摘要:目的:探讨血清CA153和BAKP在乳腺癌骨转移显像诊断中的应用。方法:对92例乳腺癌患者的核素骨显像结果、血清CA153和BAKP结果进行回顾性研究。结果:①血清CA15-3和B-AKP的值随着骨转移分期的增高而逐步升高,且差异显著(Plt;0. 01);②血清CA15-3和B-AKP与骨转移的数目呈正相关;③血清CA15-3gt;25 U/mL时,骨转移的阳性率为63.3%,血清CA15-3lt;25 U/mL时,骨转移的阴性预测值为94. 5%;血清B-AKPgt;20 U/L时,骨转移的阳性率为59. 6%时,骨转移的阴性预测值为73.5%;当血清CA15-3lt;25 U/mL同时B-AKPlt;20 U/L时,骨转移的阴性预测值为100%。结论:血清CA15-3和BAKP测定在乳腺癌骨显像诊断中具有重要的应用价值。Abstract: Objective: To evaluate the diagnosis value of serum CA153 and BAKP measurements for scanning bone metastatic images in patients with mammary Cancer. Methods: Retrospective study on the bone scan images and serum CA153 (with CLIA) and bone alkaline phosphatase (BAKP, with ELISA) levels were performed in 92 patients with confirmed mammary gland cancer. Results: ①The serum levels of CA153 and BAKP were increased step by step along with the advancement of bone metastatic grading from M0 to M3 with significant difference between values in successive gradings (Plt;0. 01).②The levels of CA153 and BAKP were significantly positively correlated. ③With serum CA153gt;25 U/mL the positive rate of bone metastasiswas 63.2%, with CA153lt;25 U/mL the negativepredictive value of bone metastasis was 94.5%, with BAKPgt;20 U/L,the positive rate of bone metastasis was 596%, with BAKPlt;20 U/L, the negative predictive value of bone metastasis was 73. 5%.However with Serum CA153lt;25 U/mL and BAKPlt;20 U/L, the negative predictive value of bone metastasis was100%. Conclusion: The combined measurement of the serum CA153 and BAKP levels would play an important role for diagnosis of bone scan images in patients with prostate cancer.
According to the inclusion and exclusion criteria, we searched for relevant original articles in some big Chinese and English databases.The qualities of the studies were evaluated with QUADAS quality assessment tool. A software program, Meta-disc, was used to obtain the pooled estimates and heterogeneity test for sensitivity, specificity, SROC curve, and so on. Finally the 17 article were included. On a per-patient basis, the pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR), Q*, SROC area under curve for 99mTc-MDP bone scan and computed tomography (CT) were 0.87 and 0.99, 0.81 and 0.98, 3.88 and 13.86, 0.2 and 0.03, 27.73 and 612.17, 0.8418 and 0.9732, 0.9097 and 0.9952, respectively. On a per-focus basis, the pooled SEN, SPE, LR+, LR-, DOR, Q*, SROC area under curve for 99mTc-MDP bone scan was 0.86, 0.97, 13.32, 0.16, 102.4, 0.8944, 0.9528, respectively. For CT, only 1 article were included. This paper demonstrate: whether 99mTc-MDP or CT both have high diagnostic efficiency for bone metastase of breast cancer.
ObjectiveTo discuss related clinical research progress of bone metastasis of breast cancer. MethodThe literatures about bone metastases of breast cancer were researched and reviewed. ResultsAlthough there were so many related researches at home and abroad for bone metastasis of breast cancer,but the specific mechanism was still not fully elucidated.At present,the diagnostic method of bone metastasis of breast cancer included X-ray examination,bone scanning,computer tomography,magnetic resonance imaging,positron tomography,positron emission computed tomography,pathology biopsy,and detection of serum markers.In clinical treatment,the treatment consisted of systemic therapy and local therapy,but there was no uniform standard. ConclusionFor high incidence and serious influence on quality of life,bone metastasis of breast cancer needs to be studied further.
Objective To use meta-analysis method to assess the efficacy of fluorine-18fluorode-oxyglucose positron emission tomography/computed tomography (PET/CT) (18F-FDG-PET/CT) scan and 99Tcm-methylene diphosphonate (99Tcm-MDP) bone scan (BS) on early diagnosis of bone metastases of cancer. Methods Computer-based retrieval was conducted on MEDLINE, PubMed, EMbase, Ovid, and The Cochrane Library (from their establishment to 2010) to search reports about diagnosing bone metastases of cancer with 18FDG-PET/CT and 99Tcm-MDP Bone Scan. Three reviewers independently selected the studies according to the inclusion and exclusion criteria, collected the data, and evaluated the quality. MetaDisc software was adopted to conduct meta-analyses. The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated, the summary receiving operating characteristic (SROC) curve was drawn, and the areas under the curve (AUC) and Q were measured. Results Five studies were included. The results of meta-analyses showed that the pooled sensitivity of 18FDG-PET/CT and 99Tcm-MDP BS in the diagnosis of bone metastases was 0.95 (95%CI 0.90 to 0.97) and 0.77 (95%CI 0.71 to 0.83), respectively; the pooled specificity was 0.98 (95%CI 0.97 to 0.99) and 0.90 (95%CI 0.88 to 0.92), respectively; the pooled DOR was 602.81 (95%CI 214.07 to 1697.51) and 41.37 (95%CI 8.15 to 210.05), respectively; the AUC was 0.984 2 and 0.901 7, respectively; and the Q index was 0.945 4 and 0.833 1, respectively. Conclusion The 18F-FDG PET/CT is more effective than the 99Tcm-MDP bone scan in the early diagnosis of bone metastases in cancer.
