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Shi J, Huang H, Xu S, Du L, Zeng X, Cao Y, Liu D, Wang X, Zhang J. XGBoost-based multiparameters from dual-energy computed tomography for the differentiation of multiple myeloma of the spine from vertebral osteolytic metastases. Eur Radiol 2023; 33:4801-4811. [PMID: 36719494 DOI: 10.1007/s00330-023-09404-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/23/2022] [Accepted: 01/02/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To evaluate the performance of extreme gradient boosting (XGBoost) combined with multiparameters from dual-energy computed tomography (mpDECT) to differentiate between multiple myeloma (MM) of the spine and vertebral osteolytic metastases (VOM). METHODS For this retrospective study, 28 patients (83 lesions) with MM of the spine and 23 patients (54 lesions) with VOM who underwent DECT were included. The mpDECT for each lesion, including normalized effective atomic number, slope of the spectral Hounsfield unit curve, CT attenuation, and virtual noncalcium (VNCa), was obtained. Boruta was used to select the key parameters, and then subsequently merged with XGBoost to yield a prediction model. The lesions were divided into the training and testing group in a 3:1 ratio. The highest performance of the univariate analysis was compared with XGBoost using the Delong test. RESULTS The mpDECT of MM was significantly lower than that of VOM (all p < 0.05). In univariate analysis, VNCa had the highest area under the receiver operating characteristic curve (AUC) in the training group (0.81) and testing group (0.87). Based on Boruta, 6 parameters of DECT were selected for XGBoost model construction. The XGBoost model achieved an excellent and stable diagnostic performance, as shown in the training group (AUC of 1.0) and testing group (AUC of 0.97), with a sensitivity of 80%, a specificity of 95%, and an accuracy of 88%, which was superior to VNCa (p < 0.05). CONCLUSIONS XGBoost combined with mpDECT yielded promising performance in differentiating between MM of the spine and VOM. KEY POINTS • The multiparameters obtained from dual-energy CT of multiple myeloma differed significantly from those of vertebral osteolytic metastases. • The virtual noncalcium offered the highest AUC in the univariate analysis to distinguish multiple myeloma from vertebral osteolytic metastases. • Extreme gradient boosting combined with multiparameters from dual-energy CT had a promising performance to distinguish multiple myeloma from vertebral osteolytic metastases.
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Affiliation(s)
- Jinfang Shi
- Department of Radiology, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Shapingba District, No.181 Hanyu Road, Chongqing, 400030, China
| | - Haiping Huang
- Department of Pathology, Chongqing University Cancer Hospital, No.181 Hanyu Road, Shapingba District, Chongqing, 400030, China
| | - Suqin Xu
- Department of Radiology, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Shapingba District, No.181 Hanyu Road, Chongqing, 400030, China
| | - Lihong Du
- Department of Radiology, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Shapingba District, No.181 Hanyu Road, Chongqing, 400030, China
| | - Xiangfei Zeng
- Department of Radiology, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Shapingba District, No.181 Hanyu Road, Chongqing, 400030, China
| | - Ying Cao
- School of Medicine, Chongqing University, No.181 Hanyu Road, Shapingba District, Chongqing, 400030, China
| | - Daihong Liu
- Department of Radiology, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Shapingba District, No.181 Hanyu Road, Chongqing, 400030, China
| | - Xiaoxia Wang
- Department of Radiology, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Shapingba District, No.181 Hanyu Road, Chongqing, 400030, China.
| | - Jiuquan Zhang
- Department of Radiology, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Shapingba District, No.181 Hanyu Road, Chongqing, 400030, China.
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2
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Qi P, Sun Y, Liu X, Wu S, Wo Y, Xu Q, Wang Q, Hu X, Zhou X. Clinicopathological, molecular and prognostic characteristics of cancer of unknown primary in China: An analysis of 1420 cases. Cancer Med 2022; 12:1177-1188. [PMID: 35822433 PMCID: PMC9883567 DOI: 10.1002/cam4.4973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/23/2022] [Accepted: 06/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cancer of unknown primary (CUP) is defined the presence of metastatic disease without an identified primary site. An unidentifiable primary site of cancer creates significant challenges for treatment selection. We aimed to describe the clinicopathological, molecular, and prognostic characteristics of Chinese CUP patients. METHODS Patients with oncologist-confirmed CUP were identified at Fudan University Shanghai Cancer Center from 2019 to 2020. Information on patient characteristics, tumor presentation, treatment, and outcome were retrospectively collected from the inpatient database and pathological consultation database for descriptive analysis. A multivariable logistic regression model was established to identify factors associated with patient prognosis. RESULTS A total of 1420 CUP patients were enrolled in this study. The baseline characteristics of the entire cohort included the following: median age (59 years old), female sex (45.8%), adenocarcinoma (47.7%), and poorly differentiated or undifferentiated tumors (92.1%). For the inpatient cohort, the most common sites where cancer spread included the lymph nodes (41.8%), bone (22.0%), liver (20.1%), and peritoneum/retroperitoneum (16.0%). A total of 77.4% and 58.2% of patients were treated with local therapy and systemic therapy, respectively. Four prognostic factors, including liver metastasis, peritoneal/retroperitoneal metastasis, number of metastatic sites (N ≥ 2), and systemic treatment, were independently associated with overall survival. Additionally, 24.8% (79/318) of patients received molecular testing, including PD-L1, human papillomavirus, genetic variation, and 90-gene expression tests for diagnosis or therapy selection. CONCLUSION Cancer of unknown primary remains a difficult cancer to diagnose and manage. Our findings improve our understanding of Chinese CUP patient characteristics, leading to improved care and outcomes for CUP patients.
