Evans D M, Wright D J
Department of Surgery, Akron General Medical Center, Northeastern Ohio Universities, College of Medicine 44307.
Am Surg. 1987 Oct;53(10):603-5.
The objective of this study is to correlate the presence of bone and liver metastases in patients with breast cancer with respect to the results of bone and liver scans, axillary nodal status, and serum alkaline phosphatase levels. One hundred ninety-seven patients with breast cancer treated by modified radical mastectomy between the years 1978 and 1981 were studied. Fifty-nine (30%) of the total group had distant metastases during the course of observation of 60 to 96 months; of 35 patients in whom bone metastases developed, 30 had normal preoperative bone scan results. Of 21 patients who had liver metastases, 19 had normal preoperative liver scans. Nineteen (70%) of the 27 patients with abnormal bone scans had normal alkaline phosphatase levels. Seven (63%) of the 11 patients who had abnormal liver scans had a normal alkaline phosphatase. The study supports the concept that preoperative bone and liver scans are ineffective indicators of metastatic involvement. Selection of patients for screening by bone and liver scans according to alkaline phosphatase determinations was not supported by this study. The appropriate use of bone scans for screening in patients with breast carcinoma is suggested as a follow-up device in patients with positive lymph nodes.
本研究的目的是，就骨扫描和肝脏扫描结果、腋窝淋巴结状态及血清碱性磷酸酶水平，探讨乳腺癌患者骨转移和肝转移的情况。研究对象为1978年至1981年间接受改良根治性乳房切除术治疗的197例乳腺癌患者。在60至96个月的观察期内，全部患者中有59例（30%）发生远处转移；在发生骨转移的35例患者中，30例术前骨扫描结果正常。在发生肝转移的21例患者中，19例术前肝脏扫描结果正常。在骨扫描异常的27例患者中，19例（70%）碱性磷酸酶水平正常。在肝脏扫描异常的11例患者中，7例（63%）碱性磷酸酶正常。该研究支持以下观点，即术前骨扫描和肝脏扫描对于转移情况的判断并无效果。本研究并不支持依据碱性磷酸酶测定结果选择患者进行骨扫描和肝脏扫描筛查。对于乳腺癌患者，建议将骨扫描作为腋窝淋巴结阳性患者的后续检查手段，合理用于筛查。
