Screening For Bone Metastases Research Articles

1749P Vertebral MRI in the screening for bone metastasis in myxoid liposarcoma: Is it justified?

1749P Vertebral MRI in the screening for bone metastasis in myxoid liposarcoma: Is it justified?

Abstract P5-04-10: Consensus guidelines for breast cancer staging during pregnancy. A Delphi Study

Abstract Background: Breast cancer is the second most common cancer occurring during pregnancy with limited evidence for appropriate staging (1,2). A Delphi study was performed to develop consensus guidelines. Methods: Guideline recommendations were constructed based on available evidence and included statements targeting highlighted areas of uncertainty from a clinician-based survey. Statements were divided into two domains: one focused on indications for staging and the second addressed imaging selection. A two round Delphi study was performed. Medical, radiation and surgical oncologists from Australia and New Zealand were invited to participate. Participants who had worked in their field for >5 years were considered experts. Participants voted using a 9-point Likert scale selecting from 1 (strongly disagree) to 9 (strongly agree). Consensus was achieved when >75% participants selected < 3, or >7 for a statement. Statements that did not reach consensus in the first round were refined and re-presented for subsequent voting. Results: 15 Australian and New Zealand experts agreed to participate: 8 medical oncologists, 3 radiation oncologists and 4 breast surgeons. 87% (13/15) of participants completed round one. Of the 18 recommendations, six did not meet consensus. These were revised, with seven recommendations re-presented in round two. 11/13 (85%) participants completed round two, with one further recommendation achieving consensus. Consensus was achieved on indications for staging including women with locally advanced or inflammatory breast cancer and clinical suspicion of metastatic disease. Staging should be delayed until after pregnancy if it will not immediately change management decisions. Staging should not routinely be used in stage I and II breast cancers. Where staging is indicated, it was agreed that visceral disease should be screened for; however, consensus was not achieved for whether screening for bone metastases should be performed. There was consensus for liver ultrasound as the imaging modality of choice for liver metastases screening. Participants did not agree on whether chest x-ray or CT chest was best practice for pulmonary metastases nor optimal imaging for bone metastases. There was also discord as to whether there is a role for PET scan. Conclusion: Consensus guidelines have been developed to standardise breast cancer staging during pregnancy. Consensus was achieved for indications for staging and use of liver ultrasound to screen for liver metastases. Optimal staging practices for bone and pulmonary metastases warrants further investigation. Acknowledgements: We thank the experts who participated in this Delphi study.

MP33-15 A STUDY OF PROGNOSTIC VALUE OF SERUM ALKALINE PHOSPHATASE AND ITS CORRELATION WITH BONE SCAN IN UROLOGICAL MALIGNANCIES

You have accessJournal of UrologyCME1 May 2022MP33-15 A STUDY OF PROGNOSTIC VALUE OF SERUM ALKALINE PHOSPHATASE AND ITS CORRELATION WITH BONE SCAN IN UROLOGICAL MALIGNANCIES Rohit Ranjan, Shivcharan Navriya, Ankur Mittal, and Arup Kumar Mandal Rohit RanjanRohit Ranjan More articles by this author , Shivcharan NavriyaShivcharan Navriya More articles by this author , Ankur MittalAnkur Mittal More articles by this author , and Arup Kumar MandalArup Kumar Mandal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002587.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bones are relatively frequent site of symptomatic metastasis in patients with genitourinary malignancies, such as prostate, kidney and urothelial carcinoma. Early detection of skeletal metastasis is very critical for precise staging and optimal management but advanced investigations are not available so easily everywhere. Further imaging and screening for bone metastasis is done if patient is having bony pain or raised serum alkaline phosphatase (ALP). This study is being done to assess the probability of having bony metastasis in urological malignancy on the basis of serum ALP levels and to find out its association in prognosis of urological cancers. METHODS: All the patients who diagnosed with urological malignancy (renal, prostate and urothelial) and underwent bone scan were included in this study. Serum ALP was correlated with the result of bone scan. RESULTS: During the study period of 30 months, we included 286 patients with 63.4% cases of prostate cancer, 24.4% cases of urothelial malignancy, 11.2% cases of renal carcinoma and 1% case with dual urological malignancies. Around 47.3% patients had metastatic disease on bone scan and most of them were carcinoma prostate (68.4%). Serum ALP was raised in 85.3% cases of bone metastasis and 26.7% of non-metastatic disease. Patients with very high serum ALP (>500 IU/L) have widespread disease with higher number of bony metastatic burden. Sensitivity of serum ALP for bone metastasis was 85.3%, specificity 73.3%, positive predictive value 76.2% and negative predictive value of 83.3%. CONCLUSIONS: Bone scan is very useful screening modality to detect bony metastasis in urological malignancy. Serum alkaline phosphatase (ALP) has got good sensitivity (85.3%) but poor specificity (73.3%), so it cannot be used as surrogative marker for bony metastasis. But patients with very high serum ALP (>500 IU/L) have much higher bony metastatic burden with poor prognosis. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e575 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rohit Ranjan More articles by this author Shivcharan Navriya More articles by this author Ankur Mittal More articles by this author Arup Kumar Mandal More articles by this author Expand All Advertisement PDF DownloadLoading ...