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Affiliation(s)
- Peng Qi
- Department of PathologyFudan University Shanghai Cancer CenterShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina,Institute of PathologyFudan UniversityShanghaiChina,The Cancer of Unknown Primary Group of Pathology CommitteeChinese Research Hospital AssociationShanghaiChina
| | - Yifeng Sun
- The Canhelp Genomics Research CenterCanhelp Genomics Co., Ltd.HangzhouChina
| | - Xin Liu
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina,Department of Head & Neck Tumors and Neuroendocrine TumorsFudan University Shanghai Cancer CenterShanghaiChina
| | - Sheng Wu
- The Canhelp Genomics Research CenterCanhelp Genomics Co., Ltd.HangzhouChina
| | - Yixin Wo
- The Canhelp Genomics Research CenterCanhelp Genomics Co., Ltd.HangzhouChina
| | - Qinghua Xu
- The Cancer of Unknown Primary Group of Pathology CommitteeChinese Research Hospital AssociationShanghaiChina,The Canhelp Genomics Research CenterCanhelp Genomics Co., Ltd.HangzhouChina,The Institute of Machine Learning and Systems Biology, College of Electronics and Information EngineeringTongji UniversityShanghaiChina,Xuzhou Engineering Research Center of Medical Genetics and Transformation, Department of GeneticsXuzhou Medical UniversityXuzhouChina
| | - Qifeng Wang
- Department of PathologyFudan University Shanghai Cancer CenterShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina,Institute of PathologyFudan UniversityShanghaiChina,The Cancer of Unknown Primary Group of Pathology CommitteeChinese Research Hospital AssociationShanghaiChina
| | - Xichun Hu
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina,Department of Medical OncologyFudan University Shanghai Cancer CenterShanghaiChina
| | - Xiaoyan Zhou
- Department of PathologyFudan University Shanghai Cancer CenterShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina,Institute of PathologyFudan UniversityShanghaiChina,The Cancer of Unknown Primary Group of Pathology CommitteeChinese Research Hospital AssociationShanghaiChina
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3
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Sun W, Wu W, Wang Q, Yao Q, Feng Q, Wang Y, Sun Y, Liu Y, Lai Q, Zhang G, Qi P, Sun Y, Qian C, Ren W, Luo Z, Chen J, Wang H, Xu Q, Zhou X, Sun W, Lin D. Clinical validation of a 90-gene expression test for tumor tissue of origin diagnosis: a large-scale multicenter study of 1417 patients. J Transl Med 2022; 20:114. [PMID: 35255924 PMCID: PMC8900384 DOI: 10.1186/s12967-022-03318-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/23/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Once malignancy tumors were diagnosed, the determination of tissue origin and tumor type is critical for clinical management. Although the significant advance in imaging techniques and histopathological approaches, the diagnosis remains challenging in patients with metastatic and poorly differentiated or undifferentiated tumors. Gene expression profiling has been demonstrated the ability to classify multiple tumor types. The present study aims to assess the performance of a 90-gene expression test for tumor classification (i.e. the determination of tumor tissue of origin) in real clinical settings. METHODS Formalin-fixed paraffin-embedded samples and associated clinicopathologic information were collected from three cancer centers between January 2016 and January 2021. A total of 1417 specimens that met quality control criteria (RNA quality, tumor cell content ≥ 60% and so on) were analyzed by the 90-gene expression test to identify the tumor tissue of origin. The performance was evaluated by comparing the test results with histopathological diagnosis. RESULTS The 1417 samples represent 21 main tumor types classified by common tissue origins and anatomic sites. Overall, the 90-gene expression test reached an accuracy of 94.4% (1338/1417, 95% CI: 0.93 to 0.96). Among different tumor types, sensitivities were ranged from 74.2% (head&neck tumor) to 100% (adrenal carcinoma, mesothelioma, and prostate cancer). Sensitivities for the most prevalent cancers of lung, breast, colorectum, and gastroesophagus are 95.0%, 98.4%, 93.9%, and 90.6%, respectively. Moreover, specificities for all 21 tumor types are greater than 99%. CONCLUSIONS These findings showed robust performance of the 90-gene expression test for identifying the tumor tissue of origin and support the use of molecular testing as an adjunct to tumor classification, especially to those poorly differentiated or undifferentiated tumors in clinical practice.
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Affiliation(s)
- Wei Sun
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Wu Ke Song, Haidian District, Beijing, China
| | - Wei Wu
- Department of Pathology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No.1 East Road of Banshan, Hangzhou, Zhejiang, China
| | - Qifeng Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, No.270 Dong'An Road, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
- The Cancer of Unknown Primary Group of Pathology Committee, Chinese Research Hospital Association, Shanghai, China
| | - Qian Yao
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Wu Ke Song, Haidian District, Beijing, China
| | - Qin Feng
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Wu Ke Song, Haidian District, Beijing, China
| | - Yue Wang
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Wu Ke Song, Haidian District, Beijing, China
| | - Yu Sun
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Wu Ke Song, Haidian District, Beijing, China
| | - Yunying Liu
- Department of Pathology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No.1 East Road of Banshan, Hangzhou, Zhejiang, China
| | - Qian Lai
- Department of Pathology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No.1 East Road of Banshan, Hangzhou, Zhejiang, China
| | - Gu Zhang
- Department of Pathology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No.1 East Road of Banshan, Hangzhou, Zhejiang, China
| | - Peng Qi
- Department of Pathology, Fudan University Shanghai Cancer Center, No.270 Dong'An Road, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
- The Cancer of Unknown Primary Group of Pathology Committee, Chinese Research Hospital Association, Shanghai, China
| | - Yifeng Sun
- The Canhelp Genomics Research Center, Canhelp Genomics Co., Ltd., Hangzhou, China
| | - Chenhui Qian
- The Canhelp Genomics Research Center, Canhelp Genomics Co., Ltd., Hangzhou, China
| | - Wanli Ren
- The Canhelp Genomics Research Center, Canhelp Genomics Co., Ltd., Hangzhou, China
| | - Zhengzhi Luo
- The Canhelp Genomics Research Center, Canhelp Genomics Co., Ltd., Hangzhou, China
| | - Jinying Chen
- The Canhelp Genomics Research Center, Canhelp Genomics Co., Ltd., Hangzhou, China
| | - Hongying Wang
- The Canhelp Genomics Research Center, Canhelp Genomics Co., Ltd., Hangzhou, China
| | - Qinghua Xu
- The Cancer of Unknown Primary Group of Pathology Committee, Chinese Research Hospital Association, Shanghai, China
- The Canhelp Genomics Research Center, Canhelp Genomics Co., Ltd., Hangzhou, China
- The Institute of Machine Learning and Systems Biology, College of Electronics and Information Engineering, Tongji University, Shanghai, China
- Xuzhou Engineering Research Center of Medical Genetics and Transformation, Department of Genetics, Xuzhou Medical University, Xuzhou, China
| | - Xiaoyan Zhou
- Department of Pathology, Fudan University Shanghai Cancer Center, No.270 Dong'An Road, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
- Institute of Pathology, Fudan University, Shanghai, China.
