Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.
Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
Clin Orthop Surg. 2023 Aug;15(4):659-667. doi: 10.4055/cios22052. Epub 2023 Jun 23.
We hypothesized that most of the atypical femoral fractures (AFFs) associated with bisphosphonate treatment for breast cancer (BC) could be found before the fracture event in another radiological examination already performed by breast surgeons, rather than on simple radiographs (SRs).
We thoroughly inspected the clinical charts of BC patients treated at our institute between 2008 and 2017. In total, 228 patients were categorized into three groups based on SRs: complete AFF on at least one side (group 1); incomplete fracture on at least one side, but not any complete fracture (group 2); and no suspicious lesion (group X) on either femur. Then, we inspected whole-body scintigraphy (WBS) and positron emission tomography (PET)-computed tomography (CT) images in all groups. For group X, patients with radiological clues from at least one femur were categorized, ultimately, into final group 3 and the rest made up the normal group.
About 35% of the patients showed AFFs (complete or incomplete) or suspicious lesions as AFFs, associated with the side effect of Bisphosphonate. In group 1, bilateral lesions (complete or incomplete fractures) were more frequently seen on SRs than unilateral lesions ( = 0.008). The initially identified findings in WBS and PET-CT for the respective complete and incomplete fractures on SRs of groups 1 and 2 were seen at a mean of 7 months previously. SRs did not reveal the lesions in group 3 until 5 months after the initial identification of the lesions in WBS and PET-CT.
Even before incomplete AFFs were detectable on SRs, they could be found at check-ups using WBS and PET-CT that had been previously examined by breast surgeons and radiologists for metastasis surveillance. Awareness of the lesions creates an opportunity for prophylactic surgery before complete fractures occur.
我们假设，与乳腺癌（BC）双膦酸盐治疗相关的大多数非典型股骨骨折（AFF）可以在骨折事件之前，在乳腺外科医生已经进行的另一项放射学检查中发现，而不是在简单的 X 光片（SRs）上发现。
我们彻底检查了 2008 年至 2017 年在我们研究所治疗的 BC 患者的临床图表。总共，根据 SRs 将 228 名患者分为三组：至少一侧有完全 AFF（组 1）；至少一侧有不完全骨折，但没有任何完全骨折（组 2）；两侧股骨均无可疑病变（组 X）。然后，我们检查了所有组的全身闪烁扫描（WBS）和正电子发射断层扫描（PET）-计算机断层扫描（CT）图像。对于组 X，对于至少一侧股骨有放射学线索的患者，最终分为最终组 3，其余患者为正常组。
约 35%的患者出现 AFF（完全或不完全）或可疑病变，与双膦酸盐的副作用有关。在组 1 中，与单侧病变相比，双侧病变（完全或不完全骨折）在 SRs 上更为常见（=0.008）。在 SRs 上最初确定的完全和不完全骨折的 WBS 和 PET-CT 最初发现的病变在 7 个月前。直到 WBS 和 PET-CT 最初发现病变后的 5 个月，SRs 才在组 3 中显示出病变。
即使在 SRs 上无法检测到不完全 AFF 之前，也可以在乳腺外科医生和放射科医生之前进行的转移监测检查中，通过 WBS 和 PET-CT 检查发现。对病变的认识为在完全骨折发生之前进行预防性手术提供了机会。
