-
乳腺癌是危害女性健康的常见癌症,发病率在近几年呈增长趋势[1-2]。乳腺癌在欧美等发达国家高发,美国癌症协会最新数据显示,乳腺癌的发病率占女性恶性肿瘤的第一位[3]。中国虽属乳腺癌相对低发国家,但随着经济社会发展,女性生殖模式向西方模式的转变,乳腺癌的发病率也呈逐年上升趋势,目前已居女性恶性肿瘤的首位[4]。据国际癌症研究中心登记资料显示,2008年世界范围内女性乳腺癌新发病例增加了22.9%,新增病例数约138万,其中乳腺癌死亡病例达46万[5],分别占女性癌症致死及女性死亡总数的13.7%和1.7%。预计2030年中国将有23.4万例新发浸润性乳腺癌,新发病例及死亡病例数将分别比2008年增加31.15%和47.94%[6]。
乳腺癌是起源于乳腺上皮组织的恶性肿瘤,具有嗜骨性,大部分患者确诊时已发生骨转移但未有明显临床症状,因此骨骼是乳腺癌远处转移常见的靶器官之一,而骨转移又是乳腺癌重要的临床特征和主要致死原因。文献报道,65%~75%的乳腺癌患者最早的远处转移出现在骨骼[7]。由骨转移引发的骨相关事件极大地危害了患者的身心健康及生活质量。研究显示乳腺癌患者在发生骨转移后,其寿命明显缩短[8-9],因此乳腺癌骨转移的早期诊治对提高乳腺癌患者的生活质量、延长生存率具有重大意义。穿刺活检是诊断乳腺癌骨转移的“金标准”,但由于其为有创检查,临床上依从性较低[7]。影像学检查在乳腺癌骨转移的筛查和早期诊断中发挥着不可替代的作用,诊断乳腺癌骨转移的影像学检查方法主要有普通X射线平片、CT、MRI、全身骨显像(wholebody bone scintigraphy,WBS)、SPECT、PET/CT等,笔者对上述影像学方法在诊断乳腺癌骨转移中的优缺点进行分析、比较,综述如下。
乳腺癌骨转移的影像学诊断进展
Imaging for diagnosis of bone metastases in breast cancer
-
摘要: 乳腺癌是“嗜骨性癌肿”,极易伴发骨转移,由骨转移引发的骨相关事件可明显影响晚期乳腺癌患者的生存质量及预后转归。因此,早期、准确诊断骨转移对乳腺癌的临床分期及治疗计划制定具有决定作用,对预后改善亦有重要意义。该文综述了乳腺癌骨转移影像学诊断的研究进展,为临床早期诊断骨转移提供影像学依据。Abstract: Breast cancer exhibits high risk to metastasize to bone.Skeletal-related events caused by bone metastases can significantly affect the quality of life and outcomes of patients with breast cancer.Therefore, such events play an important role in clinical staging and treatment protocols for early and accurate diagnosis of bone metastasis in breast cancer and for improving patient prognosis.The review summarizes the research status of imaging examination of bone metastasis in breast cancer and provides evidence for early diagnosis of bone metastasis.
-
Key words:
- Breast neoplasms /
- Neoplasm metastasis /
- Imaging diagnosis
-
[1] DeSantis C, Ma J, Bryan L, et al. Breast cancer statistics, 2013[J]. CA Cancer J Clin, 2014, 64(1):52-62. DOI:10.3322/caac.21203. [2] Zhou C, He JJ, Li J, et al. A nation-wide multicenter 10-year (1999-2008) retrospective clinical study of endocrine therapy for Chinese females with breast cancer[J/OL]. PLoS One, 2014, 9(7):e100159[2017-01-12]. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0100159. DOI:10.1371/journal.pone.0100159. [3] Siegel R, Naishadham D, Jemal A. Cancer Statistics[J]. CA Cancer J Clin, 2013, 63(1):11-30. DOI:10.3322/caac.21166. [4] 贺捷, 陈万青. 2012中国肿瘤登记年报[M].北京:军事医学科学出版社, 2012:28.
He J, Chen WQ. 2012 Annual Report of Cancer Registry in China[M]. Beijing:Press of Military Medical Sciences, 2012:28.[5] Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008:GLOBOCAN 2008[J]. Int J Cancer, 2010, 127(12):2893-2917. DOI:10.1002/ijc.25516. [6] Fan L, Strasser-Weippl K, Li JJ, et al. Breast cancer in China[J].Lancet Oncol, 2014, 15(7):e279-e289. DOI:10.1016/S1470-2045(13)70567-9. [7] 张敏璐, 黄哲宙, 郑莹.中国2008年女性乳腺癌发病、死亡和患病情况的估计及预测[J].中华流行病学杂志, 2012, 33(10):1049-1051. DOI:10.3760/cma.j.issn.0254-6450.2012.10.012.
