Frequency of Bone Metastases with Metabolic Super Scan in Cancer Breast Patients

Document Type : Original Paper, Oncology

Author

National Cancer Institute , Cairo University

Abstract

Background: Metabolic skeletal changes particularly metabolic super scan (MSS) may provide unsuitable soil for survival and growth of tumor cells in cancer breast patients. We aimed to verify the presence of MSS in cancer breast patients in correlation with the available biomarker for bone metabolism and to explore its influence on the frequency of bone metastases compared to patients without MSS features. Methods: From July 2008 to December 2010, 450 histo-pathologically proved breast cancer patients referred to nuclear medicine department in national cancer institute (NCI), Cairo University, Egypt underwent whole body bone Scan. Bone metabolism was evaluated by laboratory biomarkers of serum alkaline phosphatase (ALP), serum calcium and parathormone (PTH) levels in addition to serum creatinine to assess renal function. Statistical correlations were done between bone scan, clinico-pathological data, radiological findings and serum biomarkers. Follow up within 16-24 months was done. Results: Based on the presence or absence of MSS features, breast cancer patients were classified into two groups: I) MSS group: - included 99 patients, with a mean age of 60.5 years ± 19.5. (II) NonMSS group: included 351 patients with a mean age of 57 years ± 22.0. Patients based data analysis showed that MSS was seen in 22% of the studied breast cancer patients with more prevalence in the post menopausal women and those treated with hormonal and bisphosphonate therapy. Moreover, a significantly lower frequency of bone metastases was noticed in MSS group (8%) compared to Non-MSS (18.2%) (P<0.05). On the other hand sensitivity, accuracy and PPV for detection of bone metastases were significantly lower in MSS group (75%,75%,64%) compared to NonMSS (90%, 88.6% and 75%) group respectively (P<0.05). A comparable low yield was obtained in PPV and specificity in both groups with no significant difference (P>0.05). Apart from significant higher level of alkaline phosphatase in MSS compared to Non-MSS group, no significant difference was noticed in the rest of the estimated metabolic biomarkers between both groups. Conclusion: MSS seems to be associated with low frequency of bone metastases in MSS compared to Non-MSS in cancer breast patients. MSS appears to be linked to menopausal status and treatment with hormonal and bisphosphonate therapy. Unfortunately MSS may have a negative impact on the accuracy of bone scan in detection of bone metastases

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