- The Cancer of Unknown Primary Group of Pathology Committee, Chinese Research Hospital Association, Shanghai, China.
| | - Wenyong Sun
- Department of Pathology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No.1 East Road of Banshan, Hangzhou, Zhejiang, China.
| | - Dongmei Lin
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Wu Ke Song, Haidian District, Beijing, China.
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Michalopoulos GD, Yolcu YU, Ghaith AK, Alvi MA, Carr CM, Bydon M. Diagnostic yield, accuracy, and complication rate of CT-guided biopsy for spinal lesions: a systematic review and meta-analysis. J Neurointerv Surg 2021; 13:841-847. [PMID: 33883210 DOI: 10.1136/neurintsurg-2021-017419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND CT-guided biopsy is a commonly used diagnostic procedure for spinal lesions. This meta-analysis aims to investigate its diagnostic performance and complications, as well as factors influencing outcomes. METHODS A systematic review of the literature was performed to identify studies reporting outcomes of CT-guided biopsies for spinal lesions. Diagnostic yield (ie, the rate of procedures resulting in a specific pathological diagnosis) and diagnostic accuracy (ie, the rate of procedures resulting in the correct diagnosis) were the primary outcomes of interest. Complications following biopsy procedures were also included. RESULTS Thirty-nine studies with 3917 patients undergoing 4181 procedures were included. Diagnostic yield per procedure was 91% (95% CI 88% to 94%) among 3598 procedures. The most common reason for non-diagnostic biopsies was inadequacy of sample. No difference in diagnostic yield between different locations and between lytic, sclerotic, and mixed lesions was found. Diagnostic yield did not differ between procedures using ≤13G and ≥14G needles. Diagnostic accuracy per procedure was 86% (95% CI 82% to 89%) among 3054 procedures. Diagnostic accuracy among 2426 procedures that yielded a diagnosis was 94% (95% CI 92% to 96%). Complication rate was 1% (95% CI 0.4% to 1.9%) among 3357 procedures. Transient pain and minor hematoma were the most common complications encountered. CONCLUSION In our meta-analysis of 39 studies reporting diagnostic performance and complications of CT-guided biopsy, we found a diagnostic yield of 91% and diagnostic accuracy of 86% with a complication rate of 1%. Diagnostic yield did not differ between different locations, between lytic, sclerotic and mixed lesions, and between wide- and thin-bore needles.
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Affiliation(s)
- Giorgos D Michalopoulos
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Yagiz Ugur Yolcu
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Abdul Karim Ghaith
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammed Ali Alvi
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA .,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
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5
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Review article: the current status of CT-guided needle biopsy of the spine. Skeletal Radiol 2021; 50:281-299. [PMID: 32815040 DOI: 10.1007/s00256-020-03584-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 02/02/2023]
Abstract
CT-guided percutaneous needle biopsy of the spine is a well-described technique for determining the nature of indeterminate vertebral lesions or establishing a diagnosis of spinal infection, the high diagnostic accuracy and the safety of the procedure having been extensively documented. The purpose of the current article is to review the literature to date on CT-guided spinal biopsy. Specifically, indications for spinal biopsy, techniques for optimising yield, detail of the approaches for various spinal levels which is dependent upon both the region within the spinal column and lesion location within the vertebra (body vs. neural arch), determinants of biopsy outcome and complications are covered. It is hoped that the review will be of particular benefit to junior radiologists who are required to perform this procedure.
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Miura K, Koda M, Abe T, Kono M, Eto F, Kumagai H, Nagashima K, Fujii K, Noguchi H, Funayama T, Yamazaki M. Comparison of clinical results of decompression/fusion surgery for paralysis caused by metastatic spinal tumors of unknown versus known origin. J Rural Med 2020; 15:189-193. [PMID: 33033540 PMCID: PMC7530598 DOI: 10.2185/jrm.2020-031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/16/2020] [Indexed: 12/03/2022] Open
Abstract
Objective: Whether or not emergent decompression/fusion surgery for
paralysis caused by metastatic spinal tumors of unknown origin improves patient
neurological outcome and survival remains unclear. This study aimed to evaluate the
clinical outcomes of emergent decompression/fusion surgery for paralysis caused by spinal
tumors of unknown or not previously diagnosed origin. Patients and Methods: Data from the medical records of 11 patients with
spinal tumors of unknown origin (study group) were compared with those of 15 patients with
metastatic spinal tumors of known origin (control group). The outcome measures were
postoperative performance status, motor function evaluated with the Frankel grade, and
actual survival after surgery as compared with the estimated survival calculated using the
Tokuhashi score. χ2 analyses were performed to evaluate differences between the
groups. Results: The mean performance status was 3.6 preoperatively, which improved
to 2.9 postoperatively (P<0.05), in the unknown origin group and 3.6
preoperatively, which improved to 2.7 postoperatively (P<0.05), in the
control group. Seven patients (64%) in the unknown origin group showed improvement in
paralysis by ≥1 Frankel grade. By contrast, only 4 patients (27%) in the control group
showed improvement in paralysis. The unknown origin group tended to show better
improvement (P=0.05). All the patients in the unknown origin group
underwent adjuvant therapy after definitive diagnosis following surgery. The unknown
origin group showed a slight tendency toward better survival than toward the estimated
survival. Conclusion: Emergent decompression/fusion surgery for patients with
paralysis caused by metastatic tumors of unknown origin is potentially useful for
diagnosing tumor origin and improving neurological outcomes and performance status, and
thus for extending survival.
