The value of bone marrow scintigraphy using 99mTc monoclonal antigranulocyte antibodies in complement to bone scintigraphy in detecting bone metastases from primary breast cancer

High uric acid (UA) downregulates bone alkaline phosphatase (BALP) expression through inhibition of its promoter activity

Bone metastases often occur in prostate cancers, lung cancers and breast cancers. Bone alkaline phosphatase (BALP) is one of the most commonly used serological markers for clinical evaluation of bone metabolism. Here, we reported that high concentrations of uric acid (UA) caused decrease of BALP levels and revealed that the effect of high concentrations of UA on the BALP expression was through inhibition of its promoter activity. Our results suggested physicians to think about serum UA status of patients with advanced cancer to avoid misdiagnosis when BALP was used to diagnose or assess the extent of bone metastases.

Implications of Cancer Staging Uncertainties in Radiation Therapy Decisions

Introduction . Radiation therapy (RT) for cancer is a critical medical procedure that occurs in a complex environment involving numerous health professionals, hardware, software, and equipment. Uncertainties and potential incidents can lead to inappropriate administration of radiation to patients, with sometimes catastrophic consequences such as premature death or appreciably impaired quality of life. The authors evaluate the impact of incorrectly staging (i.e., estimation of extent of cancer) breast cancer patients and resulting inappropriate treatment decisions. Methods . The authors employ analytic and simulation methods in an influence-diagram framework to estimate the probability of incorrect staging and treatment decisions. As inputs, they use a combination of literature information on the accuracy and precision of pathology and tests as well as expert judgment. Sensitivity and value-of-information analyses are conducted to identify important uncertainties. Results and conclusions . The authors find a small but nontrivial probability that breast cancer patients will be incorrectly staged and thus may be subjected to inappropriate treatment. Results are sensitive to a number of variables, and some routinely used tests for metastasis have very limited information value. This work has implications for the methods used in cancer staging, and the methods are generalizable for quantitative risk assessment of treatment errors.

Diagnosis of bone metastases: a meta-analysis comparing ¹⁸FDG PET, CT, MRI and bone scintigraphy

OBJECTIVE

To perform a meta-analysis to compare (18)FDG PET, CT, MRI and bone scintigraphy (BS) for the diagnosis of bone metastases.

METHODS

Databases including MEDLINE and EMBASE were searched for relevant original articles published from January 1995 to January 2010. Software was used to obtain pooled estimates of sensitivity, specificity and summary receiver operating characteristic curves (SROC).

RESULTS

67 articles consisting of 145 studies fulfilled all inclusion criteria. On per-patient basis, the pooled sensitivity estimates for PET, CT, MRI and BS were 89.7%, 72.9%, 90.6% and 86.0% respectively. PET=MRI>BS>CT. ("="indicated no significant difference, P > 0.05; ">" indicated significantly higher, P < 0.05). The pooled specificity estimates for PET, CT, MRI and BS were 96.8%, 94.8%, 95.4% and 81.4% respectively. PET = CT = MRI>BS. On per-lesion basis, the pooled sensitivity estimates for PET, CT, MRI and BS were 86.9%, 77.1%, 90.4% and 75.1% respectively. PET = MRI>BS>CT. The pooled specificity estimates for PET, CT, MRI and BS were 97.0%, 83.2%, 96.0% and 93.6% respectively. PET>MRI>BS>CT.

CONCLUSION

PET and MRI were found to be comparable and both significantly more accurate than CT and BS for the diagnosis of bone metastases.

A meta-analysis of 18FDG-PET, MRI and bone scintigraphy for diagnosis of bone metastases in patients with breast cancer

OBJECTIVE

To perform a meta-analysis comparing the diagnostic value of (18)FDG-PET, MRI, and bone scintigraphy (BS) in detecting bone metastases in patients with breast cancer.

MATERIALS AND METHODS

MEDLINE, EMBASE, Scopus, ScienceDirect, SpringerLink, Web of Knowledge, EBSCO, and the Cochrane Database of Systematic Review databases were searched for relevant original articles published from January 1995 to January 2010. Inclusion criteria was as follows: (18)FDG-PET, MRI or (99m)Tc-MDP BS was performed to detect bone metastases (the number of published CT studies was inadequate for meta-analysis and therefore could not be included in this study); sufficient data were presented to construct a 2 × 2 contingency table; histopathological analysis and/or close clinical and imaging follow-up for at least 6 months were used as the reference standard. Two reviewers independently assessed potentially eligible studies and extracted relevant data. A software program called "META-DiSc" was used to obtain the pooled estimates for sensitivity, specificity, diagnostic odds ratio (DOR), summary receiver operating characteristic (SROC) curves, and the *Q index for each modality.

RESULTS

Thirteen articles consisting of 23 studies fulfilled all inclusion criteria. On a per-patient basis, the pooled sensitivity estimates for MRI (97.1%) were significantly higher than those for PET (83.3%) and BS (87.0%; P <0.05). There was no significant difference between PET and BS (P <0.05). The pooled specificity estimates for PET (94.5%) and MRI (97.0%) were both significantly higher than those for BS (88.1%; P <0.05). There was no significant difference between PET and MRI (P >0.05). The pooled DOR estimates for MRI (298.5) were significantly higher than those for PET (82.1%) and BS (49.3%; P <0.05). There was no significant difference between PET and BS (P >0.05). The SROC curve for MRI showed better diagnostic accuracy than those for PET and BS. The SROC curve for PET was better than that for BS. The*Q index for MRI (0.935), PET (0.922), and BS (0.872) showed no significant difference (P ≥0.05). On a per-lesion basis, the pooled sensitivity estimates for BS (87.8%) were significantly higher than those for PET (52.7%; P <0.05). The pooled specificity estimates for PET (99.6%) were significantly higher than those for BS (96.1%; P <0.05).The pooled DOR estimates for PET (283.3) were significantly higher than those for BS (66.8%; P <0.05). The SROC curve for PET showed better diagnostic accuracy than that for BS. The*Q index for PET (0.941) was significantly higher than that for BS (0.893; P <0.05).

CONCLUSION

Magnetic resonance imaging was found to be better than (18)FDG-PET and BS for diagnosis of bone metastases in patients with breast cancer on a per-patient basis. On a per-lesion basis, (18)FDG-PET had lower sensitivity, higher specificity, a higher DOR, and a higher *Q index than BS.