DPD, respectively. ROC curves were generated separately for BALP, OC and DPD to assess the diagnostic efficiency of markers in a different manner. DPD showed the best curve characteristics among the studied bone markers, followed by the BALP curve. OC curve showed poor characteristics. Conclusions: Our results suggest that the measurement of DPD and BALP may be useful in detecting bone metastases in lung cancer patients. Also it could help in the follow-up of bone metastases from lung cancer since they can be repeated more often than roentgenography and bone scintigraphy, at less cost and with less discomfort to the patients.
What do early bone scans tell about breast cancer patients?
European Journal of Cancer and Clinical Oncology, 1982
Zn 1978, 1012 out of a total of 1888 Danish breast cancer patients registered for a nationwide therapeutical trial were bone-scanned to find osseous melastases. A re-reading group (N.R., O.M. and S.P.N.) interpreted 842 of fhe scans produced in the twelve participating hospitals. Specijic criteria were used for grading the scintiscans. Of fhe 842 scans 682 were performed wi6hin 30 days of the operation and were defined as initial. The re-reading group found 50 (7%) of these scans to be equivocal and 46 (7%) to be indicative of bone metastasei al the time of operation. The number of X-ray-verified bone metastases was only 5 (0.6%). The frequency of positive bone scans correlated with the age of the patients and tumor size, but not with clinical staging at the time of operation, number of positive axillary lymph nodes or degree of tumor anaplasia. Recurrences and death rates during a 2-yr follow-up period correlated significantly with initial clinical staging. In the clinical low-risk group a positive initial bone scan worsened the prognosis, but this was nof statistically significant for all patienrs grouped together. Although the prognoslic value of Qe initial bone scan per se is dubious, it serves as a guidance for elective X-ray examination and as a basis for comparing subsequent scans.
The Value of Pre-Scheduled Bone Scintigraphies in Breast Cancer
Acta Oncologica, 1988
During the first 10 years of Danish Breast Cancer Cooperative Group (DBCG), the subcommittee on bone scintigraphy has focused on the value of bone scintigraphy at the time of operation in all patients and then yearly in those considered to be primarily operable (stage I and 11). Out of 1175 patients examined at time of operation, bone metastases could be verified by x-ray or histology in only 16, of whom the majority had bone pain and/or spread to other organs. Similarly, around 2.5 % per year for the first 3 postoperative years and about 1 % per year during the next 4 postoperative years had bone metastases verified by x-ray or histology within 12 months after the latest scheduled bone scintigraphy. It is concluded that bone scintigraphy is of no value in primarily operable patients with breast cancer, and that the examination should be reserved for patients with symptoms andlor signs of bone metastases and for patients with relapse.
Revista Española de Medicina Nuclear (English Edition), 2007
To determine the percentage of bone scintigraphy examinations (BS) requested according to established indications and to assess the clinical impact of the scintigraphic results. Materials and methods. A retrospective study was performed including BS in 117 patients (70 women and 47 men) carried out in our department during the year 2001. All patients had a primary extraosseous malignancy. The correctness of the indication of each study requested was analyzed according to established criteria from the literature. BS results were classified as positive, negative, and equivocal for metastatic disease. Results. 96 out of the 117 BS were performed in patients affected with the most prevalent primary malignancies: breast (57), prostate (21), and lung (18). The remaining studies were included in a miscellaneous group (gynecological [3], colorectal [4], oropharyngeal [4], and renal malignancies [4]; lymphoma [2], melanoma [2], hemangioendothelioma [1]; and cancer of the bladder [1] or pancreas [1]). Ninety-nine (85%) of the 117 BS performed met the criteria for appropriate indication. The indication was correct in 75% of breast, 90% of prostate (19/21), and 100% of lung cancers. The indication was correct in 90% of the cases in the miscellaneous group. BS were positive in 21 patients (20 of which were confirmed). BS were equivocal in 24 patients (in 5 of whom bone metastases were confirmed). BS were negative in 72 patients (one of whom had bone metastases). The BS findings changed staging in 9 % (9/99) of the correctly indicated cases. Conclusion. Most BS (85%) were indicated according to the established criteria and the clinical impact was greater in this group.
Rationale for the use of bone scans in selected metastatic and primary bone tumors
Seminars in Nuclear Medicine, 1978
Since the introduction of bone scans in 1951, there have been many studies comparing biologic and physical characteristics of new bone-imaging agents and the results of scintigraphy and radiology in large numbers of patients. Relatively speaking, there have been fewer studies detailing the health benefits and financial cost associated with the use of skeletal scintigraphy. This review concerns these aspects in patients with malignancies of various sites and stages. About 2% of patients with stage I or II breast cancer have bone metastases at the time they first present, whereas nearly 28% of patients with stage III disease have bone metastases. A large percentage of patients with initially negative scans develop bone metastases during the first 3-4 yr; many of them develop them within the first 12-18 mo after initial diagnosis, For patients with lung cancer, the use of bone scans in staging their disease is somewhat controversial. Several studies indicate that the yield of positive bone scans may range from as low as 2% to as high as 35%. Data on the use of bone scans in staging prostatic cancer initially are similar to those in patients with breast cancer, that is, yields of 7% in patients with stage I or II disease and a yield of about 20% with stage III disease. Children with osteosarcoma or Ewing's sarcoma rarely have bone disease distant from the site of their primary bone lesion at presentation. However, a large percentage of them (30%-40% or so) develop bone metastases during the follow-up period. As in the case with patients with breast cancer, about half of these bone metastases are evident by 12-18 too.
