Evaluation of characteristic of breast cancer bone metastasis with 99mTc-MDP bone imaging
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摘要:
目的 探讨乳腺癌骨转移99mTc-亚甲基二膦酸盐（MDP）全身骨显像及SPECT/CT融合显像的特征。 方法 收集我院2016年1月~2017年5月经病理组织学及免疫组化确诊的乳腺癌资料。初诊时即发现骨转移的患者46例，所有患者均在治疗前行99mTc-MDP全身骨显像，疑骨转移或不明原因骨痛部位行SPECT/CT融合显像。分析三阴乳腺癌（TNB）与非TNBC骨转移病灶分布情况，总结乳腺癌骨转移99mTc-MDP全身骨显像及SPECT/CT融合显像的特点。 结果 共检出46例患者204处病变，脊柱62处（30.39%），是转移最常见部位，其次肋骨57处（27.94%）、胸部骨31处（15.20%）、骨盆骨28处（13.73%）、颅面骨15处（7.35%）、四肢骨11处（5.39%）。三阴乳腺癌与非三阴乳腺癌、TNBC与非TNBC骨转移在脊柱、肋骨、胸部骨、骨盆骨、颅面骨及四肢骨的病灶分布比例差异无统计学意义（χ2=0.591，P=0.988）。三阴乳腺癌骨转移占整个乳腺癌骨转移的28.26%（13/46）。13例TNBC骨转移共51处病灶，放射性浓聚占90.20%（46/51）, 混合型病灶占7.84%（4/51），放射性稀疏病变1.96%（1/51）, 且主要为多发骨转移病变, 占84.62%（11/13）。 结论 99mTc-MDP全身骨显像及SPECT/CT融合显像对乳腺癌的早期诊断有重要价值，TNBC骨转移好发与脊柱、肋骨、胸骨，以多发性、放射性浓聚病变为主。 -
关键词:
- 三阴性乳腺癌 /
- 骨转移 /
- 骨显像 /
- 单光子发射计算机断层扫描
Abstract:Objective To investigate the characteristics of bone metastasis of triple negative breast cancer (TNBC) with 99mTc-MDP whole-body bone imaging and SPECT/CT bone fusion imaging. Methods Clinical records of 46 untreated patients with confirmed bone metastases of breast cancer by pathology or clinical follow-up were collected. All cases had received 99mTc-MDP whole-body bone imaging before treatment, and SPECT/CT bone fusion imaging was performed on sites of suspected bone metastasis or bone pain of unknown reason. Results A total of 46 patients with 204 lesions were detected. The spine was found to be the most common site for bone metastases (62, 30.39%), followed by ribs (57, 27.94%), thoracic bones (31, 15.20%), pelvic bones (28, d13.73%), craniofacial bones (15, 7.35%) and limb bones (11, 5.39%). No significant differences were found in lesion distribution in the spine, ribs, thoracic bones, pelvic bones, craniofacial bones and limb bones between TNBC and non-TNBC and their bone metastases(X2=0.591, P=0.988). The bone metastasis of TNBC accounted for 28.26% (13/46) of the whole breast cancer bone metastasis. There were 51 bone metastases in 13 cases of TNBC. Totally 90.20% (46/51) of metastatic lesion had high radioactivity concentration, 7.84% (4/51) were mixed lesions, 1.96% (1/51) had low radioactivity concentration, and most of lesions were multiple bone metastases, accounting for 84.26% (11/13). Conclusion 99m Tc-MDP bone imaging and SPECT/CT bone fusion imaging are of great value in the early diagnosis of TNBC. Bone metastasis of TNBC often occurs in the spine, ribs and thoracic bones, and it is mainly caused by multiple and strong radioactivity concentration. -
图 1 TNBC骨转移病例一
女, 53岁, 因左乳肿块2月余就诊, 无骨痛; 病理为左乳浸润性导管癌, 免疫组化ER、PR和HER-2均-; A: 全身骨显像示右侧肱骨近端、胸3椎及腰1椎异常放射性浓聚影; B: 定位CT示胸3椎体病灶处为混合性骨质破坏; C: 腰1椎处为溶骨性破坏为主.
图 2 TNBC骨转移病例二
女, 40岁, 发现左乳肿胀8月余就诊, 病理为左乳浸润性导管癌, 免疫组化ER、PR和HER-2均-; 全身骨显像示全身多处骨无规律分布异常放射性浓聚影.
图 3 非TNBC骨转移
女, 44岁, 左乳疼痛3月就诊, 无骨痛, 病理为左乳浸润性导管癌, 免疫组化ER+++、PR和HER-2-; A: 全身骨显像示胸骨柄左侧异常放射性浓聚影; B: 定位CT显示胸骨柄溶骨性骨质破坏.
表 1 乳腺癌骨转移病灶分布及转移率分布
骨转移
部位非TNBC骨转移
病灶（n）百分比（%） TNBC骨转移
病灶（n）百分比（%） 合计病灶
（n, %）胸部骨 22 14.38 9 17.35 31（15.20） 肋骨 43 28.10 14 27.45 57（27.94） 脊柱骨 47 30.72 15 29.41 62（30.39） 骨盆骨 21 13.73 7 13.73 28（13.73） 颅面骨 11 7.12 4 7.84 15（7.35 四肢骨 9 5.88 2 3.92 11（5.39） 合计 153 100 51 100 204（100） 
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