Füsun AYDOĞAN, Ebuzer KALENDER, Murat RİFAİOĞLU, Recep DOKUYUCU

Regional distribution of bone metastases in skeletal system

Giriş: Kemik metastazları iskelet sisteminin en sık görülen malign lezyonlarıdır. Çalışmamızın amacı sintigrafik olarak tespit edilen kemik metastazlarının iskelet sistemindeki bölgesel dağılımını belirlemektir. Yöntemler: Çalışmaya Ocak 2012 ve Ağustos 2013 tarihleri arasında kliniğimizde kemik sintigrafisi çekimi yapılan primer maligniteli 97 hasta (53 erkek, 44 kadın) dahil edildi. Hastaların yaş ortalaması 59,0±15,9 (yaş aralığı, 19-84) yıl idi. Kemik metastazı olan hastalar ve bu metastazların bölgesel dağılımı tespit edildi. Bulgular: Hastaların 38\'inde (%39,2) kemik metastazı tespit edildi. Otuz iki (%84,2) hastada metastazlar multipl, 6 (%15,8) hastada ise soliter (tek) idi. Kemiğe metastaz yapan malignitelerin 15\'i (%39,5) prostat kanseri, 8\'i (%21) meme kanseri, 2\'si (%5,3) akciğer kanseri, 3\'ü (%7,9) mesane kanseri, 10\'u (%26,3) ise diğer malignitelerden (rektum, mide, serviks, lenfoma vs) oluşmaktaydı. Doksan iki adet metastaz bölgesi saptandı. Bunların 24\'ü (%26,1) vertebra, 15\'i (%16,3) pelvik kemikler, 17\'si (% 18,5) kosta, 6\'sı (% 6,5) üst ekstremite, 12\'si (% 13) alt ekstremite, 5\'i (% 5,45) kalvaryum, 6\'sı (% 6,5) sternum, 4\'ü (% 4.35) skapula, 3\'ü (% 3,3) klavikula idi. Sonuç: Kemik metastazları metastatik kanser olgularının 2/3\'ünde saptanmaktır. Kemik metastazlarının en sık izlendiği bölge aksiyel iskelet sistemidir ve bu sistem içerisinde de vertebralar ilk sırayı almaktadır. Kemik metastazlarının değerlendirilmesinde kullanılan en önemli görüntüleme yöntemi ise kemik sintigrafisidir.

Anahtar Kelimeler:

Kemik, metastaz, sintigrafi.

Regional distribution of bone metastases in skeletal system

Objective: Bone metastases are the most common malign lesions of skeletal system. The aim of this study is to determine regional distribution of bone metastases detected scintigraphically. Methods: Ninety-seven patients (53 male, 44 female) with primary malignancy who performed bone scintigraphy in our clinic between January 2012 and August 2013 included to study. The mean age of patients was 59±15.9 years (range 19-84).The patients who had bone metastasis and regional distribution of these metastases were detected. Results: Bone metastasis was detected in 38 (39.2%) of all patients. The metastases were multipl in 32 (84.2%) patients and single in 6 (15.8%) patients. Fifteen of malignancies that metastasize to bone were prostate cancer in 15 (39.5%) patients, breast cancer in 8 (21%) patients, lung cancer in 2 (5.3%) patients, urinary bladder cancer in 3 (7.9%) patients and other malignancies (rectum, stomach, cervix, lymphoma etc.) in 10 (26.3%) patients. Ninety-two metastasis regions were detected. 24 (26.1%) of them were vertebrae, 15 (16.3%) of them were pelvic bone, 17 (18.5%) of them were costa, 6 (6.5%) of them were upper extremity, 12 (13%) of them were lower extremity, 6 (6.5%) of them were calvarium, 6 (6.5%) of them were sternum, 4 (4.35%) of them were scapula and 3 (3.3%) of them were clavicula. Conclusion: Bone metastases are detected in two thirds of metastatic cancer cases. The most common site of bone metastases is axial skeletal system and vertebrae take the first place in this system. Bone scintigraphy is the most important imaging modality used in the evaluation of bone metastases.

