The Patients with Cancer Evaluation the Relationship Between Alkaline Phosphatase Level and Number of Lesions Detected on Bone Scintigraphy

Yıl 2014, Cilt: 4 Sayı: 3, 128 - 132, 18.01.2015

Zekiye Hasbek Serdar Gül Bülent Turgut

https://doi.org/10.16899/ctd.90093

Öz

Bone metastasis is usually associated with poor prognosis. Bone scintigraphy (BS) and serum alkaline phosphatase level are used to detect bone metastasis in malignancy. This retrospective study aimed to examine the relationship among bone scintigraphy and serum ALP level in cancer patients.

Material-Methods: BS was performed by the i.v. administration of Tc99m-MDP (Methylendiphosphonate) at a dose of about 20mCi. The reference range for ALP level was 35-105 IU/L. Scintigraphic findings of the patients were divided into four groups regarding the number of lesion as; “no metastatic lesion”, “one bone involvement”, “two bones involvement” and “more than three-bones involvement”.

Results: Fifty three of 102 patients had breast cancer; 16 patients had lung cancer; 16 patients had prostate cancer; 3 patients had ovary carcinoma, 2 patients had testicle cancer; 2 patients had endometrium cancer; 2 patients had pancreas cancer; 2 patients had gastric cancer; patients had thyroid cancer; 2 patients had rectum cancer; 1 patient had esophagus cancer and 1 patient had bladder cancer. The mean value of serum ALP level was higher in patients with bone metastasis than in patients without bone metastasis. The mean serum level of ALP was;  92.76±26 IU/L in patients with single bone involvement; 106.18±22 IU/L in patients with two bones involvement; 302.92±210 IU/L in patients with more than three-bones involvement and 70.07±17 IU/L in patients without bone metastasis.

Conclusion: In our study, while ALP levels were within normal values at patients without metastatic bone lesion and patients monitored with single metastasis, and these were above normal values at patients with 2 lesion; there was a significant increase at patients with 3 or more lesions. Consequently, it’s been thought that controlling the ALP level of patients who had bone scintigraphy for evaluation of the skeletal system metastasis increase the specificity of the bone scintigraphy.

Anahtar Kelimeler

Whole Body Bone Scintigraphy; Alkaline Phosphatase

Kanserli Hastalarda Alkalen Fosfataz Düzeyi ile Kemik Sintigrafisinde Tespit Edilen Lezyon Sayısı Arasındaki İlişkinin Değerlendirilmesi

Öz

Kemik metastazı genellikle kötü prognoz ile ilişkilidir. Kemik sintigrafisi ve serum alkalen fosfataz (ALP) düzeyi malignitelerde kemik metastazının deteksiyonu için kullanılır. Bu retrospektif çalışmadaki amacımız, kanser hastalarında kemik sintigrafisi ve serum ALP düzeyleri arasındaki ilişkiyi araştırmaktır.

Gereç-Yöntemler: Kemik sintigrafisi yaklaşık 20mCi Tc99m-MDP (Metilendifosfonat)’ın i.v. olarak verilmesiyle yapıldı. ALP seviyesi için referans aralığı 35-105 IU/L idi. Hastalar sintigrafik bulgulara göre “metastatik lezyon yok”, “tek kemik tutulumu”, “2 kemik tutulumu” ve “ 3 ve daha fazla kemik tutulumu” olarak 4 gruba ayrıldı.

Bulgular: 102 hastanın 53’ü meme kanseri, 16’sı akciğer kanseri, 16’sı prostat kanseri, 3’ü over kanseri, 2’si hasta testiskanseri, 2’si endometrium kanseri, 2’si pankreas kanseri, 2’si mide kanseri, 2’si tiroid kanseri, 2’si rektum kanseri, 1’i hasta özefagus kanseri ve 1’i mesane kanseri idi. Kemik metastazlı hastalarda ortalama serum ALP seviyesi kemik metastazı olmayanlardan yüksekti. Ortalama serum ALP seviyesi tek lezyonu olanlarda 92.76±26 IU/L; 2 lezyonu olan hastalarda 106.18±22 IU/L; 3 ve daha fazla lezyonu olan hastalarda 302.92±210 IU/L ve kemik metastazı olmayanlarda 70.07±17 IU/L idi. 

    Sonuç: Çalışmamızda metastatik kemik lezyonu olmayanlarda ve tek metastaz izlenen hastalarda ALP seviyeleri normal değerler arasında, 2 lezyon bulunanlarda normalin üst seviyesinde iken; 3 lezyon ve üzerindekilerde anlamlı yükseklik mevcuttu. Sonuç olarak, iskelet sistemi metastazının değerlendirilmesi için kemik sintigrafisi yapılan hastalarda ALP düzeyine bakılmasının, kemik sintigrafisinin spesifitesini artıracağı düşünüldü.

