Skip to main content
NCBI home page
British Journal of Cancer logoLink to British Journal of Cancer
. 1999 Mar;79(9-10):1443–1447. doi: 10.1038/sj.bjc.6690230

The role of tumour markers in predicting skeletal metastases in breast cancer patients with equivocal bone scintigraphy

A Nicolini 1, P Ferrari 1, A Sagripanti 1, A Carpi 1
PMCID: PMC2362708  PMID: 10188888

Abstract

Bone scintigraphy (BS) is commonly performed in the staging and postoperative monitoring of breast cancer. Nevertheless, due to low specificity it often demonstrates hot spots with equivocal interpretation, which may be misleading in the management of these patients. The aim of this study was to assess the value of a serum tumour marker panel in selecting among the patients with equivocal BS those with bone metastases. Between January 1986 and December 1995, 297 breast cancer patients were followed-up after mastectomy with serial determinations of a CEA-TPA-CA15.3 tumour marker panel, BS and liver echography. The tumour marker panel was used to select patients with equivocal BS for examination of suspicious bone areas by further imaging techniques. Up to December 1995, 158 (53%) patients showed an equivocal BS and 47 patients developed bone metastases. In the 158 patients with equivocal BS, prolonged clinical and imaging follow-up over 45 months (mean; range 12–120) was used to ascertain the presence or absence of bone metastases. In these 158 patients the negative predictive value and positive predictive value of the tumour marker panel to predict bone metastases was 97% and 75% respectively. This study shows that in breast cancer patients the CEA-TPA-CA15.3 tumour marker panel has a high value in selecting those patients with bone metastases, or at high risk of developing clinically-evident bone metastases, among the large number of subjects with equivocal BS. © 1999 Cancer Research Campaign

Keywords: breast cancer, bone metastases, tumour markers, equivocal bone scanning