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Affiliation(s)
- Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Mamoru Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Fumihiko Eto
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiroshi Kumagai
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Katsuya Nagashima
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Kengo Fujii
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiroshi Noguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
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Dang L, Zhu J, Liu Z, Liu X, Jiang L, Wei F, Song C. A new approach to the treatment of spinal instability: Fusion or structural reinforcement without surgery? Med Hypotheses 2020; 144:109900. [PMID: 32562916 DOI: 10.1016/j.mehy.2020.109900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023]
Abstract
Spinal instability related low back pain is a common condition resulting from degeneration and loss of stiffness of the intervertebral joint. In order to restore stability, highly invasive surgical fusion is needed for patients who are not responding to conservative treatment. Given the risk and complications of surgery, there has been the urge for improvement with a less invasive solution. Formation of vertebral body osteophytes is a common observation that has been treated as a degenerative condition. However, recent studies have associated it with reduced motion of spinal segments. Unlike the traditional view, we regard it as adaptive reactions aiming to repair and hypothesize that the spinal segments could be stabilized or fused by intentionally induced osteophytes growth at the mobile parts of the intervertebral joint. This could be achieved by injecting Bone Morphogenetic Proteins to the anterior ends of the vertebral bodies and/or the facet joints on both sides of two consecutive vertebrae percutaneously. If verified, it would be the first time that fusion could be achieved without surgery. Hence it would provide a valuable alternative to current treatments of spinal instability. Preliminary test in favor of this hypothesis is presented and we recommend that a formal study with sufficient number of samples is needed for verification.
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Affiliation(s)
- Lei Dang
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Jinglin Zhu
- Department of Orthopedics, Beijing Shijitan Hospital, No. 10 Tieyi Rd., Yangfangdian Subdistrict, Haidian District, Beijing, PR China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Liang Jiang
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Feng Wei
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Chunli Song
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China.
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8
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Skeletal Metastases of Unknown Primary: Biological Landscape and Clinical Overview. Cancers (Basel) 2019; 11:cancers11091270. [PMID: 31470608 PMCID: PMC6770264 DOI: 10.3390/cancers11091270] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/16/2019] [Accepted: 08/27/2019] [Indexed: 02/06/2023] Open
Abstract
Skeletal metastases of unknown primary (SMUP) represent a clinical challenge in dealing with patients diagnosed with bone metastases. Management of these patients has improved significantly in the past few years. however, it is fraught with a lack of evidence. While some patients have achieved impressive gains, a more systematic and tailored treatment is required. Nevertheless, in real-life practice, the outlook at the beginning of treatment for SMUP is decidedly somber. An incomplete translational relevance of pathological and clinical data on the mortality and morbidity rate has had unsatisfactory consequences for SMUP patients and their physicians. We examined several approaches to confront the available evidence; three key points emerged. The characterization of the SMUP biological profile is essential to driving clinical decisions by integrating genetic and molecular profiles into a multi-step diagnostic work-up. Nonetheless, a pragmatic investigation plan and therapy of SMUP cannot follow a single template; it must be adapted to different pathophysiological dynamics and coordinated with efforts of a systematic algorithm and high-quality data derived from statistically powered clinical trials. The discussion in this review points out that greater efforts are required to face the unmet needs present in SMUP patients in oncology.
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9
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Schroten-Loef C, Verhoeven R, de Hingh I, van de Wouw A, van Laarhoven H, Lemmens V. Unknown primary carcinoma in the Netherlands: decrease in incidence and survival times remain poor between 2000 and 2012. Eur J Cancer 2018; 101:77-86. [DOI: 10.1016/j.ejca.2018.06.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/22/2018] [Accepted: 06/23/2018] [Indexed: 11/29/2022]
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10
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Wänman J, Grabowski P, Nyström H, Gustafsson P, Bergh A, Widmark A, Crnalic S. Metastatic spinal cord compression as the first sign of malignancy. Acta Orthop 2017; 88:457-462. [PMID: 28492105 PMCID: PMC5499341 DOI: 10.1080/17453674.2017.1319179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Metastatic spinal cord compression (MSCC) as the initial manifestation of malignancy (IMM) limits the time for diagnostic workup; most often, treatment is required before the final primary tumor diagnosis. We evaluated neurological outcome, complications, survival, and the manner of diagnosing the primary tumor in patients who were operated for MSCC as the IMM. Patients and methods - Records of 69 consecutive patients (51 men) who underwent surgery for MSCC as the IMM were reviewed. The patients had no history of cancer when they presented with pain (n = 2) and/or neurological symptoms (n = 67). Results - The primary tumor was identified in 59 patients. In 10 patients, no specific diagnosis could be established, and they were therefore defined as having cancer of unknown primary tumor (CUP). At the end of the study, 16 patients were still alive (median follow-up 2.5 years). The overall survival time was 20 months. Patients with CUP had the shortest survival (3.5 months) whereas patients with prostate cancer (6 years) and myeloma (5 years) had the longest survival. 20 of the 39 patients who were non-ambulatory preoperatively regained walking ability, and 29 of the 30 ambulatory patients preoperatively retained their walking ability 1 month postoperatively. 15 of the 69 patients suffered from a total of 20 complications within 1 month postoperatively. Interpretation - Postoperative survival with MSCC as the IMM depends on the type of primary tumor. Surgery in these patients maintains and improves ambulatory function.
