Hanyok Brian T, Everist Mary M, Howard Lauren E, De Hoedt Amanda M, Aronson William J, Cooperberg Matthew R, Kane Christopher J, Amling Christopher L, Terris Martha K, Freedland Stephen J
Urology Section, Department of Surgery, Veterans Affairs Medical Center, Durham, NC, USA.
New York Medical College, Valhalla, NY, USA.
Asian J Urol. 2019 Jul;6(3):242-248. doi: 10.1016/j.ajur.2019.01.004. Epub 2019 Jan 18.
To review follow-up imaging after equivocal bone scans in men with castration resistant prostate cancer (CRPC) and examine the characteristics of equivocal bone scans that are associated with positive follow-up imaging.
We identified 639 men from five Veterans Affairs Hospitals with a technetium-99m bone scan after CRPC diagnosis, of whom 99 (15%) had equivocal scans. Men with equivocal scans were segregated into "high-risk" and "low-risk" subcategories based upon wording in the bone scan report. All follow-up imaging (bone scans, computed tomography [CT], magnetic resonance imaging [MRI], and X-rays) in the 3 months after the equivocal scan were reviewed. Variables were compared between patients with a positive negative follow-up imaging after an equivocal bone scan.
Of 99 men with an equivocal bone scan, 43 (43%) received at least one follow-up imaging test, including 32/82 (39%) with low-risk scans and 11/17 (65%) with high-risk scans ( = 0.052). Of follow-up tests, 67% were negative, 14% were equivocal, and 19% were positive. Among those who underwent follow-up imaging, 3/32 (9%) low-risk men had metastases 5/11 (45%) high-risk men ( = 0.015).
While 19% of all men who received follow-up imaging had positive follow-up imaging, only 9% of those with a low-risk equivocal bone scan had metastases versus 45% of those with high-risk. These preliminary findings, if confirmed in larger studies, suggest follow-up imaging tests for low-risk equivocal scans can be delayed while high-risk equivocal scans should receive follow-up imaging.
回顾去势抵抗性前列腺癌（CRPC）男性患者骨扫描结果不明确后的随访影像学检查，并探讨与随访影像学检查阳性相关的不明确骨扫描特征。
我们从五家退伍军人事务医院中识别出639例CRPC诊断后接受过锝-99m骨扫描的男性患者，其中99例（15%）骨扫描结果不明确。根据骨扫描报告中的措辞，将骨扫描结果不明确的男性患者分为“高风险”和“低风险”亚组。对不明确扫描后3个月内的所有随访影像学检查（骨扫描、计算机断层扫描[CT]、磁共振成像[MRI]和X线）进行回顾。比较不明确骨扫描后随访影像学检查阳性与阴性患者之间的变量。
99例骨扫描结果不明确的男性患者中，43例（43%）接受了至少一项随访影像学检查，包括低风险扫描的82例中的32例（39%）和高风险扫描的17例中的11例（65%）（P = 0.052）。在随访检查中，67%为阴性，14%不明确，19%为阳性。在接受随访影像学检查的患者中，低风险男性中有3/32（9%）发生转移，高风险男性中有5/11（45%）发生转移（P = 0.015）。
虽然接受随访影像学检查的所有男性中有19%随访影像学检查阳性，但低风险不明确骨扫描的患者中只有9%发生转移，而高风险患者中这一比例为45%。这些初步发现若在更大规模研究中得到证实，则表明低风险不明确扫描的随访影像学检查可延迟进行，而高风险不明确扫描应接受随访影像学检查。
