全身骨扫描在临床诊断肺癌骨转移中的作用

The evaluation of whole-body bone scanning in detecting bone metastases in patients with lung cancer

背景与目的:骨是肺癌最常见的转移部位之一,骨转移是肺癌患者预后较差的原因之一,较早发现骨转移,对指导临床治疗有重要意义,本研究旨在探讨99mTc-亚甲基二膦酸盐(MDP)全身骨扫描在检测肺癌患者骨转移中的作用。方法:我院2005年5月—2007年5月对400例确诊的肺癌患者进行99mTc-MDP骨显像检查,对骨转移的症状、部位、数量、病理类型、TNM分期进行回顾性分析。结果:骨痛是肺癌骨转移最常见的症状。骨转移(749处)部位以胸部骨骼为最多,共311处(41.52%),其他依次为脊柱242处(32.31%)、骨盆119处(15.89%)、四肢65处(8.68%)、颅骨12处(1.60%)。多发性骨转移占80.25%(126/157)。腺癌患者骨转移为48.09%(88/183),鳞癌33.33%(43/129),两者差异有显著性(P<0.05)。无其他远处转移者骨转移占30.74%(79/257);有其他远处转移者骨转移占54.55%(78/143),二者比较差异显著(P<0.05)。结论:肺癌骨转移以多发性病灶较为常见,骨转移部位以胸部、脊柱为多发,腺癌、有区域淋巴结转移及远处骨外组织转移者易发生骨转移。肺癌患者应常规进行全身骨扫描,这对疾病的分期、治疗方案的选择、预后的评价均有重要的意义。

Background and purpose：The skeleton is one of the most common sites of metastasis in patients with lung cancer.Bone metastases often cause poor prognosis.It is important to early detect bone metastases.Therefore,we planned a retrospective study to investigate the role of radionuclide bone scanning with 99mTc-MDP in detecting bone metastases in lung cancer patients.Methods：It was a retrospective analysis.400 patients with lung cancer diagnosed in our hospital from 2005.5 to 2007.5 were recruited.Using ^99mTc-MDP bone scanning,we analyzed the symptoms,sites,numbers,pathological types and TNM stages of bone metastases.Results：Ostealgia was the most frequent symptom in lung cancer patients with bone metastases.The sites of bone metastases were：thoracic bones（41.52%）,vertebras（32.31%）,pelvic bones（15.89%）,extremities（8.68%）,skull（1.60%）.126 patients had multiple bone metastases（80.25%）.There was a statistical significance of bone metastases in adenocarcinoma patients（48.09%）compared with in squamous cell carcinoma patients（33.33%）（P〈0.05）.In comparison with the patients only having bone metastases（30.74%）,there was a significant difference of bone metastases（54.55%）in patients with other distant metastases（P〈0.05）.Conclusions：Multiple bone metastases is more frequent in lung cancer patients.The frequent metastatic sites are thoracic bones and vertebras.The adenocarcinoma patients with local lymph node and other distant sites metastases have higher risk of bone metastases.Whole-body bone scanning should be a routine examination in lung cancer patients,it is beneficial to determine lung cancer stage,select appropriate treatment regimens and estimate prognosis.