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Affiliation(s)
- Johan Wänman
- Departments of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden.
| | - Pawel Grabowski
- Departments of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden.
| | - Helena Nyström
- Departments of Community Medicine and Rehabilitation (Geriatrics), Umeå University, Umeå, Sweden.
| | - Patrik Gustafsson
- Departments of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden.
| | - Anders Bergh
- Departments of Medical Biosciences (Pathology), Umeå University, Umeå, Sweden.
| | - Anders Widmark
- Departments of Radiation Sciences (Oncology), Umeå University, Umeå, Sweden
| | - Sead Crnalic
- Departments of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden.;,Correspondence:
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11
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Surgery for metastatic spine tumors in the elderly. Advanced age is not a contraindication to surgery! Spine J 2017; 17:759-767. [PMID: 26239762 DOI: 10.1016/j.spinee.2015.07.440] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/31/2015] [Accepted: 07/13/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND With recent advances in oncologic treatments, there has been an increase in patient survival rates and concurrently an increase in the number of incidence of symptomatic spinal metastases. Because elderly patients are a substantial part of the oncology population, their types of treatment as well as the possible impact their treatment will have on healthcare resources need to be further examined. PURPOSE We studied whether age has a significant influence on quality of life and survival in surgical interventions for spinal metastases. STUDY DESIGN We used data from a multicenter prospective study by the Global Spine Tumor Study Group (GSTSG). This GSTSG study involved 1,266 patients who were admitted for surgical treatments of symptomatic spinal metastases at 22 spinal centers from different countries and followed up for 2 years after surgery. PATIENT SAMPLE There were 1,266 patients recruited between March 2001 and October 2014. OUTCOME MEASURES Patient demographics were collected along with outcome measures, including European Quality of Life-5 Dimensions (EQ-5D), neurologic functions, complications, and survival rates. METHODS We realized a multicenter prospective study of 1,266 patients admitted for surgical treatment of symptomatic spinal metastases. They were divided and studied into three different age groups: <70, 70-80, and >80 years. RESULTS Despite a lack of statistical difference in American Society of Anesthesiologists (ASA) score, Frankel neurologic score, or Karnofsky functional score at presentation, patients >80 years were more likely to undergo emergency surgery and palliative procedures compared with younger patients. Postoperative complications were more common in the oldest age group (33.3% in the >80, 23.9% in the 70-80, and 17.9% for patients <70 years, p=.004). EQ-5D improved in all groups, but survival expectancy was significantly longer in patients <70 years old (p=.02). Furthermore, neurologic recovery after surgery was lower in patients >80 years old. CONCLUSIONS Surgeons should not be biased against operating elderly patients. Although survival rates and neurologic improvements in the elderly patients are lower than for younger patients, operating the elderly is compounded by the fact that they undergo more emergency and palliative procedures, despite good ASA scores and functional status. Age in itself should not be a determinant of whether to operate or not, and operations should not be avoided in the elderly when indicated.
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Takayanagi A, Hariri O, Ghanchi H, Miulli DE, Siddiqi J, Vrionis F, Asgarzadie F. Unusual Metastasis of Papillary Thyroid Cancer to the Thoracic Spine: A Case Report, New Surgical Management Proposal, and Review of the Literature. Cureus 2017; 9:e1132. [PMID: 28473950 PMCID: PMC5415380 DOI: 10.7759/cureus.1132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Papillary thyroid carcinoma (PTC) is significantly more common than follicular thyroid carcinoma (FTC), yet FTC has a much higher tendency to metastasize to the spinal column. We present a rare case of a metastatic thoracic spinal column lesion originating from the PTC. Thyroid carcinoma is known to be highly vascular with a significant tendency to hemorrhage during surgical resection. This increased tendency to hemorrhage leads to unanticipated intraoperative risks when the type of cancer is not diagnosed before surgical resection. Complications related to intraoperative bleeding can be prevented by visualization using angiography and preoperative embolization. The type of cancer is ideally diagnosed before tumor resection either by the standard metastatic workup or histologically after the biopsy. However, limitations exist in these methods, therefore, hypervascular tumors such as metastatic thyroid cancer can go undiagnosed until after surgical resection. In addition to our case report, we present a review of the literature regarding diagnostic and treatment strategies for hypervascular thyroid tumors and propose a new algorithm for the surgical management of spinal tumors with an unknown origin for optimization of preoperative and perioperative care.
