1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2University of Applied Health Sciences, Zagreb, Croatia; 3Department of Radiology and Nuclear Medicine, PET/CT Center, Medikol Polyclinic, Zagreb, Croatia; 4Department of Nuclear Medicine and Radiology, Martini Hospital, Groningen, The Netherlands; 5Department of Surgery, University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 6School of Dental Medicine, University of Zagreb, Zagreb, Croatia.
Acta Clin Croat. 2021 Dec;60(4):617-626. doi: 10.20471/acc.2021.60.04.08.
The bone health guidelines for breast cancer (BC) patients recommend bone mineral density (BMD) testing. Patients with low BMD and elevated serum calcium levels (SCLs) are further evaluated for primary hyperparathyroidism (PHPT). We aimed to determine the prevalence of PHPT in treated BC patients with low BMD and analyze the association of SCLs with histopathologic tumor features and cancer treatment. This retrospective study included postmenopausal BC patients examined at Osteoporosis Clinic between 2013 and 2020. Clinical and BMD data were collected from patient medical records. Patients with biochemical suspicion of PHPT underwent standard parathyroid imaging procedures. Nine out of 137 (6.6%) patients were diagnosed with PHPT; 8/9 patients underwent parathyroidectomy and one patient was advised to follow-up. Among the rest of 128 non-PHPT patients, higher SCLs showed a trend of positive association with higher tumor grade and axillary lymph node involvement, and received immunotherapy, although without statistical significance. We found a higher prevalence of PHPT in treated BC patients compared to the general population. Higher SCLs show a trend of positive correlation with some more aggressive histopathologic tumor features and with immunotherapy. The results of this study suggest that assessment of SCLs should be routinely performed to rule out PHPT in treated BC patients with low BMD.
乳腺癌（BC）患者的骨骼健康指南建议进行骨密度（BMD）检测。对于低 BMD 和血清钙水平升高（SCL）的患者，进一步评估是否患有原发性甲状旁腺功能亢进症（PHPT）。我们旨在确定患有低 BMD 的治疗后 BC 患者中 PHPT 的患病率，并分析 SCL 与组织病理学肿瘤特征和癌症治疗的关联。这项回顾性研究纳入了 2013 年至 2020 年在骨质疏松症诊所接受检查的绝经后 BC 患者。从患者病历中收集了临床和 BMD 数据。疑似有 PHPT 生化表现的患者接受了标准甲状旁腺成像检查。137 名患者中有 9 名（6.6%）被诊断为 PHPT；9 名患者中，8 例行甲状旁腺切除术，1 名患者建议随访。在其余 128 名非 PHPT 患者中，虽然没有统计学意义，但 SCL 较高与较高的肿瘤分级和腋窝淋巴结受累呈正相关趋势，且接受了免疫治疗。与一般人群相比，我们发现治疗后的 BC 患者中 PHPT 的患病率更高。较高的 SCL 与一些侵袭性更高的组织病理学肿瘤特征以及免疫治疗呈正相关趋势。这项研究的结果表明，应常规评估 SCL，以排除患有低 BMD 的治疗后 BC 患者中的 PHPT。