Comparison of the distribution pattern of metastatic bone disease and Skeletal related events between breast and prostate cancer: A retrospective study in Khartoum Oncology Hospital 2020

Background: Bone metastasis (BM) and its consequence skeletal-related events (SREs) are the most common cause of cancer pain and disability. In this study, we compare the distribution pattern of BM and SREs in breast cancer (BC) and prostate cancer (PC). Materials and Method: A Retrospective study in Khartoum oncology hospital of the medical record from 29 September 2019 to March 2020. Demographic and clinical information extracted from the medical records of eligible patients in the last 5 years 2015-2019 included age, sex, social habits, duration of breast and prostate cancer, duration of treatment, site of BM, and SREs if present. Statistical analyses were performed using SPSS, Version 22.0. (IBM, USA). Results: Out of 3216 patients, medical records 71.8% diagnosed with BC and 28.2% diagnosed with PC.5.6% had to BM the ratio between the breast and prostate is 1:4, Both cancers commonly metastasize to Spinal and pelvic bones. In comparison between BC and PC, the common site for BM according to the affected segment is lumber 48.8%, thoracic 32.9%, and pelvic 32.9% in BC. While in the PC: 56.9%, 50.5%, and 42.2% for lumbar, pelvic, and thoracic vertebrae respectively. SREs occur in 45.7% and 63.3% of BC and PC patients respectively. Conclusion: Based on high incidence BM in the BC and PC, screening for BM as soon as cancer diagnosed should be done promptly. Skeletal complications signs should always be considered as a matter of priority, as it has an impact on patient quality of life.

Advanced Hepatocellular Carcinoma with Bone Metastases: Prevalence, Associated Factors, and Survival Estimation.

BackgroundThe objective of the present research was to explore the prevalence, risk, and prognostic factors associated with bone metastases (BM) in newly diagnosed hepatocellular carcinoma (HCC) patients.Material/MethodsFrom 36 507 HCC patients who were registered in Surveillance, Epidemiology, and End Results (SEER) database, we enrolled 1263 with BM at the initial diagnosis of HCC from 2010 to 2014. Kaplan-Meier curves and log-rank tests were used to estimate overall survival for different subgroups. Univariate and multivariate logistic and Cox regression analyses were performed to identify risk factors and independent prognostic factors for BM.ResultsA total of 1567 (4.29%) HCC patients were detected with BM at initial diagnosis. Male sex, unmarried status, higher T stage, lymph node involvement, intrahepatic metastases, and extrahepatic metastases (lung or brain) were positively associated with BM. The median survival of the patients was 3.00 months (95% CI: 2.77–3.24 months). Marital status and primary tumor surgery were independently associated with the better survival.ConclusionsA list of factors associated with BM occurrence and the prognosis of the advanced HCC patients with BM were found. These associated factors may provide a reference for BM screening in HCC and guide prophylactic treatment in clinical settings.

