Diagnosis Of Osseous Metastasis Research Articles

The low and disproportionate utilization of antiresorptive therapy in patients with osseous metastasis

IntroductionAntiresorptive therapies are commonly utilized to mitigate and prevent skeletal-related-events in patients with metastatic osseous disease. However, limited data exists on the incidence or factors associated with prescription of antiresorptives or their effects on the incidence of pathologic fractures in patients with osseous metastatic disease. The aims of this study were to determine 1) the proportion of patients with osseous metastasis who receive antiresorptive therapy and sustain a pathologic fracture within 2-years of a new diagnosis, 2) factors associated with sustaining a pathologic fracture, and 3) factors are associated with the likelihood of receiving antiresorptive therapy. MethodsBetween January 2010 and October 2021, 1,492,301 patients with a new diagnosis of osseous metastasis were captured in the Mariner dataset of the PearlDiver database. Patients were identified using International Classification of Disease (ICD) 10 codes for osseous metastasis. We excluded patients with a prior diagnosis of osseous metastasis and if they had less than two-years of follow-up. There were 696,459 patients (46.7 %) included for analysis. Of these patients, 63 % (N = 437,716) were over the age of 65, 46 % were women, and 5.6 % had Medicaid insurance. We identified patients who were prescribed antiresorptive therapy within 2-years of a new diagnosis of osseous metastasis. Cox proportional hazard ratio models were created to predict factors associated with 1) pathologic fracture and 2) receiving antiresorptive therapy within 2-years of a new diagnosis of osseous metastasis, respectively. ResultsThe incidence of antiresorptive therapy prescription was 7.7 % in our cohort. The incidence of pathologic fracture within 2-years of a new diagnosis was 7.3 %. The risk of sustaining a pathologic fracture was higher for patients aged 35–44 (HR 1.27 [95 % CI 1.08–1.51]; p = 0.004), those with primary kidney cancer (HR 1.78 [95 % CI 1.71–1.85]; p < 0.001), p = 0.005), multiple myeloma (HR 2.49 [95 % CI 2.39–2.59]; p < 0.001), and Medicaid insurance (HR 1.17 [95 % CI 1.13–1.21]; p < 0.001). The risk of sustaining a pathologic fracture was lower for patients on antiresorptive therapy (HR 0.71 [95 % CI 0.66–0.83]; p < 0.001). Increasing age was an independent predictor for antiresorptive therapy prescription (HR 1.77–16.38, all p < 0.05). Male sex as well as diagnosis of primary prostate, lung, or kidney cancer and Medicaid insurance were negative predictors for antiresorptive prescription (HR 0.15–0.87, all p < 0.001). ConclusionsThe utilization of antiresorptive therapy in patients with osseous metastases remains unacceptably low, with only 7.7% patients being prescribed these therapies, despite shown efficacy in reduction of pathologic fractures incidences. This study identified younger patients, males, and those diagnosed with primary prostate, kidney, and lung cancers to be at increased risk of not being prescribed antiresorptive therapy, suggesting possible bias in prescription patterns. Greater efforts are needed by providers who care for this vulnerable population to increase the utilization and reduce disparities of prescribing antiresorptive therapy.

The imaging features of osseous metastasis of hepatic alveolar hydatida

Objective To investigate the CT and MR imaging feature of osseous metastasis of hepatic alveolar hydatida. Methods CT and MR imaging features of osseous metastasis of hepatic alveolar hydatid were retrospectively analyzed in 14 cases confirmed by clinic and radiology. Results Of the 10 vertebral metastasises, three vertebral bodies were involved in 6 cases, two adjacent vertebral bodies were involved in 2 cases, single vertebral body was involved in 1 case, corresponding vertebral accessory was involved in 9 cases, irregular mass was formed in paravertebral muscles with ill-defined margins in 9 cases, adjacent ribs were involved in 6 cases. On CT scans, the lesions of vertebral body showed osteolytic and geographical bone destruction with bone sclerosis. The lesions of vertebral accessory showed swelling and osteolytic bone destruction, small cystic density and calcification of cystic wall and irregular calcification were found in 7 cases. The lesions of scapula, costal cartilage, ribs and pelvis showed swelling and osteolytic bone destruction, and bone sclerosis, and revealed cystic density with calcified speckles. On MR scans, the lesions of vertebral body and paravertebral muscles showed high and low mixed signal, with hypointensity on T1WI and T2WI, vertebral accessory and adjacent ribs were involved in 6 cases. Small cyst with T2 hyperintensity was found in 4 cases. The lesions of ribs and pelvis showed swelling and osteolytic bone destruction and adjacent medullary appeared hypointensity on T1WI and T2WI, cystic signal of T2 hyperintensity was identified. There were 5 cases of pulmonary metastasis and 6 cases of retroperitoneal metastasis. Conclusion Imaging features of osteolytic, geographical bone destruction with bone sclerosis, small cystic density or cystic signal and calcified speckles or arc calcification in mass are helpful for the diagnosis of osseous metastasis of hepatic alveolar hydatid. Key words: Echinococcosis, hepatic; Spinal diseases; Tomography, spiral computed; Magnetic resonance imaging; Alveolar echinococcosis; Metastasis

The application value of Wb-dwi and Spect on diagnosing osseous metastases

Objective To investigate values of Wb-dwi on diagnosis of osseous metastases compared with Spect materials. Methods 20 cases with osseous metastases underwent Wb-dwi and Spect.The bones were divided into 6 groups: skull, collarbone, trunk bone, haunch bone, upper limb bone, lower limb bone.the high uptake regions on Spect and high signal on Wb-dwi for positive groups or positive lesions were recorded.Meanwhile, the total numbers of positive groups and positive lesions in different groups were also recorded.Finally, the diagnostic sensitivity and specificity of Wb-dwi and Spect were calculated, which was based on the total numbers of positive groups. Results Wb-dwi showed 69 positive groups, the numbers of positive lesions in each group were 2, 1, 85, 55, 22, 12.Spect showed 66 positive groups, the numbers of positive lesions in each group were 4, 3, 79, 47, 20, 18.The diagnostic sensitivity and specificity on Spect were 81.1%, 80.3%.The diagnostic sensitivity and specificity on Wb-dwi were 86.9%, 84.3%.No statistical difference was assessed between the sensitivity and specificity of two methods. Conclusion Compared with Spect, the Wb-dwi can show more osseous metastasis lesions and has higher sensitivity on diagnosis osseous metastases.In additional, it can demonstrate primary tumors and extraskeletal metastasis lesions. Key words: Magnetic resonance imaging, diffusion; Tomography, emission-computed, single-photon; Single-photon emission computed tomography

Serum bone-specific alkaline phosphatase as a biomarker for osseous metastases in patients with malignant carcinomas: a systematic review and meta-analysis.

Bone metastasis was common in patients with malignant tumors. The purpose of this study was to investigate the serum bone-specific alkaline phosphatase (B-ALP) as a biomarker in the diagnosis of osseous metastases in patients with cancers. We searched the databases of Pubmed, Cochrane Library, Medline, CNKI and Wanfang to screen the relevant articles about the serum B-ALP detection in the diagnosis of osseous metastases in patients with malignant carcinomas. The pooled sensitivity, specificity, summary receiver operating characteristic (SROC) curve were calculated by STATA12.0 software. Nineteen trials with 3 268 subjects were finally included in this study. The mean level of serum B-ALP was 41.50 ± 26.61 μg/L (216.90 ± 139.00U/L) in patients with osseous metastases and 14.49 ± 5.52 μg/L (103.30 ± 39.44 U/L) in patients without osseous metastases. The serum level of B-ALP was significant higher in the osseous metastases group than that in the control group (P < 0.05); The pooled sensitivity and specificity for diagnosis of osseous metastases were 0.74 with its 95% confidence interval (95% CI) of 0.62-0.83 and 0.80 (95% CI: 0.67-0.89), respectively. The area under the SRCO was 0.86 (95% CI: 0.83-0.89). Serum B-ALP can be a promising biomarker for detection of osseous metastases in patients with cancers.

Comparison of Image Enhancement Methods for the Effective Diagnosis in Successive Whole-Body Bone Scans

Whole-body bone scan is one of the most frequent diagnostic procedures in nuclear medicine. Especially, it plays a significant role in important procedures such as the diagnosis of osseous metastasis and evaluation of osseous tumor response to chemotherapy and radiation therapy. It can also be used to monitor the possibility of any recurrence of the tumor. However, it is a very time-consuming effort for radiologists to quantify subtle interval changes between successive whole-body bone scans because of many variations such as intensity, geometry, and morphology. In this paper, we present the most effective method of image enhancement based on histograms, which may assist radiologists in interpreting successive whole-body bone scans effectively. Forty-eight successive whole-body bone scans from 10 patients were obtained and evaluated using six methods of image enhancement based on histograms: histogram equalization, brightness-preserving bi-histogram equalization, contrast-limited adaptive histogram equalization, end-in search, histogram matching, and exact histogram matching (EHM). Comparison of the results of the different methods was made using three similarity measures peak signal-to-noise ratio, histogram intersection, and structural similarity. Image enhancement of successive bone scans using EHM showed the best results out of the six methods measured for all similarity measures. EHM is the best method of image enhancement based on histograms for diagnosing successive whole-body bone scans. The method for successive whole-body bone scans has the potential to greatly assist radiologists quantify interval changes more accurately and quickly by compensating for the variable nature of intensity information. Consequently, it can improve radiologists' diagnostic accuracy as well as reduce reading time for detecting interval changes.