Zhang ML, Huang ZZ, Zheng Y. Estimates and prediction on incidence, mortality and prevalence of breast cancer in China, 2008[J]. Chin J Epidemiol, 2012, 33(10):1049-1051. doi: 10.3760/cma.j.issn.0254-6450.2012.10.012[8] 江泽飞, 陈佳艺, 牛晓辉, 等.乳腺癌骨转移和骨相关疾病临床诊疗专家共识(2014版)[J].中华医学杂志, 2015, 95(4):241-247. DOI:10.3760/cma.j.issn.0376-2491.2015.04.001.
Jiang ZF, Chen JY, Niu XH, et al. Expert consensus on clinical diagnosis and treatment of bone metastasis and bone related diseases in breast cancer(2014 edition)[J]. Nat Med J China, 2015, 95(4):241-247. doi: 10.3760/cma.j.issn.0376-2491.2015.04.001[9] Lipton A, Cook RJ, Major P, et al. Zoledronic acid and survival in breast cancer patients with bone metastases and elevated markers of osteoclast activity[J]. Oncologist, 2007, 12(9):1035-1043. DOI:10.1634/theoncologist.12-9-1035. [10] Hirsh V, Major PP, Lipton A, et al. Zoledronic acid and survival in patients with metastatic bone disease from lung cancer and elevated markers of osteoclast activity[J]. J Thorac Oncol, 2008, 3(3):228-236. DOI:10.1097/JTO.0b013e3181651c0e. [11] 于世英.恶性肿瘤骨转移的诊断与治疗[M].北京:中国协和医科大学出版社, 2012:25-35.
Yu SY. Diagnosis and treatment of bone metastases in malignant tumor[M]. Beijing:Peking Union Medical College Press, 2012:25-35.[12] 李林, 赵祯, 郭兴.恶性肿瘤骨转移影像学诊断[J].中华核医学杂志, 2006, 26(5):315-318. DOI:10.3760/cma.j.issn.2095-2848. 2006.05.023.
Li L, Zhao Z, Guo X. Malignant tumor imaging in the diagnosis of bone metastases[J]. Chin J Nucl Med, 2006, 26(5):315-318. doi: 10.3760/cma.j.issn.2095-2848.2006.05.023[13] 郑飞波, 刘晚霞, 丁月云, 等.转移性骨肿瘤的影像学诊断进展[J].实用医学影像杂志, 2015, 16(3):253-255. DOI:10.16106/j.cnki.cn14-1281/r.2015.03.025.
Zheng FB, Liu WX, Ding YY, et al. The progress of imaging diagnosis of metastatic bone tumor[J]. J Pract Med Imaging, 2015, 16(3):253-255. doi: 10.16106/j.cnki.cn14-1281/r.2015.03.025[14] 邱艳芳, 赵艳萍.骨转移瘤的影像学诊断研究现状[J].海南医学, 2015, 26(4):543-546. DOI:10.3969/j.issn.1003-6350.2015.04. 0196.
Qiu YF, Zhao YP. Research status of imaging diagnosis of osseous metastatic tumor[J]. Hainan Med J, 2015, 26(4):543-546. doi: 10.3969/j.issn.1003-6350.2015.04.0196[15] 齐红艳, 孙逊, 安锐.骨转移瘤影像学检查方法及相关进展[J].华中科技大学学报:医学版, 2015, 44(1):121-124. DOI:10.3870/j.issn.1672-0741.2015.01.025.
Qi HY, Sun X, An R. Bone metastases imaging examnination method and the related progress[J]. Acta Med Univ Sci Technol Huazhong, 2015, 44(1):121-124. doi: 10.3870/j.issn.1672-0741.2015.01.025[16] 王兵, 董越, 郑邵微, 等. CT能谱成像鉴别诊断肺癌成骨性转移瘤与骨岛的价值[J].中国医学影像技术, 2014, 30(10):1552-1556.
Wang B, Dong Y, Zheng SW, et al. Spectral CT imaging in differential diagnosis of osteoblastic metastases and bone islands in patients with lung cancer[J]. Chin J Med Imaging Technol, 2014, 30(10):1552-1556.[17] 胡鸿, 唐刚华, 聂大红.乳腺癌分子显像研究进展[J].国际放射医学核医学杂志, 2015, 39(1):91-95. DOI:10.3760/cma.j.issn.1673-4114. 2015.01.019.
Hu H, Tang GH, Nie DH. Progress on molecular imaging of breast cancer[J]. Int J Radiat Med Nucl Med, 2015, 39(1):91-95. doi: 10.3760/cma.j.issn.1673-4114.2015.01.019[18] 赵应满, 陈峰, 许琴, 等. MR弥散加权成像骨髓对比率与核素骨显像在脊柱转移瘤诊断中的价值[J].中国脊柱脊髓杂志, 2013, 23(9):810-814. DOI:10.3969/j.issn.1004-406X.2013.09.09.
Zhao YM, Chen F, Xu Q, et al. Comparison of MR diffusion weighted imaging bone marrow ratio and radionuclide bone imaging in the diagnosis of spine metastasis[J]. Chin J Spine Spinal Cord, 2013, 23(9):810-814. doi: 10.3969/j.issn.1004-406X.2013.09.09[19] 王警建, 崔尊社, 李娜.全身MRI和骨扫描诊断乳腺癌骨转移比较[J].湖北医药学院学报, 2011, 30(5):458-460.