Patterns of bone metastases in newly diagnosed colorectal cancer: a real-world analysis in the SEER database.

To investigate the incidence and the associated factors for bone metastases (BM) development and prognosis in initial colorectal cancer (CRC) with a large sample using Surveillance, Epidemiology, and End Results (SEER) cohort. Primary CRC patients, who were initially diagnosed between 2010 and 2015 in the SEER database, were included to analyze BM incidence and risk factors for BM occurrence. The patients with at least 1-year follow-up were involved to investigate the prognostic factors for BM. Multivariable logistic and proportional hazard regression models were used to investigate the risk factors for BM development and prognosis, respectively. A total of 212,787 eligible CRC patients were included and 2557 of them were diagnosed with de novo BM (1.20%). Rectal cancer presented significantly higher BM incidence than right and left colon cancer (χ2 = 107.64, P < 0.001). T1 stage, poor differentiated grade, and brain metastases were homogeneously associated factors for BM development and BM patients' survival. Male gender, higher N stage, rectal site, elevated carcinoembryonic antigen, and lung and liver metastases were positively associated with BM occurrence. Older age, unmarried status, right colon site, and non-surgery were found to positively correlate with the death risk of CRC patients with BM. BM is rare in CRC patients. Homogeneous and heterogeneous factors were found for BM development and BM patients' survival. The risk factors and prognostic factors can be used for BM screening and patient's prognosis estimation.

Real-World Study of the Incidence, Risk Factors, and Prognostic Factors Associated with Bone Metastases in Women with Uterine Cervical Cancer Using Surveillance, Epidemiology, and End Results (SEER) Data Analysis.

BackgroundThe aims of this study were to investigate the incidence and risk factors for the development of bone metastases and prognosis in women with cancer of the uterine cervix using database analysis.Material/MethodsThe National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) database was analyzed for the incidence and survival rates of women diagnosed with uterine cervical cancer in the United States between 2010–2015. Multivariate logistic regression analysis identified risk factors for bone metastases. Kaplan-Meier analysis estimated the overall survival. Proportional hazard regression analysis estimated prognostic factors associated with bone metastases.ResultsThere were 19,363 women with uterine cervical cancer, and 469 women were diagnosed with bone metastases on initial diagnosis (2.42%). Increased T-stage, N-stage, non-squamous and non-adenocarcinoma histology, high-grade tumors, and the presence of lung, liver, and brain metastases were all significantly associated with early bone metastases. There were 364 patients with cervical cancer and bone metastases on initial diagnosis who were followed-up for at least one year. Multivariate Cox regression analysis showed that unmarried status and lung, liver, and brain metastases were significantly associated with reduced overall survival. No other significant risk or prognostic associations were found.ConclusionsSEER data analysis showed that women with uterine cervical cancer had some standard risk factors associated with bone metastases, and with prognosis, but a heterogeneous group of risk factors was also present. The findings of this study may have clinical application in screening for bone metastases in women with cervical cancer.

Characteristics and clinical values of SPECT/CT whole-body bone scanning in detecting bone metastases in patients with lung adenocarcinoma or squamous cell carcinoma

Objective To investigate the clinical values and characteristics of whole body bone imaging (SPECT/CT) in detecting bone metastases in the preoperative patients with lung adenocarcinoma or squamous cell carcinoma for staging and determining the best treatment plan. Methods Eighty-two preoperative patients with primary pulmonary adenocarcinoma or squamous cell carcinoma performed 99Tcm-MDP SPECT/CT whole-body bone imaging. One week before surgery, parts of positive lesions performed MRI scan. The difference of the incidence of bone metastasis was analysed by χ2 test. Results In all 82 patients with lung cancer, there were 38 adenocarcinomas and 44 squamous cell carcinomas. Bone metastases were detected in 38 cases, the incidence rate was 46.3%. Of which, among lung adenocarcinoma, the incidence rate was 57.9% (22/38), and the incidence rate was 36.4% (16/44) in lung squamous cell carcinoma, and the difference was statistically significant (χ2=12.66, P=0.027). The most common area was bilateral ribs, followed by vertebra, pelvis, bones of the extremities and skull. Conclusion Lung adenocarcinoma compared with squamous cell carcinoma is prone to bone metastases, and bone metastases are more common in bilateral ribs. It has important value that whole body bone imaging in screening for bone metastases of pre-operative patients with lung cancer for staging and making the treatment plan. Key words: Lung neoplasms; Neoplasm metastasis; Diagnostic imaging; Single photon emission computed tomography/computed tomography

Should Bone Scan be Performed in Chinese Prostate Cancer Patients at the Time of Diagnosis?

