Abstract
Purpose
It is well known that bone metastases from breast cancer usually show osteolytic changes. We retrospectively analysed the computed tomography (CT) appearance of bone metastases to quantify the distribution of lytic, mixed and sclerotic changes in a series of patients presenting with neoplastic bone involvement from breast cancer.
Materials and methods
Between 1996 and 2005, 468 women with a diagnosis of breast cancer were referred to our department for staging or follow-up CT examinations. Staging CT examinations detected systemic metastases in 142/468 patients, 60 of which had bone involvement. Patients with a second primary tumour or bone metabolic disorders were excluded from this retrospective analysis.
Results
In patients with bone metastases, CT identified 18 with osteolytic lesions (30%), 32 with osteosclerotic lesions (53.3%) and ten with mixed lesions (16.7%). Analysis of the cases observed for the first time during the 1996–2000 period showed osteolytic lesions in 53.6% (15/28), osteosclerotic lesions in 32.1% (9/28) and mixed lesions in 14.3% (4/28). Results were 9.4% (3/32), 71.9% (23/32) and 18.7% (6/32), respectively, for the same groups in the 2001–2005 period. Histological analysis of all cases included 81.9% of infiltrative ductal carcinoma, 11.2% of infiltrative lobular carcinoma, 3.7% of ductal lobular mixed carcinoma and 3% of medullar carcinoma. We found no statistically significant correlation between histological type of breast cancer and radiological appearance of bone metastasis. A significant difference between patients treated with or without zoledronic acid was observed, with a higher prevalence of osteosclerotic lesions in the former group of patients (p<0.05).
Conclusions
We observed an increasing prevalence of osteosclerotic bone metastasis when comparing the 1996–2000 period with the 2001–2005 period. The significance of these distribution changes is not clear. However, we found a significant correlation of osteosclerotic lesions with zoledronic acid treatment. The advent of third generation bisphosphonates may have changed the CT appearance of bone metastasis from breast cancer.
Riassunto
Obiettivo
È ormai accertato che le metastasi ossee da carcinoma della mammella spesso si presentano come lesioni osteolitiche. Abbiamo analizzato retrospettivamente le immagini TC di metastasi ossee al fine di quantificare la distribuzione delle lesioni litiche, miste o addensanti in una serie di pazienti che presentavano localizzazione ossea metastatica da carcinoma della mammella.
Materiali e metodi
Tra il 1996 e il 2005, 468 pazienti con carcinoma della mammella sono stati sottoposti presso il nostro dipartimento ad una TC di stadiazione o per follow-up. La TC di stadiazione ha rilevato la presenza di metastasi sistemiche in 42/468 pazienti, 60 delle quali presentavano coinvolgimento del tessuto osseo. Pazienti con secondo tumore primitivo o pazienti con disordini metabolici ossei sono stati esclusi dallo studio.
Risultati
In pazienti con metastasi ossee, la TC ha rilevato 18 pazienti con lesioni osteolitiche (30%), 32 con lesioni osteoaddensanti (53,3%) e 10 (16,7%) con lesioni miste. L’analisi dei casi osservati per la prima volta nel periodo compreso tra il 1996 e 2000, ha mostrato lesioni osteolitiche nel 53,6% dei casi (15/28), lesioni osteoaddensanti nel 32,1% dei casi (9/28) e miste nel 14,3% dei casi (4/28) mentre i risultati erano rispettivamente del 9,4% (3/32), 71,9% (23/32) e 18,7% (6/32) per gli stessi gruppi nel periodo compreso tra il 2001 e 2005. L’analisi istologica di tutti i casi evidenziava la presenza di carcinoma duttale infiltrante nel 81,9% dei casi, di carcinoma lobulare infiltrante nel 11,2% dei casi, di carcinoma duttale lobulare misto nel 3,7% dei casi e nel 3% dei casi di carcinoma midollare. Non abbiamo rilevato una correlazione statisticamente significativa tra il tipo istologico di carcinoma della mammella e l’aspetto radiologico delle metastasi ossee. È stata osservata una differenza significativa tra i pazienti trattati con o senza acido zoledronico, con una maggiore prevalenza di lesioni osteoaddensanti nel gruppo di pazienti trattati (p<0,05).
Conclusioni
Abbiamo osservato un aumento della prevalenza delle metastasi ossee osteoaddensanti nel periodo compreso tra il 2001–2005 rispetto a quello compreso tra il 1996–2000. Il significato del cambiamento di tale distribuzione non è ancora chiaro. Tuttavia abbiamo rilevato una correlazione significativa tra le lesioni osteoaddensanti e il trattamento con acido zoledronico. L’avvento dei bifosfonati di terza generazione può aver cambiato l’aspetto TC delle metastasi ossee da carcinoma della mammella.
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Quattrocchi, C.C., Piciucchi, S., Sammarra, M. et al. Bone metastases in breast cancer: higher prevalence of osteosclerotic lesions. Radiol med 112, 1049–1059 (2007). https://doi.org/10.1007/s11547-007-0205-x
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DOI: https://doi.org/10.1007/s11547-007-0205-x