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Affiliation(s)
- Ariel Takayanagi
- Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States
| | - Omid Hariri
- Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States
| | - Hammad Ghanchi
- Department of Neurosurgery, Riverside University Health System-Medical Center, Moreno Valley, California, United States
| | - Dan E Miulli
- Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States
| | - Javed Siddiqi
- Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States
| | - Frank Vrionis
- Department of Neurological Surgery, Marcus Neuroscience Institute, Boca Raton, Florida, United States
| | - Farbod Asgarzadie
- Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California, United States
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Hua WB, Wu Q, Zhang B, Yang SH, Shao ZW, Xu WH, Wang Y, Zhang XD. Initial CT-guided percutaneous biopsy of vertebral lesions: Evaluation of its diagnostic accuracy and clinical value. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s11596-015-1472-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Piccioli A, Maccauro G, Spinelli MS, Biagini R, Rossi B. Bone metastases of unknown origin: epidemiology and principles of management. J Orthop Traumatol 2015; 16:81-6. [PMID: 25726410 PMCID: PMC4441638 DOI: 10.1007/s10195-015-0344-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 02/06/2015] [Indexed: 12/01/2022] Open
Abstract
UNLABELLED Metastases are the most common malignancies involving bone; breast, prostate, lung and thyroid are the main sites of primary cancer. However, up to 30 % of patients present with bone metastases of unknown origin, where the site of the primary neoplasm cannot be identified at the time of diagnosis despite a thorough history, physical examination, appropriate laboratory testing and modern imaging technology (CT, MRI, PET). Sometimes only extensive histopathological investigations on bone specimens from biopsy can suggest the primary malignancy. At other times, a bone lesion can have such a highly undifferentiated histological appearance that a precise pathological classification on routine hematoxylin-eosin-stained section is not possible. The authors reviewed the relevant literature in an attempt to investigate the epidemiology of the histological primaries finally identified in patients with bone metastases from occult cancer, and a strategy of management and treatment of bone metastases from occult carcinomas is suggested. Lung, liver, pancreas and gastrointestinal tract are common sites for primary occult tumors. Adenocarcinoma is the main histological type, accounting for 70 % of all cases, while undifferentiated cancer accounts for 20 %. Over the past 30 years, lung cancer is the main causative occult primary for bone metastases and has a poor prognosis with an average survival of 4-8 months. Most relevant literature focuses on the need for standardized diagnostic workup, as surgery for bone lesions should be aggressive only when they are solitary and/or the occult primaries have a good prognosis; in these cases, identification of the primary tumor may be important and warrants special diagnostic efforts. However, in most cases, the primary site remains unknown, even after autopsy. Thus, orthopedic surgery has a mainly palliative role in preventing or stabilizing pathological fractures, relieving pain and facilitating the care of the patient in an attempt to provide the most appropriate therapy for the primary tumor as soon as possible. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Andrea Piccioli
- Oncologic Center, “Palazzo Baleani”, Teaching Hospital Policlinico Umberto I, Rome, Italy
| | - Giulio Maccauro
- Department of Geriatrics, Orthopedics and Neurosciences, Agostino Gemelli University Hospital, School of Medicine, Catholic University of the SacredHeart, Rome, Italy
| | - Maria Silvia Spinelli
- Department of Geriatrics, Orthopedics and Neurosciences, Agostino Gemelli University Hospital, School of Medicine, Catholic University of the SacredHeart, Rome, Italy
| | - Roberto Biagini
- Unit of Oncological Orthopaedics, Regina Elena National Cancer Institute, Rome, Italy
| | - Barbara Rossi
- Unit of Oncological Orthopaedics, Regina Elena National Cancer Institute, Rome, Italy
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15
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Daniel JW, Veiga JCE. Prognostic parameters and spinal metastases: a research study. PLoS One 2014; 9:e109579. [PMID: 25310095 PMCID: PMC4195682 DOI: 10.1371/journal.pone.0109579] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 09/03/2014] [Indexed: 12/28/2022] Open
Abstract
OBJECT To identify pre-operative prognostic parameters for survival in patients with spinal epidural neoplastic metastasis when the primary tumour is unknown. METHODS This study was a retrospective chart review of patients who underwent surgery for spinal epidural neoplastic metastases between February 1997 and January 2011. The inclusion criteria were as follows: known post-operative survival period, a Karnofsky Performance Score equal to or greater than 30 points and a post-operative neoplastic metastasis histological type. The Kaplan-Meier method was used to estimate post-operative survival, and the Log-Rank test was used for statistical inference. RESULTS A total of 52 patients who underwent 52 surgical procedures were identified. The mean age at the time of spinal surgery was 53.92 years (std. deviation, 19.09). The median survival after surgery was 70 days (95% CI 49.97-90.02), and post-operative mortality occurred within 6 months in 38 (73.07%) patients. Lung cancer, prostate cancer, myeloma and lymphoma, the 4 most common primary tumour types, affected 32 (61.53%) patients. The three identified prognostic parameters were the following: pre-operative walking incapacity (American Spinal Injury Association, A and B), present in 86.53% of the patients (p-value = 0.107); special care dependency (Karnofsky Performance Score, 10-40 points), present in 90.38% of the patients (p-value = 0.322); and vertebral epidural neoplastic metastases that were in contact with the thecal sac (Weinstein-Boriani-Biagini, sector D), present in 94.23% of the patients (p-value = 0.643). When the three secondary prognostic parameters were combined, the mean post-operative survival was 45 days; when at least one was present, the survival was 82 days (p-value = 0.175). CONCLUSIONS Walking incapacity, special care dependency and contact between the neoplastic metastases and the thecal sac can help determine the ultimate survival of this patient population and, potentially, which patients would benefit from surgery versus palliation alone. A 2- to 3-month post-operative survival period justified surgical treatment.