Anahtar Kelimeler

Tüm Vücut Kemik Sintigrafisi; Alkalen Fosfataz

Kaynakça

• Tyrrell PNM, Cassar-Pullicino VN, Lalam RK, Tins BJ. Bone Metastases 1: Spine. Chapter 26. In: Davies AM, Sundaram M, James SLJ (eds). Imaging of Bone Tumors and Tumor-Like Lesions. Springer-Verlag Berlin Heidelberg 2009:461-79.
• Damle NA, Bal C, Bandopadhyaya GP, Kumar L, Kumar P, Malhotra A, Lata S. The role of 18F-fluoride PET-CT in the detection of bone metastases in patients with breast, lung and prostate carcinoma: a comparison with FDG PET/CT and 99mTc-MDP bone scan. Jpn J Radiol. 2013;31(4):262-9.
• Choi YJ, Shin YD, Kang YH, Lee MS, Lee MK, Cho BS, Kang YJ, Park JS. The Effects of Preoperative (18)F-FDG PET/CT in Breast Cancer Patients in Comparison to the Conventional Imaging Study. J Breast Cancer. 2012;15(4):441-8.
• Ortapamuk H, Arslan A, Naldöken S, Doğrar A, Genç H, Esen M. Kemik Metastazlarının Saptanmasında Alkalen Fosfataz Kemik İzoenziminin Değeri ve Kemik Sintigrafisi İle Karşılaştırılması. T Klin Tıp Bilimleri 2001, 21:180-185.
• Meijer WG, van der Veer E, Willemse PH. Biochemical parameters of bone metabolism in bone metastases of solid tumors (review). Oncol Rep. 1998;5(1):5-21.
• Rajarubendra N, Bolton D, Lawrentschuk N. Diagnosis of Bone Metastases in Urological Malignancies—An Update. Urology. 2010;76(4):782-90.
• Bayrak SB, Ceylan E, Serter M, Karadağ F, Demir E, Çildağ O. The clinical importance of bone metabolic markers in detecting bone metastasis of lung cancer. Int J Clin Oncol. 2012;17(2):112-8
• Leeming DJ, Koizumi M, Byrjalsen I, Li B, Qvist P, Tankó LB. The relative use of eight collagenous and noncollagenous markers for diagnosis of skeletal metastases in breast, prostate, or lung cancer patients. Cancer Epidemiol Biomarkers Prev. 2006;15(1):32-8.
• Ebert W, Muley T, Herb KP, Schmidt-Gayk H. Comparison of bone scintigraphy with bone markers in the diagnosis of bone metastasis in lung carcinoma patients. Anticancer Res. 2004;24(5B):3193-201.
• Wakabayashi H, Nakajima K, Mizokami A, Namiki M, Inaki A, Taki J, Kinuya S. Bone scintigraphy as a new imaging biomarker: the relationship between bone scan index and bone metabolic markers in prostate cancer patients with bone metastases. Ann Nucl Med. 2013;27(9):802-7.
• Metler FA, Guiberteau MJ. Essentials of Nuclear Medicine Imaging. Chapter 8. Skeletal System. 6th ed. Elsevier Inc 2012;271-314.
• Erturan S, Yaman M, Aydin G, Uzel I, Müsellim B, Kaynak K. The role of whole-body bone scanning and clinical factors in detecting bone metastases in patients with non-small cell lung cancer. Chest. 2005;127(2):449-54.
• Schindler F, Lajolo PP, Pinczowski H, Fonseca FL, Barbieri A, Massonetto LH, Katto FT, Del Giglio A. Bone and total alkaline phosphatase for screening skeletal metastasis in patients with solid tumours. Eur J Cancer Care (Engl). 2008;17(2):152-6.
• Lenora J, Norrgren K, Thorsson O, Wollmer P, Obrant KJ, Ivaska KK. Bone turnover markers are correlated with total skeletal uptake of 99mTc-methylene diphosphonate (99mTc-MDP). BMC Med Phys. 2009;30;9:3.
• Taoka T, Mayr NA, Lee HJ, Yuh WT, Simonson TM, Rezai K, Berbaum KS. Factors influencing visualization of vertebral metastases on MR imaging versus bone scintigraphy. AJR Am J Roentgenol. 2001;176(6):1525-30.
• Ahn JB, Ha TK, Kwon SJ. Bone metastasis in gastric cancer patients. J Gastric Cancer. 2011;11(1):38-45.
• Min JW, Um SW, Yim JJ, Yoo CG, Han SK, Shim YS, Kim YW. The role of whole-body FDG PET/CT, Tc 99m MDP bone scintigraphy, and serum alkaline phosphatase in detecting bone metastasis in patients with newly diagnosed lung cancer. J Korean Med Sci. 2009;24(2):275-80.