Full Text

The Full Text of this article is available as a PDF (70.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Colman L. K., Porter B. A., Redmond J., 3rd, Olson D. O., Stimac G. K., Dunning D. M., Friedl K. E. Early diagnosis of spinal metastases by CT and MR studies. J Comput Assist Tomogr. 1988 May-Jun;12(3):423–426. doi: 10.1097/00004728-198805010-00013. [DOI] [PubMed] [Google Scholar]
  2. Cuschieri A. Urinary hydroxyproline excretion in early and advanced breast cancer-a sequential study. Br J Surg. 1973 Oct;60(10):800–803. doi: 10.1002/bjs.1800601012. [DOI] [PubMed] [Google Scholar]
  3. Cuschieri A. Urinary hydroxyproline in the management of breast cancer. World J Surg. 1977 May;1(3):299–302. doi: 10.1007/BF01556842. [DOI] [PubMed] [Google Scholar]
  4. Galasko C. S., Doyle F. H. The detection of skeletal metastases from mammary cancer. A regional comparison between radiology and scintigraphy. Clin Radiol. 1972 Jul;23(3):295–297. doi: 10.1016/s0009-9260(72)80051-5. [DOI] [PubMed] [Google Scholar]
  5. Gielen F., Dequeker J., Drochmans A., Wildiers J., Merlevede M. Relevance of hydroxyproline excretion to bone metastasis in breast cancer. Br J Cancer. 1976 Sep;34(3):279–285. doi: 10.1038/bjc.1976.163. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Guzzo C. E., Pachas W. N., Pinals R. S., Krant M. J. Urinary hydroxyproline excretion in patients with cancer. Cancer. 1969 Aug;24(2):382–387. doi: 10.1002/1097-0142(196908)24:2<382::aid-cncr2820240221>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  7. Held P., Breit A. Methodenvergleich von CT und MRT in der Diagnostik von Tumoren des Para- und Retropharyngealraumes und des Schläfenbeines. Bildgebung. 1994 Dec;61(4):263–271. [PubMed] [Google Scholar]
  8. Komaki R., Donegan W., Manoli R., Yeh E. L. Prognostic value of pretreatment bone scans in breast carcinoma. AJR Am J Roentgenol. 1979 Jun;132(6):877–881. doi: 10.2214/ajr.132.6.877. [DOI] [PubMed] [Google Scholar]
  9. Moulopoulos L. A., Dimopoulos M. A., Smith T. L., Weber D. M., Delasalle K. B., Libshitz H. I., Alexanian R. Prognostic significance of magnetic resonance imaging in patients with asymptomatic multiple myeloma. J Clin Oncol. 1995 Jan;13(1):251–256. doi: 10.1200/JCO.1995.13.1.251. [DOI] [PubMed] [Google Scholar]
  10. Mundy G. R., Ibbotson K. J., D'Souza S. M., Simpson E. L., Jacobs J. W., Martin T. J. The hypercalcemia of cancer. Clinical implications and pathogenic mechanisms. N Engl J Med. 1984 Jun 28;310(26):1718–1727. doi: 10.1056/NEJM198406283102607. [DOI] [PubMed] [Google Scholar]
  11. Nicolini A., Anselmi L., Michelassi C., Carpi A. Prolonged survival by 'early' salvage treatment of breast cancer patients: a retrospective 6-year study. Br J Cancer. 1997;76(8):1106–1111. doi: 10.1038/bjc.1997.515. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Nicolini A., Carpi A., Di Marco G., Giuliani L., Giordani R., Palla S. A rational postoperative follow-up with carcinoembryonic antigen, tissue polypeptide antigen, and urinary hydroxyproline in breast cancer patients. Cancer. 1989 May 15;63(10):2037–2046. doi: 10.1002/1097-0142(19890515)63:10<2037::aid-cncr2820631028>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
  13. Nicolini A., Colombini C., Luciani L., Carpi A., Giuliani L. Evaluation of serum CA15-3 determination with CEA and TPA in the post-operative follow-up of breast cancer patients. Br J Cancer. 1991 Jul;64(1):154–158. doi: 10.1038/bjc.1991.260. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Robinson LA. Radioisotope-Guided Surgical Biopsy of Suspected Osseous Metastases. Cancer Control. 1997 Nov;4(6):516–522. doi: 10.1177/107327489700400605. [DOI] [PubMed] [Google Scholar]
  15. Rosselli Del Turco M., Palli D., Cariddi A., Ciatto S., Pacini P., Distante V. Intensive diagnostic follow-up after treatment of primary breast cancer. A randomized trial. National Research Council Project on Breast Cancer follow-up. JAMA. 1994 May 25;271(20):1593–1597. doi: 10.1001/jama.271.20.1593. [DOI] [PubMed] [Google Scholar]
  16. Sanal S. M., Flickinger F. W., Caudell M. J., Sherry R. M. Detection of bone marrow involvement in breast cancer with magnetic resonance imaging. J Clin Oncol. 1994 Jul;12(7):1415–1421. doi: 10.1200/JCO.1994.12.7.1415. [DOI] [PubMed] [Google Scholar]
  17. Shreve P. D., Grossman H. B., Gross M. D., Wahl R. L. Metastatic prostate cancer: initial findings of PET with 2-deoxy-2-[F-18]fluoro-D-glucose. Radiology. 1996 Jun;199(3):751–756. doi: 10.1148/radiology.199.3.8638000. [DOI] [PubMed] [Google Scholar]
  18. Touitou Y., Proust J., Klinger E., Nakache J. P. Biological and pathological factors affecting plasma gamma-glutamyl transpeptidase and alkaline phosphatase activity in the elderly. Clin Chim Acta. 1985 Feb 28;146(1):1–10. doi: 10.1016/0009-8981(85)90118-4. [DOI] [PubMed] [Google Scholar]
  19. White D. R., Maloney J. J., 3rd, Muss H. B., Vance R. P., Barnes P., Howard V., Rhyne L., Cowan R. J. Serum alkaline phosphatase determination. Value in the staging of advanced breast cancer. JAMA. 1979 Sep 14;242(11):1147–1149. doi: 10.1001/jama.242.11.1147. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES