Evaluation Of Bone Metastases Research Articles

Extraosseus Uptake of F-18 Fluoride in the Primary Malignancy and Cerebral Metastasis in a Case of Non–Small-Cell Lung Cancer

A 68-year-old man with history of heavy smoking was admitted for increasing falls during the past 4 weeks. Chest x-ray revealed a right upper lobe mass. Biopsy demonstrated poorly differentiated non-small-cell carcinoma. F-18 fluoride positron emission tomography/computer tomography (PET/CT) was performed to evaluate bone metastasis. Review of the sectional PET images demonstrated extraosseous fluoride uptake in the primary lung mass, as well as ring-shaped fluoride uptake in the cerebral metastatic lesion. Neither of these lesions demonstrated calcifications on CT images. The patient received radiation treatment of the brain metastasis after F-18 fluoride PET/CT study.

Incidental Vesicocolic Fistula on Routine Bone Scintigraphy

An unexpected vesicocolic fistula can be detected incidentally on routine bone scintigraphy. A 55-year-old man who had a radical colectomy for carcinoma of the sigmoid colon 1 year previously underwent bone scintigraphy to evaluate bone metastasis. Whole-body images showed an abnormal accumulation of radioactivity in the right lower quadrant of the abdomen, but the radioactivity did not precisely define a structure. Additional delayed images obtained after 15 and 24 hours of the initial image localized a vesicocolic fistula. Subsequent radionuclide cystography confirmed leakage of the radioactivity from the bladder.

Preliminary result on the use of bone scan and plain X-rays in the evaluation of bone metastasis from breast cancer in a tertiary institution: A study of 30 patients

Preliminary result on the use of bone scan and plain X-rays in the evaluation of bone metastasis from breast cancer in a tertiary institution: A study of 30 patients

The Role of Whole-Body FDG PET/CT, Tc 99m MDP Bone Scintigraphy, and Serum Alkaline Phosphatase in Detecting Bone Metastasis in Patients with Newly Diagnosed Lung Cancer

Bone scan (BS) and serum alkaline phosphatase (ALP) concentration are used to detect bone metastasis in malignancy, although whole-body fluoro-D-glucose positron emission tomography computed tomography (FDG PET/CT) is being used increasingly. But BS is still used for the detection of metastatic bone lesion. So we compared the usefulness of PET/CT, BS, and serum ALP in detecting bone metastases in patients with newly diagnosed lung cancer. The medical record database was queried to identify all patients with a new diagnosis of lung cancer between January 2004 and December 2005, who had a PET/CT, BS, and serum ALP before treatment. We retrospectively reviewed all patients' records and radiological reports. One hundred eighty-two patients met the inclusion criteria. Bone metastases were confirmed in 30 patients. The sensitivity values were 93.3% for PET/CT, 93.3% for BS, 26.7% for serum ALP concentration, and 26.7% for BS complemented with serum ALP concentration. The respective specificity values were 94.1%, 44.1%, 94.1%, and 97.3%. The kappa statistic suggested a poor agreement among the three modalities. FDG PET/CT and BS had similar sensitivity, but PET/CT had better specificity and accuracy than BS. PET/CT is more useful than BS for evaluating bone metastasis. However, in the advanced stage, because of its high specificity, BS complemented with serum ALP is a cost-effective modality to avoid having to use PET/CT.

Rational imaging in locally advanced prostate cancer

Prostate cancer is one of the principal medical problems facing the male population in developed countries with an increasing need for sophisticated imaging techniques and risk-adapted treatment options. This article presents an overview of the current imaging procedures in the diagnosis of locally advanced prostate cancer. Apart from conventional gray-scale transrectal ultrasound (TRUS) as the most frequently used primary imaging modality we describe computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). CT and MRI not only allow assessment of prostate anatomy but also a specific evaluation of the pelvic region. Color-coded and contrast-enhanced ultrasound, real-time elastography, dynamic contrast enhancement in MR imaging, diffusion imaging, and MR spectroscopy may lead to a clinically relevant improvement in the diagnosis of prostate cancer. While bone scintigraphy with (99m)Tc-bisphosphonates is still the method of choice in the evaluation of bone metastasis, whole-body MRI and PET using (18)F-NaF, (18)F-FDG, (11)C-choline, (11)C-acetate, and (18)F-choline as tracers achieve higher sensitivities.

Bone scintigraphy is really unnecessary for evaluation of bone metastasis?

Bone scintigraphy is really unnecessary for evaluation of bone metastasis?

