Materiały źródłowe

• #1 Bone Metastasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507911/

  Apoorva Jayarangaiah; Alysia K. Kemp; Pramod Theetha Kariyanna. […] The skeleton is the third most common site of metastatic disease after lung and liver. […] This review outlines the etiology, epidemiology, clinical presentation, evaluation, and management of bone metastasis and shows the importance of a multidisciplinary approach to patient care. […] Describe how an interprofessional team can collaborate to improve the diagnosis, evaluation, pain control, and management of bone metastasis. […] Metastatic bone cancer, also known as secondary bone cancer, is the term used to describe tumors that originate in other tissues and spread (metastasize) to the bone. […] Bone metastases affect survival rates ranging from 6 to 7 months in lung cancer to several years in the breast (19 to 25 months) or prostate cancer (12 to 53 months).

• #2 Bone metastases | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/bone-metastases-1?lang=us

  Bone (skeletal) metastases are the third most frequent behind lung and liver metastases. They result in significant morbidity in patients with metastatic disease. Although the diagnosis is often straightforward, especially as in many cases there is a well-documented history of metastatic malignancy, sometimes they may mimic benign disease or other primary malignancies. […] In most cases, the diagnosis of metastatic disease is already known. If no known primary exists, or there is uncertainty regarding the diagnosis (e.g. no known metastases; unusual imaging appearances) then a bone biopsy can usually allow a definitive diagnosis. […] Laboratory investigations are of limited value, but will often demonstrate increased serum calcium and alkaline phosphatase. An increase in hydroxyproline excretion may also be present.

• #3 Bone Metastases Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/387840-overview

  Bone metastases are common in patients with advanced solid tumors. Cancers that are particularly associated with bone metastases include those of the prostate and breast (65-75% of patients) and those affecting the lung (30-40%) and kidney (20-32%). […] Early detection of skeletal metastasis is critical for accurate staging and optimal treatment. A substantial proportion of patients with advanced cancer and bone metastases develop skeletal-related events (SREs), including pathologic fracture, spinal cord compression, myelosuppression, and hypercalcemia. SREs are associated with moderate/severe pain, opioid analgesic use, reduced emotional well-being, and decreased survival. […] Imaging has an important role in the detection, diagnosis, prognostication, treatment planning, and follow-up monitoring of bone metastases. In patients with proven nonskeletal tumors, imaging is useful for screening the skeleton to assess metastatic disease and, if it is present, to determine its extent.

• #4 Bone Metastasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507911/

  A study by Hernandez et al. estimated the cumulative incidence of bone metastases in the United States as 2.9% at 30 days, 4.8% at one year, 5.6% at two years, 6.9% at five years, and 8.4% at ten years. […] The histopathology of bone metastases may vary considerably, even within the same tumor. A bone biopsy should be performed to confirm the diagnosis of metastatic disease when the patient has an unknown primary cancer or history of cancer without previous bone metastasis. […] It is pertinent to identify bone metastasis early, both for staging and prognostication as well as the implementation of prophylactic and treatment strategies which may lead to decreased morbidity and mortality. […] Bone metastases can be characterized as osteolytic, sclerotic (osteoblastic), or mixed on imaging studies.

• #5 Mechanisms, Diagnosis and Treatment of Bone Metastases

  https://www.mdpi.com/2073-4409/10/11/2944

  Bone and bone marrow are among the most frequent metastatic sites of cancer. The occurrence of bone metastasis is frequently associated with a dismal disease outcome. The prevention and therapy of bone metastases is a priority in the treatment of cancer patients. […] Current therapeutic options for patients with bone metastatic disease are limited in efficacy and associated with increased morbidity. Therefore, most current therapies are mainly palliative in nature. A better understanding of the underlying molecular pathways of the bone metastatic process is warranted to develop novel, well-tolerated and more successful treatments for a significant improvement of patients’ quality of life and disease outcome. […] For patients, the occurrence of bone metastases is an unfavorable prognostic factor. It worsens their quality of life and increases morbidity and mortality.

• #6 Bone metastasis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bone-metastasis/diagnosis-treatment/drc-20370196

  Imaging tests are used to investigate signs and symptoms that may indicate bone metastasis. Which tests you undergo depends on your specific situation. […] Tests may include: X-ray, Bone scan (bone scintigraphy), Computerized tomography (CT), Magnetic resonance imaging (MRI), Positron emission tomography (PET), Biopsy. […] Common treatments for bone metastasis include medications, radiation therapy and surgery. What treatments are best for you will depend on the specifics of your situation. […] If you’re diagnosed with bone metastasis, you’ll be referred to a cancer specialist (oncologist).

• #7 Diagnostic methods for detection of bone metastases

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5611498/

  The use of modern imaging techniques allows rapid diagnosis of bone metastases. Standard and well-known examinations, such as X-ray examination and bone scintigraphy, are characterised by adequate sensitivity. Thus, they remain important diagnostic tools. […] After ascertaining the presence of a tumour, due to imaging examinations, its histological verification is necessary.