Wang JJ, Cui ZS, Li N. Comparison of whole-body MRI and bone scintigraphy for diagnosing osseous metastasis in patients with breast cancer[J]. J Hubei Univ Med, 2011, 30(5):458-460.[20] Gutzeit A, Doert A, Froehlich JM, et al. Comparison of difusion-weighted whole body MRI and skeletal scintigraphy for the detection of bone metastases in patients with prostate or breast carcinoma[J]. Skeletal Radiol, 2010, 39(4):333-343. DOI:10.1007/s00256-009-0789-4. [21] 孙梦恬, 程敬亮, 张勇, 等.背景抑制全身扩散加权成像对不同类型骨转移瘤诊断价值的探讨[J].临床放射学杂志, 2013, 32(2):236-241.
Sun MT, Cheng JL, Zhang Y, et al. The diagnostic value of DWIBS in various types of bone metastasis[J]. J Clin Radiol, 2013, 32(2):236-241.[22] 汪建强, 曹春晓, 杨琦, 等. 18F-FDG SPECT/CT符合线路显像、99Tcm-MDP骨显像及MRI对脊柱转移瘤诊断效能的对比[J].中华核医学与分子影像杂志, 2015, 35(5):403-404. DOI:10.3760/cma.j.issn.2095-2848.2015.05.015.
Wang JQ, Cao CX, Yang Q, et al. The comparsion of 18F-FDG SPECT/CT, 99Tcm-MDP bone scan and MRI in the diagnosis of spinal metastases[J]. Chin J Nucl Med Mol Imaging, 2015, 35(5):403-404. doi: 10.3760/cma.j.issn.2095-2848.2015.05.015[23] Chakraborty D, Bhattacharya A, Mete UK, et al. Comparison of 18F fluoride PET/CT and 99mTc-MDP bone scan in the detection of skeletal metastases in urinary bladder carcinoma[J]. Clin Nucl Med, 2013, 38(8):616-621. DOI:10.1097/RLU.0b013e31828da5cc. [24] 董科, 傅健飞, 楼菁菁, 等.分子影像SPECT/CT对乳腺癌骨转移的临床应用价值[J].中国临床医学影像杂志, 2015, 26(7):465-468.
Dong K, Fu JF, Lou JJ, et al. The clinical application value of molecular imaging SPECT/CT for bone metastases from breast cancer[J]. J Chin Clin Med Imaging, 2015, 26(7):465-468.[25] 彭东, 徐可为, 王荣辉, 等. SPECT/CT融合显像诊断肿瘤骨转移的临床价值[J].广西医学, 2014, 36(8):1153-1155. DOI:10.11675/j.issn.0253-4304.2014.08.44.
Peng D, Xu KW, Wang RH, et al. The value of SPECT/CT fusion imaging in diagnosis of tumor bone metastases[J]. Guangxi Med J, 2014, 36(8):1153-1155. doi: 10.11675/j.issn.0253-4304.2014.08.44[26] Schirrmeister H, Guhlmann A, Kotzerke J, et al. Early detection and accurate description of extent of metastatic bone disease in breast cancer with fluoride ion and positron emission tomography[J]. J Clin Oncol, 1999, 17(8):2381-2389. DOI:10.1200/JCO.1999. 17.8.2381. [27] Ohta M, Tokuda Y, Suzuki Y, et al. Whole body PET for the evaluation of bony metastases in patients with breast cancer:comparison with 99Tcm-MDP bone scintigraphy[J]. Nucl Med Commun, 2001, 22(8):875-879. DOI:10.1097/00006231-200108000-00005. [28] 郭粹, 陈虞梅, 童林军, 等. PET/CT在乳腺癌疗效监测中的作用[J].国际医学放射学杂志, 2016, 39(2):146-150, 161. DOI:10.19300/j.2016.Z3667.
Guo C, Chen YM, Tong LJ, et al. The role of PET/CT in monitering the treatment effect of breast cancer[J]. Int J Med Radiol, 2016, 39(2):146-150, 161. doi: 10.19300/j.2016.Z3667[29] Minamimoto R, Loening A, Jamali M, et al. Prospective comparison of 99mTc-MDP scintigraphy, combined 18F-NaF and 18F-FDG PET/CT, and Whole-Body MRI in patients with breast and prostate cancer[J]. J Nucl Med, 2015, 56(12):1862-1868. DOI:10.2967/jnumed.115. 162610. [30] 辛军, 孙洪赞, 王鹏远, 等.同机PET/MR显像临床应用价值初探[J].中华核医学与分子影像杂志, 2014, 34(6):428-432. DOI:10.3760/cma.j.issn. 2095-2848. 2014.06.003.
Xin J, Sun HZ, Wang PY, et al. Preliminary clinical application of hybrid PET/MR[J]. Chin J Nucl Med Mol Imaging, 2014, 34(6):428-432. doi: 10.3760/cma.j.issn.2095-2848.2014.06.003
计量
- 文章访问数: 4396
- HTML全文浏览量: 3398
- PDF下载量: 8