Background: Prostate cancer (PCa) is increasingly being diagnosed in China. Early detection of bone metastases (BM) is critical in the management of patients with high-risk PCa. The aim of this study is to establish a screening model to determine if bone scan should be performed for BM in Chinese patients at the time when PCa is diagnosed. Materials and Methods: The study included 488 patients who were diagnosed with PCa between 2009 and 2011 at a single center. All patients received bone scans using technetium ^99mTc methylene diphosphonate at the initial staging. If the bone scan finding was equivocal, computed tomography or magnetic resonance imaging was performed to confirm the diagnosis. Age, prostate-specific antigen (PSA) at diagnosis, clinical stage assigned according to the TNM 2002 staging system and biopsy Gleason score were collected in all patients. Multivariate logistic regression analysis was performed to identify statistically significant covariates and then receiver operating characteristic (ROC) curves were generated to identify optimal cut-off values. Using these cut-off values, a formula was devised to calculate an index value for BM screening at diagnosis. The model was cross-validated using the leave-one-out method. Results: Of the 488 patients, 65 patients (13.3%) had BM. The area under the ROC curve was 0.87 (95% confidence interval 0.83-0.94). The sensitivity of the cut-off point was 87.7% and the specificity was 73.1%. Bone scan is needed for all cT4 PCa patients, however, it is also advisable for cT1-T3 PCa patients who have a biopsy Gleason score ≤3 + 4 and a PSA >132.1, and for cT1-T3 patients having a Gleason score of ≥4 + 3 and PSA >44.5. Conclusions: The regression model may help determine if bone scan is needed to detect BM from PCa at the time of diagnosis. The model was generated upon a single center experience. Further validation is needed in future studies.

Scintigraphie osseuse dans le bilan d’extension des carcinomes épidermoïdes des voies aérodigestives supérieures

Objectives To determine the value of technetium-99 m bone scintigraphy in the screening of bone metastases in the systematic initial extension assessment of upper aerodigestive tract suamous cell carcinomas; to identify risk factors of these bone metastases for better screening. Material and methods In this prospective study, the initial assessment of tumoral extension was systematically associated with bone scintigraphy. Only patients with no malignant tumors were included in the study. Any skeletal fixation identified was then analyzed with standard radiography and/or tomodensitometry and with the patient's clinical progression to confirm whether or not the fixation was metastatic. The sensitivity and specificity of bone scintigraphy was then calculated. A correlation between bone pain or hypercalcemia and confirmed bone metastases was also systematically sought to determine whether these factors were predictive of bone metastases so as to better target the screening. Results Among the 55 patients included in the study, three had confirmed bone metastases. All were detected by the bone scintigraphy, with a sensitivity of 100%. However, the 20 false-positive results gave a low specificity of 62%. Bone pain was described by two patients, but they were among the three metastatic patients. Specificity was 100%, but the sensitivity was only 67%. Three patients had hypercalcemia: the three metastatic patients. The sensitivity and specificity were 100%. In the tumoral status of the three patients with bone metastasis, tumors were small, classified as T1 or T2, but with substantial node involvement, classified N3, and with invasion of the internal jugular vein in two cases. Conclusion The incidence of bone metastases in the initial extension assessment was low; consequently, they are not sought systematically. However, their presence radically changes the prognosis and the therapeutic management, raising the question of screening. The technetium-99 m bone scintigraphy has limits, with many false-positive resulting the need for additional investigations. Defining the risk factors for bone metastases would improve screening. Two questions remain: what factors are involved? The bone pain and the hypercalcemia must be analyzed with a larger number of cases, but they seem to be nonspecific. The node involvement stage could be a more reliable parameter, in particular in cases of jugular vein invasion; what method should be used? In the future, the PET scan could be the key procedure not only in the locoregional extension assessment, but also for general extensions, in a single procedure investigating the whole body.

