^(99m)Tc-亚甲基二膦酸盐骨显像评价乳腺癌骨转移的特征

Evaluation of characteristic of breast cancer bone metastasis with ^(99m)Tc-MDP bone imaging

目的探讨乳腺癌骨转移^(99m)Tc-亚甲基二膦酸盐(MDP)全身骨显像及SPECT/CT融合显像的特征。方法收集我院2016年1月~2017年5月经病理组织学及免疫组化确诊的乳腺癌资料。初诊时即发现骨转移的患者46例,所有患者均在治疗前行^(99m)Tc-MDP全身骨显像,疑骨转移或不明原因骨痛部位行SPECT/CT融合显像。分析三阴乳腺癌(TNB)与非TNBC骨转移病灶分布情况,总结乳腺癌骨转移^(99m)Tc-MDP全身骨显像及SPECT/CT融合显像的特点。结果共检出46例患者204处病变,脊柱62处(30.39%),是转移最常见部位,其次肋骨57处(27.94%)、胸部骨31处(15.20%)、骨盆骨28处(13.73%)、颅面骨15处(7.35%)、四肢骨11处(5.39%)。三阴乳腺癌与非三阴乳腺癌、TNBC与非TNBC骨转移在脊柱、肋骨、胸部骨、骨盆骨、颅面骨及四肢骨的病灶分布比例差异无统计学意义(χ2=0.591,P=0.988)。三阴乳腺癌骨转移占整个乳腺癌骨转移的28.26%(13/46)。13例TNBC骨转移共51处病灶,放射性浓聚占90.20%(46/51),混合型病灶占7.84%(4/51),放射性稀疏病变1.96%(1/51),且主要为多发骨转移病变,占84.62%(11/13)。结论 ^(99m)Tc-MDP全身骨显像及SPECT/CT融合显像对乳腺癌的早期诊断有重要价值,TNBC骨转移好发与脊柱、肋骨、胸骨,以多发性、放射性浓聚病变为主。

Objective To investigate the characteristics of bone metastasis of triple negative breast cancer（TNBC） with ^99mTcMDP whole-body bone imaging and SPECT/CT bone fusion imaging. Methods Clinical records of 46 untreated patients with confirmed bone metastases of breast cancer by pathology or clinical follow-up were collected. All cases had received ^99mTcMDP whole-body bone imaging before treatment, and SPECT/CT bone fusion imaging was performed on sites of suspected bone metastasis or bone pain of unknown reason. Results A total of 46 patients with 204 lesions were detected. The spine was found to be the most common site for bone metastases（62, 30.39%）, followed by ribs（57, 27.94%）, thoracic bones（31, 15.20%）,pelvic bones（28, d13.73%）, craniofacial bones（15, 7.35%） and limb bones（11, 5.39%）. No significant differences were found in lesion distribution in the spine, ribs, thoracic bones, pelvic bones, craniofacial bones and limb bones between TNBC and nonTNBC and their bone metastases（χ^2=0.591,P=0.988）. The bone metastasis of TNBC accounted for 28.26%（13/46） of the whole breast cancer bone metastasis. There were 51 bone metastases in 13 cases of TNBC. Totally 90.20%（46/51） of metastatic lesion had high radioactivity concentration, 7.84%（4/51） were mixed lesions, 1.96%（1/51） had low radioactivity concentration, and most of lesions were multiple bone metastases, accounting for 84.26%（11/13）. Conclusion ^99mTc-MDP bone imaging and SPECT/CT bone fusion imaging are of great value in the early diagnosis of TNBC. Bone metastasis of TNBC often occurs in the spine, ribs and thoracic bones, and it is mainly caused by multiple and strong radioactivity concentration.