Nishimura R, Nagao K, Miyayama H, Yasunaga T, Asao C, Matsuda M, Baba K, Matsuoka Y, Yamashita H, Fukuda M
Department of Surgery, Kumamoto City Hospital, Kumamoto, Japan.
Cancer. 1999 Apr 15;85(8):1782-8.
Bone metastases from breast carcinoma are frequently observed as postoperative pathologic conditions; however, in many cases, diagnosis and treatment are difficult. Although most diagnoses of bone metastases are made by plain radiography (X-P) or bone scintigraphy, the use of magnetic resonance imaging (MRI) has enabled detailed imaging of foci, and many more lesions have become detectable. In the current study, the authors evaluated the relation between the diagnosis of bone metastases of breast carcinoma and clinicopathologic factors, especially those of proliferative activity and effects of treatment.
The subjects consisted of 51 breast carcinoma patients (mean age, 51.2 years) with vertebral metastases diagnosed by plain radiography, bone scintigraphy, or MRI. Twenty-eight of the 51 patients were premenopausal and 27 of the 51 had bone metastases only. The patients were classified into the following groups: Group A, 24 patients who showed similar findings in plain radiography, bone scintigraphy, and MRI; Group C, 14 who showed no abnormalities on radiography or bone scintigraphy but whose lesions were diagnosed by MRI only; and Group B, 13 patients with findings intermediate between Groups A and C. The proliferative activity of tumors was evaluated by determining the level of DNA polymerase alpha.
Regarding the relation to clinicopathologic factors, a significant number of patients with estrogen receptor (ER) negative tumors who had a high level of DNA polymerase alpha, short disease free intervals (DFI), and metastases to other organs were included in Group C. Prognoses of patients in Group C were poor.
For the diagnosis of breast carcinoma with bone metastasis, different correlations were noted among the various biologic characteristics, such as ER status and proliferative activity. That is, bone scintigraphy sufficiently reflected foci in patients with ER positive tumors or tumors with low proliferation, whereas bone scintigraphy was false-negative in patients with ER negative or highly proliferative tumors, showing that MRI was useful in diagnosing such patients. Therefore, consideration of malignant features, such as proliferative activity and ER status, is believed necessary during the postoperative follow-up of breast carcinoma patients.
乳腺癌骨转移是常见的术后病理情况；然而，在许多病例中，诊断和治疗都很困难。虽然大多数骨转移的诊断是通过X线平片（X-P）或骨闪烁显像做出的，但磁共振成像（MRI）的应用能够对病灶进行详细成像，从而发现更多的病变。在本研究中，作者评估了乳腺癌骨转移的诊断与临床病理因素之间的关系，尤其是增殖活性和治疗效果。
研究对象为51例经X线平片、骨闪烁显像或MRI诊断为椎体转移的乳腺癌患者（平均年龄51.2岁）。51例患者中，28例为绝经前患者，51例中27例仅有骨转移。患者分为以下几组：A组，24例在X线平片、骨闪烁显像和MRI上表现相似的患者；C组，14例在X线平片或骨闪烁显像上无异常但仅通过MRI诊断出病变的患者；B组，13例表现介于A组和C组之间的患者。通过测定DNA聚合酶α水平评估肿瘤的增殖活性。
关于与临床病理因素的关系，C组中有大量雌激素受体（ER）阴性、DNA聚合酶α水平高、无病间期（DFI）短且有其他器官转移的患者。C组患者的预后较差。
对于乳腺癌骨转移的诊断，在不同的生物学特征如ER状态和增殖活性之间观察到了不同的相关性。也就是说，骨闪烁显像能充分反映ER阳性肿瘤或增殖性低的肿瘤患者的病灶，而骨闪烁显像在ER阴性或高增殖性肿瘤患者中为假阴性，表明MRI对诊断此类患者有用。因此，在乳腺癌患者术后随访期间，考虑增殖活性和ER状态等恶性特征被认为是必要的。