• #8 Metastatic Bone Disease: Practice Essentials, Pathophysiology and Etiology, Epidemiology

  https://emedicine.medscape.com/article/1253331-overview

  Metastatic bone disease occurs when cancer spreads from a primary organ site to bone. The spine is the most common location of metastatic disease. Pain is an important symptom of musculoskeletal metastases, but it is nonspecific. The pain pattern can be helpful if, in addition to being activity related, it is present at rest and at night, especially in patients older than 50 years. However, this pain pattern can be present in patients with osteomyelitis and Paget disease, and in these instances, it is also nonspecific. Laboratory tests that can be used to aid in the diagnosis of metastatic bone disease include the following: Serum alkaline phosphatase: Indirect reflection of bone destruction, Serum protein electrophoresis, Urinalysis, urine protein electrophoresis, N-telopeptide of type II collagen: Marker of bone resorption but not widely used. The following radiologic studies may be used to evaluate metastatic bone disease: Radiography: For the basic assessment of the extent of a tumor and the degree of cortical erosion; can also be used for skeletal survey in patients with multiple myeloma, Computed tomography: Most sensitive imaging modality to detect bone destruction, providing the best assessment of the extent of cortical destruction, Magnetic resonance imaging: Most sensitive study for the assessment of the anatomic (intramedullary and extraosseous) extent of a lesion, Bone scanning: Very sensitive study for the detection of occult lesions and the assessment of the biologic activity of lesions, Angiography: Depicts devascularization of vascular metastases; may also be used to assess pain palliation in patients with nonresectable metastases. Biopsies should be obtained from any soft-tissue mass or, if no soft-tissue mass is present, from the most accessible bone in a mechanically safe area (eg, metaphysis vs diaphysis, acetabulum vs subtrochanteric femur). In selected patients with metastatic disease of the spine, the following diagnostic procedures may be performed: Percutaneous core needle biopsy, Open biopsy. The orthopedic surgeon has two major tasks to perform when treating patients who develop bone metastases. The first task is to biopsy a bony lesion of unknown origin, which may be found during evaluation/staging studies or as a result of a patient’s symptoms. The second is to manage the stabilization of impending or already completed pathologic fractures of bones in a critical area, such as an upper or lower extremity, the pelvis, or the spine. In one study of patients with breast carcinoma, 19% of the patients developed a pathologic fracture or hypercalcemia as the first sign that the carcinoma had spread to bone. Moreover, 10% of the patients suffered spinal cord compression, and 9% of them experienced bone marrow failure. In patients with bone metastases, it is important to develop strategies that emphasize maintenance of function, including ambulation, for the remainder of these patients lives and to intervene when possible before a fracture occurs. The morbidity and mortality associated with metastatic bone disease are greater when intervention is delayed. Patients with metastatic bone disease are generally treated with surgery or radiation therapy (RT). RT remains a primary therapeutic modality for the treatment of spinal metastasis, because nearly 95% of patients who are ambulatory at the start of radiation therapy remain so. Consequently, the possibility of regaining cord function once it is lost as a result of spinal metastasis is dismal. Therefore, such loss must be prevented by means of early diagnosis, treatment, and, if indicated, surgical intervention. The goals of surgical intervention for spinal surgery in patients with metastatic bone disease include decreasing or eliminating pain, decompressing neural elements to protect cord function, and mechanically stabilizing the spine. Anterior or posterolateral decompression, combined with anteroposterior reconstruction, may be used in the following: Diagnostic spinal surgery, Cervical spinal surgery, Thoracic and lumbar spinal surgery. For the management of long-bone metastatic disease accompanied by an impending or completed fracture, open internal fixation is usually the preferred method of treatment. Stabilization with a locked intramedullary device followed by RT to the entire bone as soon as the surgical wounds have healed is preferred. Medications used in the treatment of metastatic bone disease include the following: Monoclonal antibody antineoplastic agents (eg, denosumab), Calcium metabolism modifiers/bisphosphonates (eg, pamidronate, zoledronate, and ibandronate).

• #9

  https://www.nhs.uk/conditions/bone-cancer/diagnosis/

  If you’re experiencing bone pain, your GP will ask about your symptoms and examine the affected area, before deciding whether you need to have any further tests. […] After being examined, you may be referred for an X-ray of the affected area to look for any problems in the bones. […] If the X-ray shows abnormal areas, you’ll be referred to an orthopaedic surgeon (a specialist in bone conditions) or bone cancer specialist for a further assessment. […] X-rays can often detect damage to the bones caused by cancer, or new bone that’s growing because of cancer. […] If an X-ray suggests you may have bone cancer, you should be referred to a specialist centre with expertise in diagnosing and treating the condition. […] The most definitive way of diagnosing bone cancer is to take a sample of affected bone and send it to a laboratory for testing. This is known as a biopsy.

• #9

  https://www.nhs.uk/conditions/bone-cancer/diagnosis/

  A biopsy can determine exactly what type of bone cancer you have and what grade it is. […] If the results of the biopsy confirm or suggest bone cancer, it’s likely you’ll have further tests to assess how far the cancer has spread. […] An MRI scan is an effective way of assessing the size and spread of any cancerous tumour in or around the bones. […] A bone scan can give more detailed information about the inside of your bones than an X-ray. […] If you have a type of bone cancer called Ewing sarcoma, you may have a test called a bone marrow biopsy to check if the cancer has spread to the bone marrow (the tissue inside your bones). […] Once these tests have been completed, it should be possible to tell you what stage and grade the bone cancer is. […] Staging is a description of how far a cancer has spread and grading is a description of how quickly the cancer is likely to spread in the future.

• #10 Diagnostic methods for detection of bone metastases

  https://www.termedia.pl/Diagnostic-methods-for-detection-of-bone-metastases,3,30169,1,1.html

  Diagnostic methods for detection of bone metastases. Classic X-ray (radiography) performed in 2 orthogonal projections is most often the first test performed in the early diagnosis of metastases. On the basis of X-ray one can not only obtain information on the size and location of the bone tumour, but also assess the risk of pathological fracture. X-ray allows us to determine whether the tumour is osteolytic, osteoblastic, mixed, or if there is a change due to tumour-like change similar to Pagets disease or brown tumour. Bone scintigraphy (BS) is a method of imaging with the highest sensitivity (95%) regarding metastases, and it is the basis of screening. It allows the depiction of the entire skeleton in one medical examination. Computed tomography (CT) is a complementary imaging technique used to diagnose bone metastases. It is recommended particularly in dealing with discrepancies between the outcomes of X-ray (negative) and scintigraphy (positive). Magnetic resonance imaging (MRI) is the most sophisticated method for imaging bone tumors. This technique is based on the detection of the proton content in the cells. Cancer cells contain more water molecules than healthy bone marrow or cortical bone. Diagnostic images determine not only the degree and type of the damage to the bone but also give the opportunity to assess the soft tissues adjacent to tumour. Positron emission tomography (PET) is a modern and recognized method of detecting cancer cells. The use of a marker 18F-FDG is an effective way of indicating cells with the increased absorption of glucose, such as metastases. To take a sample of the tumour for histopathological examination the following should be performed: fine-needle aspiration biopsy (FNAB), core-needle biopsy (CNB), or open biopsy (OB), which is a surgical treatment. Each of these three techniques is an established and widely used method of diagnosing neoplastic lesions of human bone. A biopsy should be planned on the basis of physical examination and diagnostic images (X-ray, Scintigraphy, CT, MRI, PET) in such a way that the final operative treatment could be carried out from the same operative approach as for biopsy. Liquid biopsies based on genetic analysis of blood-serum and bone morrow for tumour markers. Tumour-specific mutations are used for detection of cancer cells and metastatic tumour cells. Liquid biopsies seem to be the most promising diagnostic method for the detection of bone metastases. Liquid biopsies enables the following: early detection, assessment of molecular heterogeneity of overall disease, monitoring of tumour dynamics, identification of genetic determinants for targeted therapy, evaluation of early treatment response, monitoring of minimal residual disease, and assessment of evaluation of resistance in real time.

• #11 Bone metastases | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/bone-metastases-1?lang=us

  Plain radiographs have low sensitivity (~50%) compared to bone scintigraphy (~80%, range 62-100%), CT (~85%, range 71-100%), and MRI (~90%, range 82-100%). Bone scintigraphy is the preferred first-line imaging modality as a much smaller change in abnormal-to-normal bone is needed than for detection on plain radiographs. […] Bone scans are the most sensitive routine imaging modality to try and identify both sclerotic and lytic lesions. In most cases, they demonstrate increased uptake (hot spot) although occasionally (in very aggressive purely lytic lesions) a photopenic defect (cold spot) may be visible. […] In general, treatment can be thought of as systemic (e.g. chemotherapy or hormonal therapy) or local (e.g. radiotherapy or surgery). Pain management is also often an important part of managing patients with skeletal metastases.

• #12 Bone Metastases | OncoLink

  https://www.oncolink.org/cancers/bone/bone-metastases/bone-metastases

  When cancer cells spread from one area of the body to another, it is called metastasis. When the cancer spreads (metastasizes) to your bones, it is called bone metastasis (or bone mets). […] If you have signs of bone metastasis, tests can be done to find the cause. In some cases, bone metastasis may be found before the symptoms start. X-rays, bone scans, CT scans, MRIs, and other tests may be used to diagnose bone metastases. […] Bone metastases often do not show up on plain X-rays until they are far along. X-rays are good at finding osteolytic lesions. These often look like „holes” or dark spots in the bone on the x-ray film. […] A bone scan can find bone metastases during very early stages. A small amount of radio-tracing material (like a dye) is injected into a vein. Special X-rays are taken a short time after the injection. The radiotracer will go to the site of the metastases, which will look darker and denser on the film.

• #13 Bone Metastases Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/387840-overview

  In a patient without a known malignancy, a possible diagnosis of bone metastases may be made by recognizing radiographic and other imaging findings. If bone metastases are present or suspected, further imaging or imaging-guided techniques may be required to confirm the diagnosis, to establish the extent of the disease, and to find the primary tumor. […] Bone metastases are often multiple at the time of diagnosis. […] Imaging modalities such as Technetium-99m (99mTc) bone scintiscanning (ie, radionuclide bone scanning) is widely regarded as the most cost-effective and available whole-body screening test for the assessment of bone metastases. […] Combined analysis and reporting of findings on radiographs and 99mTc bone scintiscans improve the diagnostic accuracy in detecting bone metastases and assessing the response to therapy.

• #14 Diagnostic methods for detection of bone metastases

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5611498/

  Skeletal metastases are severe complications in the course of cancer, and they indicate a worse prognosis. The use of modern imaging techniques allows rapid diagnosis of bone metastases. Properly selected diagnostic imaging (scintigraphy, positron emission tomography, whole body MRI) allows us to evaluate the number of metastatic foci in the skeletal system. […] A biopsy is the final stage of the diagnostic process, which allows us to assess cell and tissue changes. Guided biopsies are performed under the control of musculoskeletal imaging methods (CT, MRI) and they are the most promising tools in bone metastases diagnosis. […] Liquid biopsy (LB) seems to be the most promising diagnostic method for detection of bone metastases. LB based on tumour-specific DNA mutation gives an opportunity for early detection and assessment of the molecular heterogeneity of the overall disease.

• #15 Bone metastases – symptoms, diagnosis and treatment in the best clinics – MedTour

  https://medtour.help/disease/bone-metastases/

  Metastatic (secondary) bone cancer refers to tumors that originate in other tissues and spread (metastasize) to the bone. The rich arterial blood supply to the bones makes them one of the most frequent areas of metastasis localization. […] Effective pain relief for bone metastases is one of the main goals of the treatment. […] The choice of therapeutic tactics or painkillers for bone metastases depends on the location and stage of the secondary foci of the disease. A doctor will select the most effective treatment method based on the results of the diagnostic examination. […] For the diagnosis of metastatic bone cancer, the following instrumental studies are most often used: X-ray, Computed tomography, Magnetic resonance imaging. […] Bone scintigraphy continues to be the most widely used radionuclide method for the study of skeletal metastases, primarily due to the fact that it is an effective and affordable technique.

• #16 Bone metastases – symptoms, diagnosis and treatment in the best clinics – MedTour

  https://medtour.help/disease/bone-metastases/

  The main advantage of radionuclide bone scanning is that the whole skeleton can be imaged with this technique. […] Another advantage is associated with the high sensitivity of scintigraphy, which makes it possible to detect bone metastases at an early stage. […] Laboratory tests are used as an aid in the diagnosis of metastatic bone cancer. […] The main goals of therapy for metastatic bone cancer are to preserve the patients quality of life, relieve pain, minimize the risk of fractures, and achieve local tumor control when possible. […] Relief of the debilitating pain that is often present in patients with bone metastases is one important aspect of the overall treatment strategy. […] Radiotherapy helps relieve the pain of bone metastases. […] Chemotherapy helps reduce the pain of bone metastases by reducing the size of the primary tumor and controlling the spread of cancer cells.

• #17 diagnostic approach to bone metastasis of unknown origin: a systematic review | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/123441-diagnostic-approach-to-bone-metastasis-of-unknown-origin-a-systematic-review

  The overall survival rate of MBD patients is approximately 5% five years after diagnosis, and this number drops to 1% after ten years, with a median survival of 5 months post-diagnosis. Diagnostic delay has been identified as a significant factor contributing to unfavorable patient outcomes, combined with the overall burden imposed by the unknown primary lesion of MBD. […] Our systematic review reported bone scan sensitivity as high as 83.3%, although past studies have shown sensitivity up to 50%. […] Moving on to more invasive approaches, this systematic review has highlighted the importance of biopsy, with the highest detection rate of 38.2%. […] A well-planned biopsy is necessary to ensure the quality of the samples taken and to avoid contamination of surrounding tissues if the suspected lesion is indeed a primary malignancy. Detection of primary tumors potentially increases patients life expectancy; it is crucial for assessing the extent of skeletal metastasis.

• #18 Role of Nuclear Medicine in Diagnosis of Bone Metastasis – Medizinonline

  https://medizinonline.com/en/role-nuclear-medicine-diagnosis-bone-metastasis/

  Accurate staging of cancer patients is essential to initiate appropriate treatment. Bone metastasis can be diagnosed by several nuclear medicine modalities, such as bone scintigraphy, 18F-FDG PET-CT or more tumor-specific modalities, such as iodine scintigraphy for thyroid cancer. […] 18F-FDG PET/CT is the preferred modality for the detection of bone metastasis in patients with 18F-FDG avid tumors, such as breast or lung cancer. Bone scintigraphy is still the preferred modality in nuclear medicine for the detection of osteoblastic bone metastasis in patients with prostate cancer. […] Bone metastasis can be diagnosed by several modalities in nuclear medicine. Depending on the tumor type and the bone lesion characteristics (mainly lytic, sclerotic or mixed), one modality may be preferred over another.

• #19

  https://www.parkwayeast.com.sg/conditions-diseases/bone-metastasis/diagnosis-treatment

  How is bone metastasis and bone cancer diagnosed? […] Your doctor may order certain tests to check for bone cancer and determine how far the cancer has spread. These tests include: […] If you have bone pain and other bone symptoms, an X-ray is often one of the first tests you will go for. An X-ray can help reveal signs of cancer in the bones. […] A bone scan can show the entire skeleton. It can usually detect bone cancer earlier than regular X-rays. It is also used to monitor how much the cancer has spread. […] A CT scan may be necessary in checking for cancer, which is sometimes unable to be detected by a bone scan. A CT scan is also ideal for checking the size and shape of a tumour in the bone. […] Like the CT scan, MRI produces detailed cross-sectional images of the body. It is the standard test that doctors require if spinal cord compression is suspected. It is also useful in evaluating the extent of soft tissue involvement.

• #20 Bone Metastases Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/387840-overview

  MRI can also help detect metastatic lesions before changes in bone metabolism make the lesions detectable on bone scintiscans. […] Whole-body MRI is increasingly being used to identify bone metastases, with a key component being diffusion-weighted imaging (DWI), which measures the microscopic diffusion properties of water to probe tissue microstructure. […] 18F-Sodium fluoride (18F-NaF) PET/CT has been shown to provide many advantages, such as early detection, accurate information about the extent of metastatic bone lesions, and excellent image quality (4-5mm spatial resolution). […] 18F-Sodium fluoride (18F-NaF) PET/CT bone scanning allows high-resolution functional imaging of bone metastases with significantly greater sensitivity (100%) and specificity (97%) than conventional planar bone scintigraphy. […] A retrospective analysis of 31 individuals with medullary thyroid cancer (MTC) who underwent 18F-NaF PET/CT to evaluate for bone metastases reported that bone lesions were identified in 62% of patients in areas not assessed by standard MRI studies.

• #21 Diagnosing and Prognosing Bone Metastasis in Prostate Cancer: Clinical Utility of Blood Biomarkers | Anticancer Research

  https://ar.iiarjournals.org/content/43/1/283

  Conventionally, BM in PC is mainly diagnosed using 99mTc-based bone scintigraphy, and recently 68 Ga-prostate-specific membrane antibody (68 Ga-PSMA) positron emission tomography/computed tomography (PET/CT) provided a major advance in the diagnosis and staging by adding functional information reflecting metabolic changes. […] Although there were many studies on the diagnostic performance of 68 Ga-PSMA PET/CT for patients with metastatic PC, the results were inconsistent with sensitivity ranging from 56% to 98%. Whole-body magnetic resonance imaging (MRI) detects BM with a sensitivity and specificity of 91% and 96%, respectively. […] However, these imaging tests have disadvantages, such as time consumption, low specificity, high cost, and risk of radiation exposure; hence, it is important to find blood biomarkers that are simple, minimally invasive, and easy to monitor treatment efficacy.

• #22 Role of Nuclear Medicine in Diagnosis of Bone Metastasis – Medizinonline

  https://medizinonline.com/en/role-nuclear-medicine-diagnosis-bone-metastasis/

  Bone scintigraphy is the most widely available modality for the detection of bone metastasis. […] The second modality for the detection of bone metastasis is 18F- sodium fluoride positron emission tomography, combined with computed tomography (18F- NaF PET/CT). […] 18F-Fluorodeoxyglucose (FDG) PET/CT is routinely used in the staging of different malignancies, and has an important role in the detection of bone metastasis. […] All these modalities allow a diversity of methods, which can each specifically target certain types of tumors. The modality chosen to detect bone metastasis is therefore highly dependent on the tumor type. […] Bone metastasis is the most common site of metastasis in breast cancer patients. […] Prostate cancer is the most common cancer in men and bone metastasis is the first site of distant metastasis in these patients.

• #23 Imaging diagnosis of metastatic breast cancer | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00885-4

  Regarding bone metastases, every above-mentioned imaging modality evaluates different aspects of the tumour: BS estimates osseous remodelling and osteoblastic activity, CT reveals bone destruction and/or presence of sclerosis, diffusion-weighted MRI assesses tissue cellularity and PET-CT using FDG tracer evaluates increased glycolytic metabolism. […] In the next section, we review the diagnostic utility of conventional imaging (BS, CT and MRI) and next generation imaging (PET-CT, PET-MRI and WBMRI) for assessing the presence, extent and biological characteristics of bone and visceral metastases in patients with breast cancer. […] Planar BS is clinically easy to read, widely available and cost effective, and has been recommended as the primary technique to detect bone metastases in asymptomatic high-risk breast cancer women.

• #24 Role of Nuclear Medicine in Diagnosis of Bone Metastasis – Medizinonline

  https://medizinonline.com/en/role-nuclear-medicine-diagnosis-bone-metastasis/

  Lung cancer has been widely used to detect lung cancer bone metastases, but seems less sensitive than 18F-FDG PET/CT. […] The most common sites of distant metastasis in differentiated thyroid cancer (DTC) patients are lung and bone. […] Bone metastasis of renal cell carcinoma (RRC) are predominantly lytic and therefore the sensitivity of bone scans is moderate and underestimates the extent of the disease. […] Nuclear medicine plays a key role in the detection of bone metastasis. The choice of modality depends not only on the onsite availability, but also on the nature of the metastatic bone lesion.

• #25 Diagnosis of Bone Metastasis | University of Michigan Rogel Cancer Center

  https://www.rogelcancercenter.org/bone-metastasis/diagnosis

  Bone metastasis can be diagnosed using laboratory tests, radiographic examinations, CAT scans, MRI and biopsy […] Your doctor may sample your blood and/or urine to help in diagnosing bone metastasis. A high level of an enzyme called alkaline phosphatase in the blood is common among bone metastasis patients. […] A condition called hypercalcemia can also be detected through blood testing. Hypercalcemia results when there is a high level of calcium in the blood. An elevated level of calcium can alert your doctor to possible bone metastasis. […] Other procedures are usually done with lab tests to confirm a bone metastasis diagnosis. […] Lytic lesions are most often detected through radiographic examination, also known as X-rays. […] CAT scans use X-ray images to look at organs and bones in the body. […] MRI can detect changes in the bone marrow caused by tumors or infections. […] A sample of bone marrow is obtained through bone marrow aspiration or biopsy. Bone marrow samples can provide information on how much the cancer has spread and/or the stage of the metastasis.

• #26

  https://link.springer.com/article/10.1007/s00520-014-2253-9

  Tumor markers were detected in 974 patients (94.9 %), and bone metabolism markers (e.g., AP, Ca2+) were measured in 927 (90.4 %). […] The treatment of bone metastasis derived from breast cancer includes antitumor endocrine and cytotoxic agents, radiotherapy, bisphosphonates, and conservative treatments. […] According to the BASO guidelines, optimum treatment of metastatic bone disease should be aimed at identifying patients who are at risk of fracture and identifying prophylactic treatment. […] The low rate of surgery may be due to an insufficient multidisciplinary approach, including the lack of orthopedic surgeons and neurosurgeons involved in the management of bone metastasis; this should be improved. […] The management practices for bone metastasis in our survey were 95 % compliant with the BASO guidelines, with the exception of the interventional diagnostic and treatment procedures such as biopsy and surgery, which were applied to a much lesser extent in our survey than is recommended by the guidelines.

• #27 Bone metastases | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/metastatic/bone-metastases

  The types of blood tests used to help diagnose bone metastases include the following. […] A complete blood count (CBC) is done to check your general health and how well the bone marrow is working. […] Calcium and alkaline phosphatase levels in the blood may be measured. High levels may mean there is damage to the bone from bone metastases. […] Tumour markers may be measured if you have had cancer before. These tests measure the amount of a specific protein in the body. […] Imaging tests are an important part of diagnosing bone metastases. It is common for people to have one or more imaging tests when the doctor thinks cancer has spread to the bone. […] An x-ray is usually one of the first tests used to check symptoms like bone pain. An x-ray can also show breaks of the bones. […] A bone scan is used to check the whole skeleton for bone metastases, especially when there is bone pain in several places.

• #28 Bone Metastases | OncoLink

  https://www.oncolink.org/cancers/bone/bone-metastases/bone-metastases

  CT scan images can show if a cancer has spread to the bone. […] An MRI is useful when looking at nerve roots that are being pressed on by a tumor or bone pieces (called spinal cord compression). […] There are no specific blood tests that are used to diagnose bone metastasis. There are blood tests that may suggest bone lesions, but the diagnosis comes from radiology tests, symptoms, and the type of cancer. […] A bone biopsy may be done to test the lesion for cancer cells. During a biopsy, a piece or all of the lesion is removed. It is looked at under a microscope by a pathologist to see what type of cells make up the tumor. The type of biopsy used depends on where the tumor is found.

• #29 Tests for bone cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/bone-cancer/getting-diagnosed/tests-bone-cancer

  Bone cancer is different from cancer that has spread to the bones from another part of the body. This is called secondary bone cancer. […] Your GP can do some tests to help them decide if you need to see a specialist. This usually includes: a physical examination, an x-ray, blood tests. […] Your specialist usually does more tests. These might include: MRI scan, CT scan, taking a sample of bone tissue called a bone biopsy, a bone marrow biopsy, bone scan, PET-CT scan, PET-MRI scan, genetic tests on your cancer cells, other blood tests. […] A biopsy is where a surgeon takes a small sample of bone from the abnormal area. They send it to the laboratory. A specialist doctor called a pathologist looks at the sample under a microscope. It is the only way to find out for sure if you have bone cancer.

• #30 Bone Cancer Diagnosis | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/bone/diagnosis

  One key test involves examining your blood to look for a specific enzyme that is often present at high levels when bone-forming cells are very active, called alkaline phosphatase. […] To make a definite diagnosis, we need to take a biopsy (a sample) of the suspicious bone tissue. […] One of our pathologists will then examine the biopsy sample under a microscope. He or she will determine whether the tissue is cancerous and, if it is, identify the exact type of cancer. […] We use imaging technology such as x-rays, CT scans, and MRI scans both after you are first diagnosed and throughout your treatment. […] We usually begin with x-rays, which allow your doctor to see any unusual bone growths. […] We also may perform a PET scan as part of your diagnosis.

• #31 diagnostic approach to bone metastasis of unknown origin: a systematic review | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/123441-diagnostic-approach-to-bone-metastasis-of-unknown-origin-a-systematic-review

  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 patients prognosis. […] 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.

• #32 Bone Cancer Diagnosis | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/bone-cancer/bone-cancer-diagnosis.html

  If possible, the surgeon who performs the biopsy should also do the surgery to remove the cancer. […] If you are diagnosed with bone cancer, your doctor will determine the stage (or extent) of the disease. […] Staging is a way of determining how much disease is in the body and where it has spread. […] This information is important because it helps your doctor determine the best type of treatment for you and the outlook for your recovery (prognosis). […] Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads. […] One system that is used to stage all bone cancer is the American Joint Commission on Cancer (AJCC) system. […] This information about the tumor, lymph nodes, metastasis and grade is combined in a process called stage grouping.