PD1-2-2: The role of whole-body FDG PET/CT, Tc 99m mdp bone scintigraphy, and serum alkaline phosphatase in detecting bone metastasis in patients with newly diagnosed lung cancer

Bone scan and serum alkaline phosphatase concentration are used to detect bone metastasis in malignancy, although whole-body FDG PET/CT is being used increasingly. To compare the usefulness of whole-body FDG PET/CT, bone scan, and serum alkaline phosphatase in detecting bone metastases in patients with newly diagnosed primary lung cancer. The electronic medical record database at our institution was queried to identify all patients with a new diagnosis of lung cancer between January 2004 and December 2005, who had a PET/CT, bone scan, and check of serum alkaline phosphatase concentration before treatment. We retrospectively reviewed all patients’ medical records and radiological reports, and confirmed bone metastases by considering all available clinical information. One hundred eighty-two patients met the inclusion criteria. Bone metastases were confirmed in 30 patients. The average interval between PET/CT and bone scan was 8.5 ± 14.0 days. Forty-nine patients had stage 4 nonsmall cell lung cancer, and seven patients had extensive stage small cell lung cancer. Tabled 1Confirmation criteriaNumber of patientsProgressing bone lesion on follow-up scan (PET/CT or bone scan)2Confirmed bone metastasis by simple radiography, CT, or MRI22Positive initial findings on both bone scan and PET/CT in the same bone lesion with symptoms5Histological confirmation1Total30 Open table in a new tab The sensitivities, specificities and accuracies of PET/CT, bone scan, and serum alkaline phosphatase concentration were noted in following Table. The kappa statistics were calculated for the three modalities. The kappa value was 0.19 between PET/CT and bone scan, 0.03 between bone scan and serum ALP concentration, and 0.15 between serum ALP concentration and PET/CT. The low kappa values suggested poor agreement between the three modalities. FDG PET/CT and bone scan had similar sensitivity, but PET/CT had better specificity and accuracy than bone scan. PET/CT is more useful than bone scan for evaluating bone metastasis. However, in the advanced stage, because of its high specificity, bone scan complemented with serum alkaline phosphatase is a cost-effective modality to avoid having to use PET/CT.

Role of fine needle aspiration cytology in the management of pediatric renal tumors

Fine needle aspiration cytology (FNAC) is a useful pre-operative procedure in pediatric renal tumors. It is a safe technique that does not upstage the tumor and permits positive diagnosis of Wilm's tumor in almost all aspirates with use of immunocytochemistry for cytokeratin and WT-1. Advanced information on diagnosis of Wilm's tumor, especially, the presence of stroma predominance or anaplastic change is a guide to selection and monitoring of chemotherapy. Early diagnosis of clear cell sarcoma of the kidney (CCSK) by FNAC helps in the evaluation of bone metastasis and selection of Doxorubicin-based chemotherapy protocols to which the tumor is responsive. Thus, the routine use of FNAC is helpful for further investigation and management of pediatric renal masses.

Roles of Skeletal Scintigraphy and FDG PET in Evaluation of Bone Metastases in Breast Cancer

With the development of positron emission tomography (PET) as well as hybrid PET scanners with computed tomography (CT), there have been questions raised about the traditional approaches to staging breast carcinoma. In particular, the use of PET and PET/CT for a one-stop evaluation without conventional bone scanning is under investigation. The following article reviews the literature in regards to the continued use of bone scanning and the importance of further evaluation in the era of PET/CT.

Role of bone scintigraphy and tumor marker-Ca 15-3 in detection of bone metastases in patients with breast cancer.

Breast cancer is one of the most frequent types of cancer affecting women. After hematogenous spreading of cancer, axial skeleton is most frequently involved. Bone scintigraphy is commonly performed in detection and evaluation of bone metastases. In breast cancer, marker Ca 15-3 is widely accepted in follow-up and detection of disease recurrence. Aim of the study was to correlate levels of tumor marker Ca 15-3 and presence of bone metastases detected by bone scintigraphy. Study included 25 patients with breast cancer, previously surgically treated. All patients underwent total body scintigraphy. Ca 15-3 was measured by radioimmunoassay. Presence, number and location of bone metastases were correlated with Ca 15-3 levels. Bone scintigraphy revealed bone metastases in 16 (64%) patients. 11 (44%) patients with metastases and 1 patient (4%) without scintigraphically visible metastases had elevated Ca 15-3 levels. Significant difference in distribution of metastases was found for spine (t=3.930, p=0.008). Correlation between intensity of radiopharmaceutical uptake and level of Ca 15-3 in patients was positive (r =0.405). A weak correlation was found between number of metastases and level of Ca 15-3 (r=0.139). Significant differences in Ca 15-3 level was found in patients with metastases compared to patients without metastases (chi square 0, p =1.0). Since no significant correlation was found between level of Ca 15-3 and number of metastases, we consider scintigraphy an appropriate method for assessment of bone metastases in breast cancer.