Bone and total alkaline phosphatase for screening skeletal metastasis in patients with solid tumours

Alkaline phosphatase (AP) has several isoforms including bone alkaline phosphatase (BAP). We evaluated BAP and AP for screening for bone metastasis (BM) in patients with solid tumours. This is a prospective non-blinded study conducted at ABC Foundation School of Medicine Oncology clinics. A total of 40 subjects without a history of cancer and 62 patients with various solid tumours referred for a bone scan had serum drawn for BAP and AP determination. Bone alkaline phosphatase and AP levels in patients with cancer and BM, without BM and with no cancer, were 70.32 +/- 3.65 and 310.21 +/- 16.87 U/L; 41.40 +/- 2.80 and 113.23 +/- 12.95 U/L; 21.19 +/- 2.76 and 148.05 +/- 12.79 U/L respectively (P < 0.0001 for both AP and BAP). For BAP and AP sensitivity, specificity, positive and negative predictive values were 0.86 and 0.52; 0.69 and 1; 0.45 and 1; 0.94 and 0.87 respectively. ROC AUC value for BAP was 0.89 and for AP was 0.93. We conclude that BAP is more sensitive than AP, whereas AP had a remarkable specificity of 100%. In screening for BM in patients with solid tumours, obtaining initially BAP and then selecting for further investigation only patients with an abnormal AP may be a cost and resource saving strategy.

P8 Screening for bone metastases in breast cancer patients: Correlation with local surgical staging

P8 Screening for bone metastases in breast cancer patients: Correlation with local surgical staging

Magnetic resonance imaging versus radionuclide scintigraphy in screening for bone metastases

AIM: To determine the frequency of isolated, asymptomatic metastases of the peripheral skeleton in patients with breast and prostate cancer. METHODS: A retrospective review was performed of staging skeletal scintigrams. Patients with hot spots in the peripheral skeleton in the absence of convincing evidence of metastatic disease in the axial skeleton were followed-up to determine the nature of the peripheral lesion(s) based on other imaging modalities, serial imaging or biopsy, and to determine if the lesion(s) had been symptomatic at the time of the scintigram. SUBJECTS: 200 patients with histologically proven carcinomas of the breast or prostate. RESULTS: Four patients (2%) had isolated metastatic involvement of the peripheral skeleton, and would, therefore, have been wrongly staged by a magnetic resonance ‘marrow screen’ of the axial skeleton. However, in three of these patients the lesions were painful, prompting diagnostic plain radiographs independent of the scintigraphic findings. Twelve patients (6%) had isolated scintigraphic abnormalities of the peripheral skeleton suggestive of metastatic disease but which on further investigation were shown to be benign lesions. CONCLUSION: A limited magnetic resonance (MR) ‘marrow screen’ confined to the axial skeleton would not result in any significant loss of accuracy in staging patients with breast and prostate carcinoma compared with skeletal scintigraphy. Given the proven increased sensitivity of MR over skeletal scintigraphy in the detection of bone metastases, and the additional information MR provides, it is likely to provide a more accurate basis for management.

The value of bone scintigraphy, bone marrow scintigraphy and fast spin-echo magnetic resonance imaging in staging of patients with malignant solid tumours: a prospective study.