Keywords:

Bone, metastasis, scintigraphy,

PDF

___

Sapir EE. Imaging of malignant bone involvement by mor- phologic, scintigraphic, and hybridmodalities. J Nucl Med 2005;46:1356–1367
Sherry HS, Levy RN, Siffert RT. Metastatic disease of bone in orthopaedic surgery. Clin Orthop 1982;169:44-52.
Simon MA, Karluk MB. Skeletal metastases of unknown ori- gin. Clin Orthop 1982;166:96-103.
Arguello F, Baggs RB, Duerst RE, et al. Pathogenesis of vertebral metastasis and epidural spinal cord compression. Cancer. 1990; 65:98–106.
Mundy GR. Metastasis to bone: causes, consequences and therapeutic opportunities. Nat Rev Cancer. 2002;2:584– 593.
Mundy GR. Mechanisms of bone metastasis. Cancer 1997;80(8 suppl):1546–56.
Weber MH, Sharp JC, Latta P, et al. Early detection and quan- tification of murine melanoma bone metastases with mag- netic resoınance imaging. Skeletal Radiol 2007;36:659– 666.
Quan GM, Vital JM, Aurouer N, et al. Surgery improves pain, function and quality of life in patients with spinal me- tastases: a prospective study on 118 patients. Eur Spine J 2011;20:1970–1978.
Memon AG, Jaleel A, Aftab J. Patten of prostatic carcinoma metastases in bones detected by bone scans using Techne- tium 99m methyl diphosphate (Tc99m MDP) imaging tech- nique. Pak J Med Sci 2006;22:180–183.
Padhani A, Husband J. Bone metastases. In: Husband JES, Reznek RH, eds. Imaging in Oncology. Oxford, U.K.: Isis Medical Media Ltd. 1998:765–787.
Hamaoka T, Madewell JE, Podoloff DA, et al. Bone imaging in metastatic breast cancer. J Clin Oncol. 2004;22:2942– 2953.
Kricun ME. Red-yellow marrow conversion: its effect on the location of some solitary bone lesions. Skeletal Radiol 1985;14:10 –19.
Coleman RE, Rubens RD. The clinical course of bone me- tastases from breast cancer. Br J Cancer 1987;55:61-66.
Min JW, Um SW, Yim JJ, et al. The role of whole-body FDG PET/CT, Tc 99m MDP bone scintigraphy, and serum alkaline phosphatase in detecting bone metastasis in pa- tients with newly diagnosed lung cancer. J Korean Med Sci 2009;24:275-280.
Tryciecky EW, Gottschalk A, Ludema K. Oncologic im- aging: interactions of nuclear medicine with CT and MRI using the bone scan as a model. Semin Nucl Med 1997;2):142–151.
Thrall JH, Ziessman HA. Skeletal System. In: Nuclear Med- icine. The Requisites. 2. ed. USA, Mosby 2001;110-145.
Love C, Din AS, Tomas MB, et al. Radionuclide bone im- aging: an illustrative review. Radio Garphics 2003;23:341- 358.
Schirrmeister H, Guhlmann A, Kotzerke J, et al. Early detection and accurate description of extent of metastatic bone disease in breast cancer with fluoride ion and positron emission tomography. J Clin Oncol 1999;17:2381–2389.
McAfee JG, Reba RC, Majd M. The musculoskeletal sys- tem. In: Wagner HN Jr, Szabo Z, Buchanan JW, eds. Prin- ciples of nuclear medicine. 2nd ed. Philadelphia, Pa: Saun- ders, 1995;986–1012.
Ziessman H, O’ Malley J, Thrall J. Nuclear Medicine: The Requisites 3rd ed. Philadelphia, U.S. 2006;113-129 .
Brooks ME. The skeletal system. In: Sharp PF, Howard GG, Murray AD (Editors). Practical Nuclear Medicine. 3 rd Edi- tion, London: Springer-Verlag London Limited, 2005:143- 161.
Beland PJ, Lane JM, Narayen S. Metastatic disease of the spine. Clin Orthop 1982;169:95-102
Dede D, Özder HT, Varoğlu E. Kanserde metastazların primer tümörlerine ve lokalizasyonlarına göre dağılımı. AÜTD. 1995;27:69-72.
Kakhki VRD, Anvari K, Sadeghi R, Mahmoudian AS, Kakhki MT. Pattern and distribution of bone metastases in common malignant tumors. Nuclear Med Rev 2013;16:66– 69.
Özpaçacı T, Aran M, Şahlan S, ve ark. Kanser metastazları- nın kemiklerdeki dağılımı. T Onkol Derg 1987;1:149-152.
Balcı TA, Uzar E, Koç ZP, Demirel BB, Taşdemir B. İs- kelet sistemindeki metastaz dağılımının tüm vücut kemik sintigrafisi ile değerlendirilmesi. F.Ü. Sağ Bil Tıp Derg 2011:25:67–71
Willis RA. The spread of tumours in the human body. 3rd edition, London, Butterworth, 1973.