Comparison with99mTc MDP Bone Scintigraphy and Whole body18FDG PET for the Evaluation of Bone metastases in Patients with Lung Cancer

Comparison with^99mTc MDP Bone Scintigraphy and Whole body¹⁸FDG PET for the Evaluation of Bone metastases in Patients with Lung Cancer

Evaluation of bone metabolic markers in breast cancer with bone metastasis.

In the present study, four bone metabolic markers were examined to clarify them meaning and clinical value in the detection of bone metastasis (BM) from breast cancer. we examined serum carboxyterminal telopeptide of type I collagen (ICTP), tartrate resistant acid phosphatase (TRACP), total alkaline phosphatase (ALP) and urinary type I collagen cross-linked N-telopeptides (NTx) as potential markers. These bone markers were evaluated simultaneously in 156 breast cancer patients; 114 patients without metastasis (group A), 23 patients with BM (group B) and 19 patients with metastasis at sites other than bone (group C). The mean values of ICTP and TRACP in group B were significantly greater than those in group A. Group B consisted of the patients with varying degrees of BM and variation in their treatments. The patients in group B were divided into BM (+) and BM (++) according to hot spots in bone scan. ICTP and TRACP were elevated in BM (++) patients compared to BM (+) patients (p<0.05). The values of ICTP and TRACP of the twelve patients without treatment in group B were significantly higher than those in group A. In the treated patients of group B, the mean values of ICTP and TRACP were lower in responders and cases of stable disease than those with progression. NTx and ALP were inferior to ICTP and TRACP for clinical evaluation of BM. We confirmed that ICTP and TRACP might be useful markers for screening and monitoring BM in breast cancer.

Biochemical markers for assessment of bone metastases in patients with breast cancer.

Breast cancer commonly metastasizes to bones, producing both osteolytic and osteoblastic deposits. Different markers for quantitative determination of bone turnover have been developed to evaluate bone metastases of breast cancer. The urinary deoxypyridinoline (Dpd), a crosslink product of collagen molecules found in bone and excreted in urine during bone degradation, and bone specific alkaline phosphatase (B-ALP), an isoenzyme localized in the membrane of osteoblasts and released in circulation during bone formation, were recently described as a group of markers of bone turnover in metastatic cancer. The urinary Dpd/creatinine (Cre) ratios and the serum B-ALP activity were determined in the samples from 148 patients who suffered from breast cancer (BC patients) with or without bone metastases, and 42 healthy women. For comparison, other biochemical markers, e.g. carcinoembryonic antigen (CEA), CA15-3, tissue polypeptide antigen (TPA), tissue polypeptide specific antigen (TPSA), and total alkaline phosphatase (T-ALP) in these samples were also evaluated. The results showed that there was a significant difference in urinary Dpd/Cre ratio between the control group and the patients with breast cancer (BC group) (mean +/- S.D., 5.69 +/- 1.26 vs. 8.19 +/- 3.95 nM/mM, P < 0.05). However, there was no significant difference between their B-ALP activities in the two groups. In addition, the BC patients with bone metastases showed elevated urinary Dpd/Cre ratios and B-ALP activities and ratios of (Dpd/Cre)/B-ALP in compare with BC patients without bone metastases (P < 0.05). Meanwhile, the urinary Dpd/Cre ratios (10.50 +/- 5.04 nmol/mmol) in the advanced stage of BC patients were higher than those in an early stage (7.45 +/- 3.23 nmol/mmol) (P < 0.05), but their serum B-ALP activities increased only in stage IV (P < 0.05). The urinary Dpd/Cre ratios also increased progressively according to the degree of bone metastases (P < 0.05), but their serum B-ALP activities only increased in severe bone metastases (P < 0.05). The results showed that the increase of a bone osteolytic activity took place earlier than that of a bone osteoblastic activity in the metastatic BC patients. In compare with other conventional markers, the best diagnostic efficiency of biochemical markers, analyzed by step wise discriminate analysis, was provided by CEA followed by Dpd/Cre ratio, CA15-3, TPA, TPSA, B-ALP and T-ALP. We conclude that showed the urinary Dpd/Cre ratio was a useful tumor marker to evaluate breast cancer with bone metastases.

