Moores D W, Line B, Dziuban S W, McKneally M F
Department of Surgery, Albany Medical College, NY 12208.
J Thorac Cardiovasc Surg. 1990 Apr;99(4):620-1.
The bone scan is a sensitive screening device that is frequently used to stage the condition of patients with known or suspected malignant disease. Abnormal findings on bone scan are associated with corresponding normal findings on radiographs in approximately 50% of cases. Definitive tissue diagnosis of the bone lesion is often needed to determine optimal therapy, but localization of the lesion is imprecise unless it is palpable. Use of the nuclear scan to localize and mark the rib enhances the precision of the biopsy procedure. Thirty-three consecutive patients with cancer who had bone scans suggestive of rib abnormalities underwent nuclear scan-guided biopsy. Each patient had a repeat localizing scan with a maximum permissible dose of technetium 99m radionuclide on the day of the planned biopsy. The site of abnormality was marked with methylene blue injected into the skin overlying the lesion and down to the periosteum at the specific site. The patient was then taken to the operating room and the marked area was excised through a small incision. Pathologic abnormality was identified in all but one of the resected specimens, an accuracy rate of 97%. Despite a presumed or proved diagnosis of cancer in 33 patients, 16 specimens (48%) were benign. There were no complications associated with this technique, which reduces the morbidity and increases the precision of rib biopsy.
骨扫描是一种敏感的筛查手段，常用于对已知或疑似患有恶性疾病的患者进行病情分期。在大约50%的病例中，骨扫描的异常发现与X线片上相应的正常表现相关。通常需要对骨病变进行明确的组织诊断以确定最佳治疗方案，但除非病变可触及，否则其定位并不精确。使用核扫描对肋骨进行定位和标记可提高活检程序的精确性。33例连续的癌症患者，其骨扫描提示肋骨异常，接受了核扫描引导下的活检。每位患者在计划活检当天接受了一次最大允许剂量的锝99m放射性核素重复定位扫描。在病变上方皮肤直至特定部位的骨膜处注射亚甲蓝标记异常部位。然后将患者送入手术室，通过小切口切除标记区域。除1例切除标本外，所有标本均发现病理异常，准确率为97%。尽管33例患者均有假定或已证实的癌症诊断，但16份标本（48%）为良性。该技术无相关并发症，可降低发病率并提高肋骨活检的精确性。
