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KMID : 0613319970030030166
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Journal of the Korean Bone and Joint Tumor Soceity
1997 Volume.3 No. 3 p.166 ~ p.171
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Early Diagnosis of Metastatic Bone Tumor Using Bone Marrow Scan-The Diagnostic Utilities of Bone Marrow Scan-
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Lee Sang-Hoon
Kim Han-Soo
Chung June-Key
Kim Hyung-Gook
Kim Jin-Sam
Lee Han-Koo
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Abstract
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Metastatic bone tumor is the most common malignancy involving the skeletal system. Bone scan[BS] is a sensitive method for detecting skeletal metastasis but has a major limitation in specificity. We used bone marrow scan[BMS] to evaluate its efficiency in detecting skeletal metastasis and to improve the specificity of abnormal BS findings in the patients with malignant tumors. Bone marrow scan[BMS] using Tc-99m labeled antigranulocyte antibody was performed in 75 patients with malignancy who demonstrated abnormal BS findings. Owing to an undetermined final diagnosis, we excluded 6 patients from consideration and 69 patients were included in this study. The final diagnosis was based on radiologic examinations including simple radiograph, CT, MRI, follow up bone scan, needle bone biopsy or clinical follow up. The final diagnosis was skeletal metastasis in 34 patients and no metastasis in 35. BMS was unhelpful in 2 patients with metastasis and 4 patients without metastasis due to overlying liver activity or previous irradiation in the region of interest. Of the 32 patients with metastasis, 31 showed bone marrow defects concordant with BS lesions, while of the 31 patients without metastasis, 24 showed normal BMS. Five of the 7 false positive cases were associated with a degenerative lumbar spine, while the remainders were due to a traumatic lesion and tuberculosis of the rib. The sensitivity of the BMS in determining skeletal metastasis in this study was 97%, and the specificity was 77%. These results suggest that in patients with an equivocal BS who have a malignancy, the likelihood of skeletal metastasis is very low when the BMS is normal. When a concordant marrow defect is demonstrated in BMS, although suspicion of metastasis can be increased, further investigations with radiologic examinations to exclude benign disease is warranted. BMS seems to be useful as a complementary study to BS in early diagnosis of metastatic
bone tumor.
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KEYWORD
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Metastatic bone tumor, Bone marrow scan
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