Objective To investigate the feasibil ity, safety and operative techniques of percutaneous vertebroplasty (PVP) in treating osteolytic bone metastasis of cervical vertebra and reconstructing the function of cervical vertebra. Methods From March 2005 to December 2007, 10 patients with osteolytic bone metastatic carcinoma in single cervical vertebral body received PVP, including 5 males and 5 females aged 38-75 years (mean 54.5 years). Among them, 5 patients had primary lung tumor, 1 primary renal tumor, 1 primary breast tumor, 1 primary cervical tumor and 2 unknown primary lesion. The course of disease was 2-4 years. All the patients suffered from obviously cervical pain and l imitation of activity, including 4 cases of metastatic tumor of the C2 vertebral body, 2 of C3, 2 of C6 and 2 of C7. The general condition of patients was stable before operation, and no blood coagulation dysfunction, radiculalgia and spinal cord compression were detected. Lateral PVP was performed on 6 cases, approaching between the vertebral artery and the carotid sheath under CT guidance and anterolateral PVP was performed on the rest 4 cases, approaching between the trachea and the internal carotid artery under continuously X-ray fluoroscopy. The amount of bone cement injected was 3-4 mL, and the fill ing rate was 50%-100%. Results Without obvious bleeding or organ injury, the puncture was performed successfully on all the patients. Without symptom of spinal cord compression, patients suffered from pain during operation (1 case) and such compl ications noted by immediate CT or X-rays examination after operation as paravertebral epidural cement leakage (2 ases),transverse foramen cement leakage (1 case) and pinhole reflux (3 cases). The pain of patients was improved to various degree postoperatively, the visual analogue scales score was (5.9 ± 1.2) points before operation, which was changed to (2.6 ± 1.2) points at 1 hour after PVP and (1.6 ± 1.3) points at 1 week after PVP, indicating there was a significant difference between pre- and postoperation (P lt; 0.05). During the regular follow-up at 1 week, 3 and 12 months after PVP, all patients had no dislocation of cervical vertebra body, spinal cord compression and paralysis. Five patients died from multiple organ failure due to primary tumor progression, including 3 cases at 6 months after PVP and 2 at 12 months after PVP, and the rest 5 patients’ cervical pain were under control, with sound functional recovery. Conclusion PVP can rel ieve pain quickly and reinforce the stabil ity of the vertebral body, and has sl ight compl ications; the lateral approach is safe and effective.
目的 探讨影响乳腺癌骨转移发生、发展的因素及治疗方法。 方法 对106例乳腺癌骨转移患者的临床特点及近期疗效进行回顾性总结。 结果 乳腺癌骨转移的发生及发生早晚与腋窝淋巴结的转移数目相关。治疗以全身治疗为主，包括化疗、内分泌治疗、放疗、放射性同位素内照射及二磷酸盐的综合治疗。 结论 乳腺癌患者，特别是伴有较多数目腋窝淋巴结转移者，应进行同位素骨扫描检查，一旦出现骨转移，应积极进行全身治疗，转移局限者，可进行局部外放射治疗。
ObjectiveTo study the influence of estrogen on zoledronic acid in preventing bone metastasis of breast cancer. MethodsTwo hundred and sixteen breast cancer patients who accepted modified radical mastectomy, chemotherapy, and the prophylaxis of zoledronate acid from January 2006 to December 2009 in this hospital were collected, including luminal A 55 cases, luminal B 63 cases, HER-2 positive 50 cases, triple negative 48 cases. Then these patients were categorized into low estrogen group(n=39) and normal estrogen group(n=177) according to the estrogen level. The patients in the low estrogen group accepted drug induced menopause, in the normal estrogen group didn't accept drug induced menopause. All the patients accepted the therapy of zoledronate acid, then with clinical follow-up for 3-5 years until progressive disease(include neoplasm recurrence, bone metastasis, and other neoplasm metastasis etc.). ResultsThe rate of bone metastasis in the low estrogen group was significantly lower than that in the normal estrogen group (χ2=21.91, P < 0.05). For the patients with luminal A, luminal B, HER-2 positive, and triple negative, the rates of bone metastases in the low estrogen group were significantly lower than those in the normal estrogen group[luminal A:5.13%(2/39) versus 12.43%(22/177), χ2=4.54, P < 0.05;luminal B:7.69%(3/39) versus 13.56%(24/177), χ2=6.04, P < 0.05;HER-2 postive:2.56%(1/39) versus 15.25%(27/177), χ2=3.95, P < 0.05;triple negative:2.56% (1/39) versus 18.08%(32/177), P < 0.05]. The rate of bone metastasis among the different subtype of breast cancer in the low estrogen group was not significant difference(χ2=0.55, P > 0.05). ConclusionsFrom the limited preliminary data, the premenopausal women patients with breast cancer who accepted drug induced menopause afer application of zoledronate acid for preverttion of bone metastasis has a obviously efficacy, and the efficacy has no difference among four molecular subtypes of breast cancer.