• #33 Tests for bone cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/bone-cancer/getting-diagnosed/tests-bone-cancer

  A bone marrow biopsy is a test to check whether there are cancer cells in your bone marrow. […] A bone scan uses a large camera called a gamma camera to look at your bones. It can show up changes and abnormalities in the bones. […] A PET-CT scan combines a CT scan with a PET scan to give detailed information about the cancer. […] You might have tests on your cancer cells to look at gene abnormalities, changes to chromosomes and genes. […] The tests you have help your doctor find out if you have bone cancer and how far it has grown. This is the stage of the cancer.

• #34 Diagnosing and Prognosing Bone Metastasis in Prostate Cancer: Clinical Utility of Blood Biomarkers | Anticancer Research

  https://ar.iiarjournals.org/content/43/1/283

  Even alkaline phosphatase, the most commonly measured bone turnover marker in daily clinical practice, does not have fixed cut-off value in studies about BM, and there are few reports on the diagnosis and prognosis of other bone turnover markers, including stable cut-off values of BM. […] Recently, the role of epigenetic regulators of tumor-bone microenvironment interactions, particularly microRNA (miRNA), circulating tumor cells (CTCs), cell free DNA (cfDNA), circulating tumor DNA (ctDNA), and extracellular vesicle (EV) gets importance. […] Liquid biopsy is a simple, non-invasive method to detect cells, exosomes, nucleic acids, and proteins released or detached from tumor tissue in a liquid outside the tissue. […] The clinical usefulness of new biomarkers in the diagnosis of BM of PC needs to be examined in prospective studies.

• #35 Artificial Intelligence in Bone Metastasis Imaging: Recent Progresses from Diagnosis to Treatment – A Narrative Review – Critical Reviews™ in Oncogenesis, Volume 29, 2024, Issue 2 – Begell House Digital Library

  https://www.dl.begellhouse.com/journals/439f422d0783386a,4c1e474921184e67,486e736f408d716b.html

  The introduction of artificial intelligence (AI) represents an actual revolution in the radiological field, including bone lesion imaging. […] Several studies have already demonstrated how the integration of AI-based tools in the current clinical workflow could bring benefits to patients and to healthcare workers. AI technologies could help radiologists in early bone metastases detection, increasing the diagnostic accuracy and reducing the overdiagnosis and the number of unnecessary deeper investigations. […] In this article, we want to provide a comprehensive summary of the most promising AI applications in bone metastasis imaging and their role from diagnosis to treatment and prognosis, including the analysis of future challenges and new perspectives.

• #36 Bone metastasis classification using whole body images from prostate cancer patients based on convolutional neural networks application | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237213

  Bone metastasis is one of the most frequent diseases in prostate cancer; scintigraphy imaging is particularly important for the clinical diagnosis of bone metastasis. […] The primary imaging method in the diagnosis of metastases, that offers the highest sensitivity among all imaging methods (95%), is Bone Scintigraphy (BS). […] At present, when other imaging or examination methods are unable to provide a reliable diagnosis, BS imaging becomes the proper modality for making a final diagnosis of bone metastasis. […] To address the considerable problem of bone metastasis diagnosis, artificial intelligent methods for medical image analysis, implemented with deep learning algorithms, have been adequately investigated. […] The implementation of deep learning in medical imaging is mainly conducted by Convolutional Neural Networks (CNNs), a relatively new and powerful way to learn useful representations of images and other structured data.

• #37 Bone metastasis classification using whole body images from prostate cancer patients based on convolutional neural networks application | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237213

  The problem of classifying bone metastasis images is a complex procedure and so, effective machine learning methods need to be exploited to cope with this diagnosis task. […] The proposed CNN method exhibits outstanding performance when RGB analysis is performed for the examined images of this case study. […] The proposed CNN architecture is superior to four out of five benchmark and well-known CNN architectures (ResNet50, VGG16, Inception V3 and Xception), which have been efficiently used in medical image processing problems. […] The proposed bone scan CNN performs efficiently, despite the fact that it was trained on a small number of images. […] It is evident that medical imaging paired with machine learning techniques, specifically with CNNs, is considerably valuable for clinical diagnosis of bone metastasis.

• #38 Deep neural network based artificial intelligence assisted diagnosis of bone scintigraphy for cancer bone metastasis | Scientific Reports

  https://www.nature.com/articles/s41598-020-74135-4

  After training and validating process, our AI model indicated considerable diagnostic accuracy of 93.38% in cancer bone metastasis in total of 1223 testing cases, which is better than other models in previous reports. […] As shown in Fig. 2, in subgroups divided by cancer types, our AI model displayed considerable high accuracy measured by AUC value, which was 0.955 for prostate cancer, 0.988 for breast cancer, 0.957 for lung cancer, and 0.971 for the other cancers. […] The comparison of diagnostic performance of AI and human physicians were shown in Fig. 3. In the interpreting competition between AI model and three qualified nuclear medicine physicians, AI model cost only 11.3 s to complete the interpretation of 400 cases, while three physicians spent 116, 140, and 153 min, respectively, to accomplish the same work, which is corresponding to a time savings of 99.88%. […] Our AI model achieved considerable time-efficiency, accuracy, specificity and sensitivity in diagnosis of bone metastasis in patients with lung cancer, prostate cancer, breast cancer, and other cancers.