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Affiliation(s)
- Jefferson W. Daniel
- Division of Neurosurgery, Santa Casa de São Paulo - Faculty of Medical Sciences, São Paulo, Brazil
- * E-mail:
| | - José C. E. Veiga
- Division of Neurosurgery, Santa Casa de São Paulo - Faculty of Medical Sciences, São Paulo, Brazil
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Kushchayeva YS, Kushchayev SV, Carroll NM, Felger EA, Links TP, Teytelboym OM, Bonichon F, Preul MC, Sonntag VKH, Van Nostrand D, Burman KD, Boyle LM. Spinal metastases due to thyroid carcinoma: an analysis of 202 patients. Thyroid 2014; 24:1488-500. [PMID: 24921429 DOI: 10.1089/thy.2013.0633] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Spinal metastases (SMs) due to thyroid cancer (TC) are associated with significantly reduced quality of life. The goal of this study is to analyze the clinical manifestations, presentation, and treatments of TC SMs, and to describe specific features of SMs associated with different TC types. PATIENTS AND METHODS A retrospective analysis of 202 TC SM patients treated at Medstar Washington Hospital Center (37) and collected from the literature (165) was performed. RESULTS The mean age of patients with SMs was 56.9±14.7 years, and the female-to-male ratio was 2.1:1. Of all patients, 29% (28% of follicular thyroid cancer [FTC] and 37% of papillary thyroid cancer [PTC]) had SMs only. Twenty-nine percent of all patients and 54% of patients with single-site SMs had neither bone non-SMs nor solid organ metastases at the time of presentation. Thirty-five percent of patients had SMs as an initial presentation of TC. TC patients presenting with SMs had a lower rate of other bone and visceral involvement compared with patients whose SMs were diagnosed at the time of thyroid surgery or during follow-up (p<0.05). SMs were more often the initial manifestation of FTC (41% vs. 24%), while PTC SMs were more commonly diagnosed after TC diagnosis (76% vs. 59%; p<0.05). PTC SMs were more frequently diagnosed as synchronous (63% vs. 36% in FTC) versus FTC SMs that developed as metachronous metastases (64% vs. 37% in PTC; p<0.01). All FTC SMs developed within 82 (0-372) months and all PTC SMs within 35 (0-144) months (p<0.01). In FTC SMs as TC manifestation, solid organ metastases involvement was less common than in FTC SMs that were found after TC diagnosis (34% vs. 67%; p<0.01); multisite FTC SMs compared to solitary FTC SMs were associated with the development of other bone nonspinal metastases (82% vs. 30%; p<0.01) and solitary organ metastases (65% vs. 41%; p<0.01). These correlations were not observed in PTC SMs. FTC patients often had neural structure compression (myelopathy/radiculopathy; 72% vs. 36% in PTC), while PTC patients frequently were asymptomatic (38% vs. 5% in FTC; p<0.01). FTC SMs more commonly were (131)I-avid (p<0.01). FTC patients required surgery more frequently (72% vs. 55% in PTC; p<0.05). CONCLUSIONS Our study reveals that a significant part of TC SMs patients have solitary spinal involvement at the time of presentation and may be considered for aggressive treatment with the intention to improve quality of life and survival. FTC SMs and PTC SMs appear to have distinct presentations, behavior, and treatment modalities, and should be categorized separately for treatment and follow-up planning.
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Affiliation(s)
- Yevgeniya S Kushchayeva
- 1 Department of Internal Medicine and Surgery, Medstar Washington Hospital Center , Washington, District of Columbia
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Shimada H, Setoguchi T, Yokouchi M, Sasaki H, Ishidou Y, Kawamura I, Abematsu M, Nagano S, Komiya S. Metastatic bone tumors: Analysis of factors affecting prognosis and efficacy of CT and 18F-FDG PET-CT in identifying primary lesions. Mol Clin Oncol 2014; 2:875-881. [PMID: 25054061 DOI: 10.3892/mco.2014.326] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 05/28/2014] [Indexed: 11/05/2022] Open
Abstract
We analyzed the prognostic factors in patients with metastatic bone tumors and evaluated the efficacy of different modalities in identifying the primary lesions. A total of 145 patients with bone metastases who attended the orthopaedic outpatient clinic were included in this study. The most frequent site of bone metastases was the spine. The primary tumor type was differently distributed between patients with a known primary tumor at the first visit and those with an unknown primary lesion. The number of breast cancer cases was statistically significantly lower in the primary-unknown group. However, the number of myeloma cases was significantly higher in the primary-unknown group. Survival was significantly lower in the skeletal-related events (SREs) compared to that in the non-SREs group. Furthermore, survival was significantly worse in patients with a performance status (PS) of ≥2 compared to those with a PS of ≤1 and neurological complications occurred statistically more often in the group with worse PS (≥2). Survival rates were significantly lower in the non-spinal compared to those in the spinal metastatic group. Since the majority of breast cancer patients presented with metastasis in the spine, a breast cancer origin was a positive prognostic factor in patients with spinal metastases. Although there were no significant differences between computed tomography (CT) and 18F-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET)-CT in detecting primary lesions, CT may be the first choice due to its feasibility. In conclusion, lung cancer, SREs and worse PS were adverse prognostic factors for patients with bone metastasis. In addition, CT scans may be more useful for determining the primary lesion of a bone metastasis compared to 18F-FDG PET-CT in a timelier manner.
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Affiliation(s)
- Hirofumi Shimada
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Takao Setoguchi
- The Near-Future Locomotor Organ Medicine Creation Course (Kusunoki Kai), Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Masahiro Yokouchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Hiromi Sasaki
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Yasuhiro Ishidou
- Department of Medical Joint Materials, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Ichiro Kawamura
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Masahiko Abematsu
- The Near-Future Locomotor Organ Medicine Creation Course (Kusunoki Kai), Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Satoshi Nagano
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Setsuro Komiya
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
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Quraishi NA, Ramoutar D, Sureshkumar D, Manoharan SR, Spencer A, Arealis G, Edwards KL, Boszczyk BM. Metastatic spinal cord compression as a result of the unknown primary tumour. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:1502-7. [PMID: 24691912 DOI: 10.1007/s00586-014-3274-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 02/27/2014] [Accepted: 03/13/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Patients presenting with metastatic spinal cord compression (MSCC) due to an unknown primary tumour (UPT) present an interesting problem with limited literature available to provide guidance on management. Our aim was twofold-first, to analyse all our patients with MSCC due to a UPT pre-operatively, to review their treatment and outcome; second, make comparisons with those patients who presented with MSCC due to a known primary tumour (KPT) during the same period. METHODS All data was collected retrospectively from October 2004 to October 2009, then prospectively from October 2009 to October 2012 (8 years). We reviewed all patient records held on the database, including patient demographics, primary tumour, neurological outcome (Frankel grade), complications and survival. RESULTS During the 8-year study period, out of the 382 patients who underwent emergency surgery for MSCC, 285 patients were included in whom complete information was available. Of these, 17 patients presented with MSCC due to a UPT (6 %; mean age 61 years, 5 M, 12 F). When compared to those with a known primary, the UPT group trended to a longer duration of symptoms prior to surgery (200 vs. 156 days, p = 0.86). They had a similar neurological outcome (88 % remained the same or improved post-operatively vs. 90 % in KPT group; p = 0.42), similar complication rate (23.5 vs. 33.6 %; p = 0.32) and survival (222 vs. 251 days, p = 0.42). The primary site in the UPT group was confirmed in 10/17 (58.8 %)-all 10 were adenocarcinoma [lung (6) and GI (4)]. DISCUSSION In our series, the incidence of MSCC due to an unknown primary was 6 %. They had similar overall outcome (neurology post-operatively, complications and survival) to those patients with MSCC from a known primary. Our experience would suggest that we need to treat these patients expeditiously with thorough evaluation and urgent treatment.
