Putro Yuni Artha Prabowo, Aryandono Teguh, Widodo Irianiwati, Magetsari Rahadyan, Pramono Dibyo, Johan Muhammad Phetrus, Abidin Mos Asri, Wikantyasa Ardanariswara, Saraswati Paramita Ayu, Huwaidi A Faiz
Doctoral Program in Medicine and Health Sciences, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako, Sendowo, Sekip Utara, Sleman, 55281, D.I. Yogyakarta, Indonesia Universitas Gadjah Mada.
Department of Orthopedics and Traumatology, RSUP Dr. Sardjito Hospital, Jl. Kesehatan Sendowo No.1, Sleman, 55281, D.I.Yogyakarta, Indonesia. Universitas Gadjah Mada.
Orthop Rev (Pavia). 2024 Sep 21;16:123441. doi: 10.52965/001c.123441. eCollection 2024.
Among all MBD cases, 3% have an unidentified origin and are commonly misdiagnosed. On average, nearly 75% of MBD cases with an unknown origin take four months to diagnose. This difficulty in identifying the primary cancer limits the treatment of skeletal metastases to palliative measures, negatively impacting a patient's prognosis. The purpose of this systematic review is to evaluate the current diagnostic work-up approaches available for MBD.
This systematic review was carried out according to the guidelines of the (PRISMA) 2020 Statement, including studies with a population of interest of MBD with unknown primary origin. We excluded studies with non-English language and MBD cases with known origin. The intervention of the diagnostic approach was the primary outcome. The authors searched three electronic medical databases. Individual reviewers performed quality and risk of bias assessments.
All ten articles were cohort studies, with the median age of the subjects ranging from 55.6 to 65.2 years. The most frequently recommended supporting examination was biopsy, with a detection rate of 38.2%, followed by chest X-ray and CT scan, both with a detection rate of 26.7%. Overall, the detection rate of the primary lesion from individual examinations ranged from 2.8% to 38.2%, highlighting the difficulty of diagnosis when relying solely on a single examination.
Biopsy is crucial in identifying the primary lesion of metastatic bone disease with an unknown origin, with a detection rate of 38.2%, making it the most frequently recommended examination. However, this review has several limitations. A few assumptions were made in the synthesis of numerical data.
在所有骨转移瘤（MBD）病例中，3%的病例来源不明，且常被误诊。平均而言，近75%来源不明的MBD病例需要四个月才能确诊。这种难以确定原发性癌症的情况限制了骨转移的治疗只能采取姑息措施，对患者的预后产生负面影响。本系统评价的目的是评估目前可用于MBD的诊断检查方法。
本系统评价按照《系统评价和Meta分析的首选报告项目》（PRISMA）2020声明的指南进行，纳入原发性来源不明的MBD感兴趣人群的研究。我们排除了非英文语言的研究和已知来源的MBD病例。诊断方法的干预是主要结局。作者检索了三个电子医学数据库。独立评审员进行了质量和偏倚风险评估。
所有十篇文章均为队列研究，受试者的中位年龄在55.6至65.2岁之间。最常推荐的辅助检查是活检，检出率为38.2%，其次是胸部X线和CT扫描，检出率均为26.7%。总体而言，单项检查对原发性病变的检出率在2.8%至38.2%之间，这突出了仅依靠单一检查进行诊断的难度。
活检对于识别来源不明的转移性骨病的原发性病变至关重要，检出率为38.2%，是最常推荐的检查。然而，本综述有几个局限性。在数值数据的综合中做了一些假设。