2018
Objective: Lung carcinoma is the most common cancer worldwide with high potentiality of being metastasized to bone. Technetium-99m methylene diphosphonate (99mTc MDP) bone scintigraphy is a sensitive nuclear medicine imaging study to detect the skeletal metastases. The utilization of bone scan upon diagnosis of lung cancer appears to help in accurate staging of patients and planning treatment. The aim of the present study was to see the role of baseline bone scintigraphy in the newly diagnosed lung carcinoma patients and also to see the number, pattern and sites of involvement of bone as well as to evaluate the skeletal metastases according to the different histological types of lung carcinoma.Patients and Methods: This observational study was carried out at the Institute of Nuclear Medicine & Allied Sciences (INMAS), Sylhet during the period of July 2014 to June 2015. A total number of 59 lung carcinoma patients who attended at the scintigraphy division of INMAS, Sylhet within thr...
Diagnostic bone scanning in oncology
Seminars in Nuclear Medicine, 1997
Over the last several decades bone scanning has been used extensively in the evaluation of oncology patients to detect bone involvement. It can provide information about disease location, prognosis, and the effect of therapy. Bone scanning offers the advantages of whole body evaluation and the detection of lesions earlier than other techniques. However, as newer diagnostic tools become available, indications for bone scanning must be revised and the results combined with these other tests in order to provide optimum patient care. Advances in instrumentation and the subsequent improvement in image quality have allowed nuclear medicine physicians to provide more accurate bone scan interpretations. By optimizing image acquisition, it is often possible to determine lesion characteristics, which are more likely to represent malignancy. Knowledge of disease psthophysiology and other specific properties of the patient's primary tumor, along with subsequent correlation of scan abnormalities to patient history, physical examination, previous studies, and other radiological examinations, is essential for determining lesion significance. The differential diagnosis of a scan abnormality should also include consideration of both false normal and abnormal causes. The final interpretation should be clearly communicated to the clinician with appropriate recommendations for further evaluation. Only through careful attention to the patient, the clinician, and appropriate study acquisition parameters will bone scanning maintain its place in the evaluation of oncology patients.
European Journal of Nuclear Medicine and Molecular Imaging, 2004
The leading European and American professional societies recommend that bone scans (BS) should be performed in the staging of lung cancer only in those patients with bone pain. This prospective study investigated the sensitivity of conventional skeletal scintigraphy in detecting osseous metastases in patients with lung cancer and addressed the potential consequences of failure to use this method in the work-up of asymptomatic patients. Subsequent to initial diagnosis of non-small cell lung cancer, 100 patients were examined and questioned regarding skeletal complaints. Two specialists in internal medicine decided whether they would recommend a bone scan on the basis of the clinical evaluation. Skeletal scintigraphy was then performed blinded to the findings of history and physical examination. The combined results of magnetic resonance imaging (MRI) of the vertebral column, positron emission tomography (PET) of skeletal bone and the subsequent clinical course served as the gold standard for the identification of osseous metastases. Bone scintigraphy showed an 87% sensitivity in the detection of bone metastases. Failure to perform skeletal scintigraphy in asymptomatic patients reduced the sensitivity of the method, depending on the interpretation of the symptoms, to 19-39%. Without the findings of skeletal scintigraphy and the gold standard methods, 14-22% of patients would have undergone unnecessary surgery or neoadjuvant therapy. On this basis it is concluded that bone scans should not be omitted in asymptomatic patients.
Indian Journal of Clinical Biochemistry, 2011
Breast cancer is one of the most frequent malignancies in the world. Available staging procedures to detect breast cancer are bone scan, chest X-ray, liver ultrasonography, computerized tomography, estimation of tumor markers like carbohydrate antigen (CA15-3) and carcino embryonic antigen. These procedures are expensive and may not be required in all cases. Out of 70 patients studied, 55 had normal CA15-3 and 15 had elevated levels of Ca15-3. Eight (14.5%) of the 55 patients with normal CA15-3 had abnormal bone scan. Fifteen patients had CA15-3 levels above the normal range and among these 9 (60%) had abnormal bone scan. While prime facie it would appear that a high level of CA15-3 correlate with abnormal bone scan, it is also true that the numbers are small at present and conclusions about the validity of CA15-3 as marker of bone metastasis may be premature.