Diagnosis of osseous metastases of malignant tumors by bone scanning combined with bone alkaline phosphatase detection

Abstract

Abstract: Objective To assess the diagnostic value of bone alkaline phosphatase (B-AKP) detection in diagnosis of osseous metastases of malignant tumors. Methods Bone scanning and B-AKP detection were performed in 106 patients with malignancies. According to the findings in bone imaging and clinical symptoms, the patients were divided into bone metastases group (BM) and non-bone metastases group (NBM), between whom B-AKP was compared by t test. According to the number of osseous lesions on bone imaging, the patients were graded and B-AKP was compared between the 4 grades. Correlation analysis was performed between B-AKP level and the number of osseous lesions. Results Among the 106 patients, bone scanning found osseous metastases in 68 patients. For diagnosing osseous metastases, the sensitivity, specificity, PPV and NPV of B-AKP detection were 89.7%, 52.6%, 77.2% and 74.0%, respectively. B-AKP was 28.4±14.8 μg/L in BM group and 12.8±7.6 μg/L in NBM group, showing significant difference (t=6.056, P<0.001). B-AKP was 13.9±6.8 μg/L, 17.2±9.4 μg/L, 23.8±10.4 μg/L and 49.5±17.6 μg/L in patients of grade 0, 1, 2, and 3, respectively, showing significant difference by comparisons between the grades (P<0.05) except for that between grades 0 and 1 (t=1.320, P>05) and between grades 1 and 2 (t=1. 803, P>0.05). B-AKP was 19.6±4.2 μg/L in patients with single hot focus and 13.1±3.4 μg/L in patients with single cold focus (t=2.570, P<0.05). Correlation analysis showed that there was low-degree correlation between B-AKP level and the number of osseous lesions (r=0.751, P<0.01). Conclusions B-AKP level detection and bone imaging yield consistent results. For diagnosis of osseous metastases in patients with malignant tumor, bone scanning is the primary choice but in cases of single hot lesions, B-AKP should be performed to prevent missed diagnosis; for false positive lesions, B-AKP should also be detected to prevent misdiagnosis.

CLC Number:

R445

FAN Yi-xiang¹, LUO Rong-cheng¹, LI Gui-ping², HUANG Kai². Diagnosis of osseous metastases of malignant tumors by bone scanning combined with bone alkaline phosphatase detection[J]. Journal of Southern Medical University, 2004, 24(07): 812-814.

References

[1] 朱君,朱瑞森,朱继芳,等.核素骨显像中单个病灶性床分析[J].中华核医学杂志,2000,20(6):254-6.Zhu J, Zhu RS, Zhu JF, et al. Analysis of single spot on bone scan[J]. Chin J Nucl Med, 2000, 20(6): 254-6.
[2] WolffJM, Ittel TH, Boeckmann W, et al. Metastatic workup of patients with prostate cancer employing skeletal alkaline phosphatase[J]. Anticancer Res, 1997, 17(4B): 2995-7.
[3] 吴文苑综述.骨型碱性磷酸酶的检测方法和临床应用[J].国外医学·临床生物化学与检验学分册(Foreign Med Sci·Section Clin Biochem),1999,20(2):64-5.
[4] Reale MG, Santini D, Marchei GG, et al. Skeletal alkaline phosphatase as a serum marker of bone metastases in the follow up of patients with breast cancer[J]. Int J Biol Markers, 1995, 10(1): 42-6.
[5] Puig S, Staudenherz A, Steiner B, et al. Differential diagnosis of atypically located single or double hot spots in whole bone scanning[J].J Nucl Med,1998,39:1263-6.
[6] 戴学之,张奇亮,冯志徐,等.99Tcm-MIBI骨显像对骨单发病灶良恶性的诊断价值[J].潍坊医学院学报,2000,22(22):138.Dai XZ, Zhang QL, Feng ZX, et al. Diagnosis on single hot spot on bone scan with 99Tcm-MIBI [J].J Weifang Med Coll, 2000, 22(22):138.
[7] 李勇,杨志洁,韩秀英.99Tcm-MIBI骨显像中单发病灶良恶性的诊断[J].中国现代医学杂志,2000,10(7):47-9.Li Y,Yang ZJ,Han XY.Diagnosis of benign and malignant of single lesion on bone scan with 99Tcm-MIBI[J]. Chin J Mod Med,2000,10(7):47-9.
[8] 林榕,王时书,周淑云,等.238例恶性淋巴瘤患者中性粒细胞碱性磷酸酶染色结果分析[J].第一军医大学学报,2003,23(10):1097-8.Lin R, Wang SS, Zhou SY, et al. Analysis of alkaline phosphatase staining in 238 cases of malignant lymphoma [J]. J First Mil Med Univ/Di Yi Jun Yi Da Xue Xue Bao, 2003, 23(10): 1097-8.
[9] Cheran SK, Hemdon JE, Patz EF. Comparison ofwbole-body FDGPET to bone scan for detection of bone metastases in patients with a new diagnosis of lung cancer[J]. Lung Cancer, 2004, 44(3): 317-25.
[10] Maffioli L, Florimonate L, Pagani L, et al. Current role of bone scan with phosphonates in the follow-up of breast cancer[J]. Eur J Nucl Med Mol Imaging, 2004, 31(suppl 1): s143-8.
[11] Merk S. Hentschel M, Talazko J, et al. Unusual bilateral Tc-99m DPD uptake on bone scan[J]. Clin Nucl Med, 2003, 28( 11): 929-30.
[12] Ovesen O, Riegels P, Lindequist S, et al. The diagnostic value of digital substraction arthrography and radionuclide bone scan in revision hip arthroplasty[J]. J Arthrolasty, 2003, 18(6): 735-40.
[13] Maini A, Tripathi M, Shekar C, et al. Sciatic schwannoma of the thigh detected on bone scan:a case report [J]. Clin Imaging, 2003,27(3): 191-3.
[14] Braillon PM, Chotel F. Bone mineral content and soft-tissue assessment in limb segments by dual-energy X-ray absorptiometry:optimal scan speed and pixel size[J]. J Clin Densitom, 2003, 6(2): 149-58.
[15] Boughattas S, LetaiefB,Hassine H, et al. Bone scan in initial staging of prostate cancer[J]. Tunis Med, 2003, 81(6): 400-6.
[16] Simon MA, Miles BJ. Benign fibrous histiocytoma: a rare finding on bone scan staging for prostate adenocarcinoma[J]. Urol Oncol, 2003,21(1): 45-7.
[17] Chun KA, Cho IH, Won KJ, et al. Osteoblastoma as a cause ofosteomalacia assessed by bone scan[J]. Ann Nucl Med, 2003, 17(5):411-4.