• #39 automatic diagnosis and analysis of bone metastasis | CMAR

  https://www.dovepress.com/deep-learning-for-the-automatic-diagnosis-and-analysis-of-bone-metasta-peer-reviewed-fulltext-article-CMAR

  Deep learning based on automatic analysis frameworks for BMs can accurately identify BMs, preliminarily realize a fully automatic analysis process from raw data to report generation. […] The sensitivity, specificity and accuracy of classification model were compared with three physicians with different clinical experience. […] The accuracy of report generation model was 78.05%. […] BSTBI can be used as a quantitative evaluation indicator to assess the effect of therapy on BMs in different patients or in the same patient before and after treatment. […] The diagnostic classification model gained an accuracy of 88.62%, which showed no statistical difference with moderately and experienced physicians, but obviously outperformed the inexperienced. […] The Dice coefficient of BMs area was 0.7387 in segmentation stage.

• #40

  https://link.springer.com/article/10.1007/s00117-020-00666-6

  Imaging plays a crucial role at different stages of the disease. The purpose of imaging of MBD includes: To detect the presence of MBD at the earliest time point possible. […] Early imaging and diagnosis can reduce morbidity and/or mortality related to MBD. […] The majority of patients with MBD present with either pain or cord compression […] The commonest sites of MBD are the spine and pelvis. […] The prevalence of MBD depends on the primary malignancythe commonest originating from breast, prostate, and lungs. […] Early and accurate diagnosis of bone metastases is therefore crucial; however, the pattern is very heterogeneous and necessitates good knowledge of the possibilities and limitations of each imaging modality. […] The multidisciplinary team should include multiple clinicians specializing in the management of skeletal oncology, including radiologists, pathologists, oncological surgeons, and oncologists.

• #41

  https://link.springer.com/article/10.1007/s00117-020-00666-6

  Diagnosis with bone biopsy should always be performed after all initial imaging assessments have been completed including MRI and in collaboration with a multidisciplinary team including discussions between histopathologists, radiologists, oncologists, and surgeons to confirm the trajectory of biopsy across anatomical planes. […] The indications for further histological verification include cases of more than one primary tumor, when a primary tumor is not verified (CUP syndrome), primary bone tumor, mono- or oligo-metastases. […] Most MBD lesions are imaged and identified after making a histological diagnosis from a confirmed primary lesion. […] An early and accurate diagnosis of bone metastases is therefore crucial; however, the pattern of bone metastases is very heterogeneous and necessitates good knowledge of the possibilities and limitations of each imaging modality.

• #42 Your role in early diagnosis & Tx of metastatic bone disease | MDedge

  https://medauth2.mdedge.com/content/your-role-early-diagnosis-tx-metastatic-bone-disease

  Most bone metastases result from carcinomas, of which up to 50% eventually spread to bone, although this process can take 10 to 15 years. The likelihood of bone metastasis depends on the primary tumor and its stage. Breast and prostate cancer account for most skeletal metastases, although these lesions are often asymptomatic. […] When a patient presents with signs and symptoms suggestive of metastatic bone disease, inquire about a history of cancer. Even if such a history is remote, it is important particularly so if the patient received chemotherapy or radiation, which can lead to secondary cancers such as leukemia or sarcoma. […] If imaging confirms a suspicious lesion and the patient has no known primary tumor, order labs, a CT scan with contrast of the chest, abdomen, and pelvis, and a bone scan, and refer the patient to an oncologist.

• #43 Bone metastases | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/metastatic/bone-metastases

  Cancer that starts in one part of the body and spreads to the bone is called bone metastases. It’s sometimes called secondary bone cancer or metastatic bone disease. Bone metastases are much more common than primary bone cancer. […] The following tests may be used to diagnose bone metastases. Many of the same tests can also help your healthcare team plan treatment and watch for changes to the cancer. […] Your health history is a record of your symptoms, risks and all the medical events and problems you have had in the past. Your doctor will ask questions about a personal history of symptoms that suggest bone metastases. […] A physical exam allows your doctor to look for any signs of bone metastases. Your doctor may feel areas that are causing pain or other symptoms and look for swelling.

• #44 Bone metastasis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bone-metastasis/symptoms-causes/syc-20370191

  Bone metastasis occurs when cancer cells spread from their original site to a bone. […] Nearly all types of cancer can spread (metastasize) to the bones. […] Bone metastasis can occur in any bone but more commonly occurs in the spine, pelvis and thigh. […] Bone metastasis may be the first sign that you have cancer, or bone metastasis may occur years after cancer treatment. […] Treatments can help reduce pain and other symptoms of bone metastases. […] When it does occur, signs and symptoms of bone metastasis include: Bone pain, Broken bones, Urinary incontinence, Bowel incontinence, Weakness in the legs or arms, High levels of calcium in the blood (hypercalcemia), which can cause nausea, vomiting, constipation and confusion. […] If you’ve been treated for cancer in the past, tell your doctor about your medical history and that you’re concerned about your signs and symptoms.

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