Shih W J, DeLand F H, Domstad P A, Magoun S, Dillon M L
Ann Thorac Surg. 1984 Jul;38(1):59-62. doi: 10.1016/s0003-4975(10)62187-x.
When abnormally increased radioactivity is seen in a rib or ribs by bone imaging in a patient with suspected or known malignancy, it frequently is difficult to differentiate fracture from metastatic disease. Histological examination of the lesion is crucial for diagnosis, staging, and planning of therapy. To assess the value of external localization of the site or sites of abnormal uptake in a rib as a guide for open rib biopsy, 10 patients (7 men, 3 women; age range, 34 to 68 years) with known or suspected malignancy were studied. With reference to the oscilloscope image, a cobalt 57 marker was placed on the skin overlying the focus of increased uptake, and the area of increased activity was marked on the skin as a guide to surgical resection. Of ten resected ribs, four showed metastatic disease and five had fractures. (One patient underwent two external marking procedures and two surgical procedures.) Rib biopsy was not performed in 1 patient because prior to the surgical procedure, a small subcutaneous nodule adjacent to the skin marker was excised and confirmed to be carcinoma. Appropriate courses of management (operation, irradiation, chemotherapy) were taken after the biopsies. The surgeon responsible for the biopsy should be present during the skin-marking procedure, and the area beneath the scapula and the region adjacent to the spine should be avoided. Our results indicate that the technique is a very useful aid for approaching open rib biopsies more precisely.
在疑似或已知患有恶性肿瘤的患者中，通过骨显像发现肋骨出现异常放射性增高时，常常难以区分骨折与转移性疾病。病变的组织学检查对于诊断、分期及治疗方案的制定至关重要。为了评估肋骨异常摄取部位的体外定位作为开放肋骨活检指导的价值，我们对10例已知或疑似患有恶性肿瘤的患者（7例男性，3例女性；年龄范围34至68岁）进行了研究。参照示波器图像，将钴57标记物置于摄取增加部位上方的皮肤上，并在皮肤上标记出活性增加区域，以此作为手术切除的指导。在切除的10根肋骨中，4根显示为转移性疾病，5根为骨折。（1例患者接受了两次体外标记程序和两次手术。）1例患者未进行肋骨活检，因为在手术前，切除了皮肤标记物附近的一个小皮下结节，经证实为癌。活检后采取了适当的治疗方案（手术、放疗、化疗）。负责活检的外科医生应在皮肤标记过程中在场，应避免肩胛骨下方区域和脊柱附近区域。我们的结果表明，该技术对于更精确地进行开放肋骨活检是一种非常有用的辅助手段。