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Affiliation(s)
- N A Quraishi
- Centre for Spine Studies and Surgery, West Block, D Floor, Queens Medical Centre, Derby Road, Nottingham, NG7 2UH, UK,
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Roug IK, McCartney LB. Metastatic non-Hodgkin lymphoma presenting as low back pain and radiculopathy: a case report. J Chiropr Med 2012; 11:202-6. [PMID: 23449990 PMCID: PMC3437349 DOI: 10.1016/j.jcm.2012.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 03/23/2012] [Accepted: 05/30/2012] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to describe a case of metastatic non-Hodgkin lymphoma in the lumbar spine presenting as lumbar radiculopathy. CLINICAL FEATURES A 46-year-old man sought care from his doctor of chiropractic for low back pain and right leg radiculopathy. The patient was referred for a magnetic resonance imaging (MRI) scan to evaluate for a suspected disk herniation. The MRI scan revealed 2 lumbar pathologic compression fractures with cauda equina compression, and MRI short tau inversion recovery (STIR) sagittal image of the lumbar spine showed high signal in T12 and S2. INTERVENTION AND OUTCOME The patient was referred for an immediate consultation with his medical physician with the preliminary diagnosis of metastatic bone lesions or primary bone lesions of unknown etiology. The patient underwent bone biopsy, computed tomography, and positron emission tomography scanning and was diagnosed with small cell non-Hodgkin lymphoma with osseous metastasis. The patient underwent chemo- and radiation therapy, and the lymphoma is now in remission 18 months later. CONCLUSION This case describes the presentation of metastatic non-Hodgkin lymphoma as a possible contributing cause in a patient presenting with lumbar radiculopathy, a common musculoskeletal condition. As well, this case highlights the importance of STIR sequences as part of a routine lumbar spine MRI examination. Without the STIR sequences, the additional deposits in T12 and S1 would not have been readily appreciated. Although metastatic non-Hodgkin lymphoma of the spine is rare, it should be remembered in the differential diagnoses.
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Affiliation(s)
- Inger K. Roug
- Chiropractic Radiologist, Private Practice, Woodstock, GA
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Kim YS, Han IH, Lee IS, Lee JS, Choi BK. Imaging findings of solitary spinal bony lesions and the differential diagnosis of benign and malignant lesions. J Korean Neurosurg Soc 2012; 52:126-32. [PMID: 23091671 PMCID: PMC3467370 DOI: 10.3340/jkns.2012.52.2.126] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 06/03/2012] [Accepted: 08/17/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purpose of this study was to present the MRI and CT findings of solitary spinal bone lesions (SSBLs) with the aims of aiding the differential diagnoses of malignant tumors and benign lesions, and proposing a diagnostic strategy for obscure SSBLs. METHODS The authors retrospectively reviewed the imaging findings of 19 patients with an obscure SSBL on MRI at our hospital from January 1994 to April 2011. The 19 patients were divided to benign groups and malignant groups according to final diagnosis. MRI and CT findings were evaluated and the results of additional work-up studies were conducted to achieve a differential diagnosis. RESULTS At final diagnoses, 10 (52.6%) of the 19 SSBLs were malignant tumors and 9 (47.4%) were benign lesions. The malignant tumors included 6 metastatic cancers, 3 multiple myelomas, and 1 chordoma, and the benign lesions included 4 osteomyelitis, 2 hemangiomas, 2 nonspecific chronic inflammations, and 1 giant cell tumor. No MRI characteristics examined was found to be significantly different in the benign and malignant groups. Reactive sclerotic change was observed by CT in 1 (10.0%) of the 10 malignant lesions and in 7 (77.8%) of the 9 benign lesions (p=0.005). CONCLUSION Approximately half of the obscure SSBLs were malignant tumors. CT and MRI findings in combination may aid the differential diagnosis of obscure SSBLs. In particular, sclerotic change on CT images was an important finding implying benign lesion. Finally, we suggest a possible diagnostic strategy for obscure SSBLs on MRI.
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Affiliation(s)
- Young Soo Kim
- Department of Neurosurgery, Pusan National University Hospital, Busan, Korea
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22
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Mulholland RC. The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the "surgical and research" articles in the European Spine Journal, 2009. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 19:11-8. [PMID: 20024664 DOI: 10.1007/s00586-009-1245-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Indexed: 01/17/2023]
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Benoist M. The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the "medical" articles in the European Spine Journal, 2009. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 19:3-10. [PMID: 20016917 DOI: 10.1007/s00586-009-1244-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Indexed: 01/17/2023]
Affiliation(s)
- Michel Benoist
- Service de Chirurgie Orthopédique, Département de Rhumatologie, Hôpital Beaujon, 100 Boulevard Général Leclerc, 92118 Clichy, France.
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