初诊时确定原发灶不明的转移性骨肿瘤原发灶的有效检查方法：一项回顾性图表审查研究。
Effective examination methods for identifying the primary origins of metastatic bone tumors of unknown primary origin during the initial visit: A retrospective chart review study.
作者信息
Fujibuchi Taketsugu, Imai Hiroshi, Kidani Teruki, Miura Hiromasa
机构信息
Department of Bone and Joint Surgery, Graduate School of Medicine, Ehime University, Toon City, Japan.
出版信息
SAGE Open Med. 2022 May 24;10:20503121221097582. doi: 10.1177/20503121221097582. eCollection 2022.
OBJECTIVE
To provide appropriate treatment for patients, early diagnosis of the primary origin of skeletal metastases of unknown primary origin is important. This study aimed to assess the examination strategy effective for identifying the primary origin of skeletal metastases of unknown primary origin.
METHODS
Sixty-one patients with skeletal metastases of unknown primary origin were reviewed. The primary origin was examined via physical examination, blood test including tumor markers, chest radiography, thoracoabdominal computed tomography scan, positron emission tomography-computed tomography scan, metastatic lesion biopsy, and other assessments. Examination methods considered effective for the diagnosis of the primary origin in a specific type of cancer were investigated.
RESULTS
The lung was the most common primary origin site, followed by the lymph nodes, prostate, and breast. Meanwhile, biopsy was the most effective examination, followed by positron emission tomography-computed tomography scan and thoracoabdominal computed tomography scan. Blood tests are useful for detecting hematological malignancies and prostate cancer. Computed tomography scans can be used to identify cancers in the lung, breast, and kidney, which are the common primary origins. Forty-one (67.2%) of the 61 patients with skeletal metastases of unknown primary origin were diagnosed via the first four steps, that is, physical examination, blood test, chest radiography, and thoracoabdominal computed tomography scan. Finally, two patients were diagnosed with skeletal metastases of unknown primary origin.
CONCLUSION
The examination steps used in this study, including physical examination, blood test including tumor markers, chest radiography, thoracoabdominal computed tomography scan, positron emission tomography-computed tomography scan, biopsy, and other assessments were effective in determining the primary origin of skeletal metastases of unknown primary origin during the initial visit.
目的
为患者提供恰当治疗，早期诊断不明原发灶的骨转移瘤的原发部位很重要。本研究旨在评估对识别不明原发灶的骨转移瘤的原发部位有效的检查策略。
方法
回顾了61例不明原发灶的骨转移瘤患者。通过体格检查、包括肿瘤标志物的血液检查、胸部X线摄影、胸腹计算机断层扫描、正电子发射断层扫描-计算机断层扫描、转移灶活检及其他评估来检查原发部位。研究了对特定类型癌症的原发部位诊断有效的检查方法。
结果
肺是最常见的原发部位，其次是淋巴结、前列腺和乳腺。同时，活检是最有效的检查方法，其次是正电子发射断层扫描-计算机断层扫描和胸腹计算机断层扫描。血液检查对检测血液系统恶性肿瘤和前列腺癌有用。计算机断层扫描可用于识别肺、乳腺和肾脏的癌症，这些是常见的原发部位。61例不明原发灶的骨转移瘤患者中有41例（67.2%）通过前四个步骤即体格检查、血液检查、胸部X线摄影和胸腹计算机断层扫描被诊断出来。最后，有2例患者被诊断为不明原发灶的骨转移瘤。
结论
本研究中使用的检查步骤，包括体格检查、包括肿瘤标志物的血液检查、胸部X线摄影、胸腹计算机断层扫描、正电子发射断层扫描-计算机断层扫描、活检及其他评估，在初次就诊时对确定不明原发灶的骨转移瘤的原发部位有效。
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