Meta-analysis: Comparison of F-18 Fluorodeoxyglucose-Positron Emission Tomography and Bone Scintigraphy in the Detection of Bone Metastases in Patients With Breast Cancer

To evaluate the diagnostic properties of FDG-PET and bone scintigraphy in the detection of osseous metastases in patients with breast cancer. Studies evaluating the diagnostic accuracy of FDG-PET and bone scintigraphy in the diagnosis of osseous metastasis were systematically searched for in the MEDLINE, CINAHL, and EBM Review databases from January 1995 to November 2006. Two reviewers independently abstracted data including research design, sample size, imaging technique and technical characteristics, reference standard, method of image interpretation, and totals of true positives, false positives, true negatives, and false negatives. Per-patient and per-lesion pooled sensitivity and specificity, and area under summary receiver operating characteristic curves were calculated using Meta-Test software. The pooled patient-based sensitivity for FDG-PET was 81% (95% CI: 70%-89%), specificity was 93% (95% CI: 84%-97%), and the area under the curve (AUC) was 0.08. The pooled sensitivity of bone scan was 78% (95% CI: 67%-86%), specificity was 79% (95% CI: 40%-95%), and the AUC was 0.43. The pooled lesion-based sensitivity for FDG-PET was 69% (95% CI: 28%-93%), specificity was 98% (95% CI: 87%-100%), and the AUC was 0.09. The pooled sensitivity for bone scan was 88% (95% CI: 82%-92%), specificity was 87% (95% CI: 29%-99%), and the AUC was 0.81. It remains inconclusive whether FDG-PET or bone scintigraphy is superior in detecting osseous metastasis from breast cancer. However, FDG-PET does have a higher specificity and may better serve as a confirmatory test than bone scintigraphy and used to monitor response to therapy.

State of the Art of Biochemical Markers in Metastatic Bone Disease and the Role of Bisphosphonates as Therapeutic Agents

Metastatic spread of cancer to bone is a frequent complication in several types of malignancies. Normal bone metabolic process is affected and the imbalance between bone formation and resorption defines bone disease in cancer. The major causes of the secondary development of the disease is either the cancer cell itself (metastatic or non-metastatic) or cancer therapies. Early diagnosis of bone metastatic disease is very important for the survival of patients. The dominant disadvantage of imaging techniques used for detection of bone metastases is that they are based on direct anatomic visualization of the metastatic sites on the skeleton and, therefore, are not able to detect metastasis in early stages of the disease. Various biomarkers have been developed and used as indicators of bone formation or resorption. Substantially, these biochemical markers are products, released during the bone metabolic cycle and can be detected in biological samples. The levels of these markers in serum or urine can be correlated with the diagnosis of osseous metastases and the bulk of tumor burden and, in addition, may provide useful data for the patients follow-up, in order to evaluate the response to various treatments. The biochemical markers often used for monitoring bone formation involve total and bone-specific alkaline phosphatase, osteocalcin and procollagen type I extension propeptides, and those for bone resorption involve urinary calcium, hydroxyproline, hydroxylysine-glycosides, pyridinium crosslinks, crosslinked telopeptides of type I collagen, tartarate-resistant acid phosphatase and bone sialoprotein. For the treatment of bone disease, many therapies have been developed. Bisphosphonates, compounds based on a phosphorous-carbon-phosphorous spine similar to endogenous pyrophosphate, have been successfully used in the treatment of osteoporosis and hypercalcemia of malignancy. They have powerful anti-resorptive activity by suppressing the action of osteoclasts, resulting in the reduction of skeletal events. The analytical methods used for the determination of biomarkers in biological samples as well as the effect of bisphosphonates on the drift of metastatic bone disease are presented in this review. Keywords: metastatic bone disease, skeletal metastases, biochemical markers, bisphosphonates

Metástasis acral digital ósea por adenocarcinoma renal con afectación cutánea

Abstract—Cutaneous metastases are a rare and late manifestation of the internal malignancies. The likelihood of a visceral malignant tumour producing deposits in the skin is increased if the lesion is anaplastic and of long duration. Acral metastasis are specially atypical. Most acral metastases affect bones with late secondary cutaneous involvement.We report the case of a 67-years-old female with metastatic renal cell carcinoma who presented swelling and blue-reddish discoloration in the distal part of the 2nd finger of her left hand that had appeared four days before. On the hand X-ray there was a lytic lesion on the third phalanx of this finger. The histopathological findings showed a clear cell proliferation replacing deep dermis. A diagnosis of osseous metastases with late secondary skin involvement from renal cell carcinoma was made.

Osseous metastases from colorectal carcinoma

In a 10 year (1970 to 1980) retrospective study of 66 patients with primary colorectal adenocarcinoma and osseous metastases, there were 47 patients who had bone and other distant metastases whereas 19 patients had osseous metastases only. The median disease-free interval was 21 months. The overall median survival time from diagnosis of osseous metastases was 7 months. Bone scanning is probably more sensitive for diagnosing bone metastases than radiography. Radiotherapy seems to be the most effective treatment for symptomatic osseous metastases.