The purpose of this prospective study was to define the value of bone scintigraphy (BS), bone marrow scintigraphy (BMS) and the new fast spin-echo (FSE) magnetic resonance imaging (MRI) sequences in screening for bone metastases in patients with solid malignant tumours. It was our particular interest to classify patients into a group with and a group without bone metastases, and not only to compare the absolute number of metastases detected by each method. Thirty-two patients were examined using technetium-99m dicarboxy propane diphosphonate bone scintigraphy, 99Tc-labelled monoclonal anti-granulocyte antibodies for bone marrow scintigraphy and 1.5 T MRI using T1-weighted and FSE T2-weighted sequences. Against a reference standard obtained by re-evaluation of all clinical and imaging data 1 year after prospective BS, BMS and MRI had been performed, the three imaging modalities were falsely positive in two, eight and two cases and falsely negative in zero and four cases, respectively. BMS was falsely positive in eight patients because of vertebral marrow degeneration which caused photopenic defects which could not be differentiated from metastases. MRI showed these lesions to unequivocally contain fat. BMS and MRI were falsely negative in four cases because of the limited field of examination. In our study the key factor in classifying a patient as bone M1 or M0 was the possibility of surveying the entire skeleton, as is the case in BS, and not that MRI had a higher sensitivity compared to BS when analysis was on a lesion-by-lesion basis.(ABSTRACT TRUNCATED AT 250 WORDS)

Tc-99m(V) DMSA Imaging

Combined Tc-99m MDP skeletal imaging and Tc-99m(V) DMSA whole body scans to detect metastases were performed during the follow-up of 30 patients who underwent surgery for breast carcinoma. Eight patients had normal Tc-99m MDP and Tc-99m(V) DMSA scans and were declared free of metastatic disease, further confirmed by no change in symptomatology over a 1-year follow-up period. Twenty-two patients had positive Tc-99m MDP scans with varied skeletal involvement. Tc-99m(V) DMSA scans showed matched areas of increased radiotracer concentration in bony metastases in 20 of these patients. Tc-99m(V) DMSA concentration was not seen in traumatic vertebral collapse or in coexistent osteoarthritic disease in vertebral metastatic involvement. Interestingly, Tc-99m(V) DMSA showed increased concentration in brain and liver metastases. Pentavalent Tc-99m(V) DMSA appears useful for detecting skeletal and soft-tissue metastases in breast carcinoma, and can improve the specificity of Tc-99m MDP bone scans in screening for bone metastases.

Precipitation method for separating and quantifying bone and liver alkaline phosphatase isoenzymes

We evaluated a method for quantifying bone isoenzyme of alkaline phosphatase (ALP) which utilizes wheat-germ lectin to precipitate this fraction. In precision studies, CVs ranged from 3.2 to 11.4% (within-day) and from 3.7 to 11.5% (day-to-day). The assay procedure was linear to 1100 U/L and was easily adapted to automated kinetic measurement. Comparison of the precipitation method with an affinity electrophoretic method, which utilizes cellulose acetate as a support, demonstrated a satisfactory coefficient of correlation (r = 0.886). The reference range was determined in sera from 188 healthy adult subjects. The distribution of bone ALP values was also studied in 73 healthy children and in 30 healthy adolescents. To evaluate the clinical applicability of the method, the bone isoenzyme was determined in samples from several groups of subjects (pregnant women, patients with hepatobiliary diseases, patients with hepatocellular carcinoma without skeletal involvement, and patients with bone, liver or lymph node metastases). We found the method suitable for routine determination of bone alkaline phosphatase and for the screening of bone metastases. Because of its technical simplicity and satisfactory analytical performance, it can be used instead of the heat-inactivation procedure.

Bone scan: a useful test for evaluating patients with low back pain

For many years it has been known that the sensitivity of bone scanning to the presence of destructive bony lesions favors its use in screening for bone metastases and osteomyelitis. More recently bone scanning has been routinely employed in evaluating benign skeletal pathology that may be the cause of low back pain. Bone scanning can play an important part in (1) identifying the cause of pain, (2) clarifying the significance of radiographic findings, and (3) evaluating the results of spinal surgery. This expansion of the role of nuclear medicine in diagnosing and managing low back pain is based in part upon novel diagnostic applications of 99mTc-methylene diphosphonate, a radiopharmaceutical that has been available for over 15 years. Equally important for this development, however, has been the recent availability of SPECT, a tomographic imaging technique that can be used to display the spine in a series of 6- to 8-mm thick sections. Slightly more than one-half of newly purchased gamma cameras are rotating systems suitable for bone SPECT studies. Thus, many community hospitals can now perform state-of-the-art bone scans for low back pain.