The relationship between urinary pyridinoline, deoxypyridinoline and bone metastasis in a rat breast cancer model

BACKGROUND: Bone metastasis from breast cancer is often recognized clinically, but there are nonetheless several difficulties in diagnosis. In this study we used an animal model of bone metastasis from breast cancer and clarified the relationship between the urinary Pyd/Cr and Dpd/Cr and the progression of bone metastasis, compared with other bone related markers: serum alkaline phosphatase bone isozyme (ALP-BI), osteocalcin, and calcium. METHODS: The evaluation of bone metastasis was assessed by histological examination of the thoracic and lumbar vertebrae. According to the histological findings 4 weeks after the tumor cell injection, 11 animals were retrospectively divided into 2 subgroups: (1) tumor-bearing rats with bone destruction due to bone metastasis (TBR-BD(+), n = 5), (2) tumor-bearing rats without bone destruction (TBR-BD(-), n =6). These animals were compared to age-matched controls without tumor cell injection (n =6). An additional 5 animals were sacrificed at 2 weeks after the tumor cell injection to evaluate micrometastasis to bone. RESULTS: The values of other markers for bone metastasis in animals with micrometastatic foci in bone marrow did not differ significantly from those of the controls. Pyd/Cr and Dpd/Cr in the TBR-BD(+) group were significantly higher than those of the TBR-BD(-) and the control group (233 +/- 78.3 vs 93.8 +/- 6.5, 98.5 +/- 18.7, 123.1 +/- 35.9 vs 67.9 +/- 6.2, 60.6 +/- 9.8, p< 0.01), while there were no significant differences between TBR-BD(-) and the control. CONCLUSION: Both Pyd/Cr and Dpd/Cr are correlated significantly with the volume of bone metastasis, and are useful for the diagnosis and evaluation of progression of bone metastasis compared with other markers.

Diagnostic problems of evaluating bone metastasis from breast cancer by proliferative activity: Comparison of findings between bone scintigraphy and MRI and their relationship to prognosis

Diagnostic problems of evaluating bone metastasis from breast cancer by proliferative activity: Comparison of findings between bone scintigraphy and MRI and their relationship to prognosis

Comparison of Markers of Bone Formation and Resorption in Prostate Cancer Patients to Predict Bone Metastasis.

We investigated the usefulness of two biochemical markers of bone formation (PICP, the carboxy-terminal propeptide of type I procollagen, and bone ALP, bone-derived alkaline phosphatase) and a marker of bone resorption (ICTP, the carboxy-terminal telopeptide of type I collagen), to determine whether the presence of bone metastasis in prostate cancer could be evaluated and the extent of bone metastasis could be stratified by the serum levels of these markers, compared to total alkaline phosphatase (T-ALP) and prostate-specific antigen (PSA). The serum levels of PICP, bone ALP, ICTP, T-ALP and PSA were significantly higher in patients with both prostate cancer and bone metastasis (n=49) than in patients with benign prostatic hyperplasia (n=35) and patients with prostate cancer without bone metastasis (n=70). The superiority of a marker in the rate of detection of bone metastasis was evaluated with receiver operating characteristic curves. The serum marker levels were compared as a function of metastatic burden in bone (i.e., the extent of disease, EOD grade). We found that bone ALP is the most suitable marker for evaluating bone metastasis, especially for stratifying the degree of bone metastasis. Both PICP and ICTP were useful in this respect, but rather inferior to bone ALP. T-ALP had the lowest ability for detecting bone metastasis, but its correlation with the EOD grade was excellent, second to that of bone ALP. PSA showed limited reliability for stratifying the extent of bone metastasis.

Evaluation of bone metastases by Tc-99m MDP imaging in patients with stomach cancer.

The authors conducted a retrospective review of 234 bone scans of stomach cancer patients who had been diagnosed at the Seoul National University Hospital. In 106 of the 234 cases (45.3%), there were abnormal bone scan results, suggestive of bone metastases. The most common site of bone metastases was the spine, followed by the ribs, pelvis, femur, and skull. These sites were similar to those known for other malignant diseases. The incidence of bone metastases increased according to the duration of disease, especially within 12 months after diagnosis in patients with stage III gastric cancer. The incidence of bone metastases increased as the clinical stage increased. However, the incidence of metastases did not relate to gastric cancer pathologic type. The authors found 6 cases of "superscan" in the 234 bone scans (2.6%). The bone scan findings correlated positively with the level of serum alkaline phosphatase.

99mTc-HMDP accumulation in a phyllodes tumor of the breast, a case report

In a patient with breast tumor, 99mTc-HMDP accumulation in the tumor was recognized in evaluating bone metastasis. Surgery and histopathology revealed that the tumor was a phyllodes tumor. This scintigraphic finding was thought to be rare and phyllodes tumor should be included in differential diagnosis when 99mTc-HMDP accumulation in the breast was recognized.