| Objective:The characteristic of number and distribution of abnormal lesions came from 447 breast cancer patients with bone scan abnormalities was retrospectively analyzed, to discuss how to deal with the bone scan abnormalities of breast cancer patients,the clinical significance and prognosis of breast cancer patients with bone scan abnormalities.Methods:During the period from January 2013 to July 2015, a total of 447 breast cancer patients with bone scan abnormalities were admitted to the First Hospital of Jilin University. The numbers and sites of abnormal lesions had been counted,summarized and analyzed.The clinical data were retrospectively analyzed.Results:1.The number and distribution of lesions on bone scan of 447 cases with abnormal bone scan: cases with solitary lesion were accounted for 38.5%(172/447),cases with two lesions were accounted for 23.3%(104/447),cases with three or more lesions were accounted for38.2%(171/447). The abnormal solitary lesion is the most common on lumbar, accounted for28.4%(48/172), and rib accounted for 13.37%(VS); lesions of distribution in the chest, spine respectively were accounted for 20.6% 92/447 and 23.3% 104/447.A total of 1060 lesions were accounted in all patients,of which 26.6%(282/1060) were rib lesions and 18.96%(201/1060)were lumbar lesions, 10.47%(111/1060) were knee joint lesions.2.Further examination for abnormal lesions on bone scan were combined,of which48.32% patients with CT, 14.32% patients with MRI, 8.5% patients with CT and MRI,only less than 1% of patients with PET,and 28.64% patients did not additional imaging examination.Of all patients,35 cases of patients were confirmed bone metastasis by the above means,334 patients were excluded of the diagnosis of bone metastasis, and 78 cases were suspected bone metastases.It shows that for patients with bone metastasis, 85.71% patientscombined with CT examination,which was the largest proportion, followed by the combination with CT and MRI examination, 11.43%, finally combined with PET/CT examination for 2.86%; for patients without bone metastasis, 43.71% patients combined with CT examination,which was the largest proportion, followed by combination with MRI examination, 14.07%, finally 5.69% patients combined with CT and MRI examination;for patients with suspected bone metastases, 51.28% patients combined with CT,which was the largest proportion,followed by 21.79% patients combination with MRI examination, and finally 19.23% patients combined with CT and MRI.3.The median follow-up was 28 months for patients who had not been confirmed bone metastasis,and mean follow-up was 31 months,from 1 month up to 67 months.The result of follow-up is that 5 patients were lost to follow-up, 72 patients ’ bone scan still display suspicious lesions, 1 case of patients for the development among 78 cases who were suspected of bone metastases.Among 73 cases who lost to follow-up, 32 cases combined WBS with CT, 13 cases with WBS and MRI,13 cases with WBS only, 4 cases of patients with WBS,CT and MRI,11 patients with CT only,no patient with MRI only. In addition,of 63 patients at least with WBS during follow-up,35 patients had a second consultant 7 to 12 months later,which was the most part,and followed by 20 patients,13 to 18 months later,then 5patients 3 to 6 months, the last few patients over 18 months; In 334 cases without bone metastases, 48 cases lost to follow-up and 14 cases developed to suspicious bone metastases,bone metastases still excluded with in 316 cases,4 cases developed to bone metastasis.4.Of 447 patients,35 cases were diagnosed as bone metastasis, of which less than 50 years old, not menopause, invasive carcinoma, vascular invasion and, T2 stage,positive lymph nodes patients relatively more.Bone metastases occurred in the three years in 9 cases,and 3 to5 years in 15 cases;124 lesions were involved in cases with bone metastasis,of which 21 cases with multiple lesions,and 9 cases with single lesion.Of all lesions, ribs accounted for 33.06%(41/124), sternum for 12.1%(15/124), thoracic and lumbar spine for 12.1%(15/124) and8.87%(11/124).Conclusion:1.Bone scan of breast cancer patients bone metastasis suggest too many positive resultswhen used to screen for bone metastasis.We should pay more attention on excluding patients with benign abnormal lesions on bone scan when diagnosed of bone metastases,and physicians should concretely analyze combining with clinical situation.2.Multiple lesions were common on bone scan of breast cancer patients with bone metastasis,solitary lesions on bones should be diagnosed by bone metastasis more carefully.Patients with abnormal bone scan who were not yet diagnosed bone metastases need regular follow-up.3.Of all patients with abnormal bone scan,younger than 50 years old,not-menopause,vascular invasion and, lager tumor, lymph node positive patients should be alert for occurrence of bone metastases. |
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