Kamby C, Guldhammer B, Vejborg I, Rossing N, Dirksen H, Daugaard S, Mouridsen H T
Cancer. 1987 Sep 15;60(6):1306-12. doi: 10.1002/1097-0142(19870915)60:6<1306::aid-cncr2820600624>3.0.co;2-x.
The occurrence of bone marrow carcinosis was investigated in 380 patients at the time of first recurrence of breast cancer. Results were related to results from radiographic bone survey, 99mTc MDP bone scintigraphy, clinical examination and serum alkaline phosphatase and serum calcium levels. Eighty-seven patients (23%) had tumor cells in the bone marrow. X-rays showed metastases in 78% of the patients with and in 16% of the patients without bone marrow carcinosis. The diagnostic efficiency of x-rays with bone marrow biopsy as the key diagnostic factor was 83%, and it was superior to that of other investigation methods. Bone tissue biopsies were positive alone in 15 patients (17%) and marrow aspirations were positive alone in seven patients (8%). Imprint preparations were positive alone in 7% of the patients and bone tissue biopsy in 5% of the patients. Heavy tumor infiltration (greater than or equal to 50%) of the bone marrow was associated with the occurrence of numerous regions of radiographically involved bone lesions and with histopathologic evidence of bone destruction. Furthermore, pronounced bone formation and marrow fibrosis were more commonly seen in patients with osteosclerotic bone metastases than in patients with osteolytic bone metastases. This study provides evidence that the primary soil of metastatic bone disease in human breast cancer is the bone marrow and that radiographic evidence of bone metastases is a result of an invasion and destruction of the bone tissue matrix by tumor cells from the marrow cavity.
在380例乳腺癌首次复发时的患者中对骨髓癌变情况进行了调查。结果与X线骨扫描、99mTc MDP骨闪烁显像、临床检查以及血清碱性磷酸酶和血清钙水平的结果相关。87例患者（23%）骨髓中存在肿瘤细胞。X线显示，有骨髓癌变的患者中78%出现转移，无骨髓癌变的患者中16%出现转移。以骨髓活检作为关键诊断因素时，X线的诊断效率为83%，优于其他检查方法。仅骨组织活检阳性的患者有15例（17%），仅骨髓穿刺阳性的患者有7例（8%）。仅印片阳性的患者占7%，仅骨组织活检阳性的患者占5%。骨髓重度肿瘤浸润（大于或等于50%）与X线显示的多处骨病变区域的出现以及骨破坏的组织病理学证据相关。此外，骨硬化性骨转移患者比溶骨性骨转移患者更常见明显的骨形成和骨髓纤维化。本研究提供了证据，表明人类乳腺癌骨转移疾病的原发部位是骨髓，并且骨转移的X线证据是骨髓腔肿瘤细胞侵袭和破坏骨组织基质的结果。
