Diagnosis of a previously unidentified primary site in patients with spinal metastasis: diagnostic usefulness of laboratory analysis, CT scanning and CT-guided biopsy
Diagnosis of a previously unidentified primary site in patients with spinal metastasis: diagnostic usefulness of laboratory analysis, CT scanning and CT-guided biopsy
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DOI：
10.1007/s00586-009-1061-2
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发表时间：
2009-10-01
影响因子：
2.8
通讯作者：
Takagishi, Kenji
中科院分区：
文献类型：
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作者：
Iizuka, Yoichi;Iizuka, Haku;Takagishi, Kenji
当脊柱转移患者的原发部位未知时，定位肿瘤起源部位可能存在问题。大多数关于不明来源转移的报道并不局限于脊柱。本研究的目的是评估实验室分析、胸部、腹部和骨盆CT以及CT引导活检在不明来源脊柱转移（SMUO）患者中的作用。回顾性分析27例smo患者的临床病史。2002年至2007年间，我院共收治了43例smo患者。在43例患者中，27例接受了所有3项检查（实验室分析包括M蛋白和肿瘤标志物，胸部、腹部和骨盆CT和CT引导活检）纳入本研究。我们回顾性地评估了这3项检查在27例患者中的诊断价值。27例患者中，26例获得最终诊断。骨髓瘤是最常见的恶性肿瘤，其次是肺癌。7例骨髓瘤患者M蛋白均为阳性，其他恶性肿瘤患者M蛋白均为阴性。17例实体瘤患者中16例肿瘤标志物水平升高，3例淋巴瘤患者中肿瘤标志物水平升高。CA15-3高架27例患者中4例,CA19-9在27日的5个病人,CA125在27例2,东航27 6例,鳞状细胞癌2 27例,分析了无7患者27日,法新社27例1,PIVKA-II 27例1,TPA 27 6例,IAP 3 12例,甲状腺球蛋白在2 27岁患者,24例sIL-2R 3, PSA在5 17岁男性病人。骨髓瘤、淋巴瘤和前列腺癌具有高敏感性和特异性的标志物（M蛋白、sIL-2R和PSA）。胸部、腹部及CT扫描共检出11个原发肿瘤部位（肺6个、前列腺1个、肾1个、甲状腺1个、肝脏1个、胰腺1个），占40.7%。27例患者中有12例（44.4%）通过活检确定最终诊断（5例骨髓瘤，3例淋巴瘤，2例前列腺癌，1例肾细胞癌，1例甲状腺癌）。在其余15例患者中，活检没有导致最终诊断的确定，因为组织学诊断为腺癌或未分化癌，组织样本不能诊断。实验室分析仅限于特定的肿瘤标志物，如PSA和蛋白质电泳被认为是有用的作出最终诊断。胸部、腹部和盆腔CT被认为对实体瘤的最终诊断有用，但对血液肿瘤则无效。与实验室分析和CT扫描对实体瘤的诊断相比，CT引导下的活检在最终诊断中的确定率较低，对于血液学肿瘤的诊断也不被认为是必要的。
When the primary site is unknown in patients with spinal metastases, there can be problems in locating the site of tumor origin. Most previous reports on metastases of unknown origin have not been limited to the spine. The purpose of this study is to assess the usefulness of laboratory analysis, chest, abdominal and pelvic CT and CT-guided biopsy in patients with spinal metastases of unknown origin (SMUO). A retrospective review of the clinical histories of 27 patients with SMUO was done. A total of 43 patients with SMUO were seen at our institution between 2002 and 2007. Of the 43 patients, 27 who underwent all 3 tests (laboratory analysis including M protein and tumor markers, chest, abdominal and pelvic CT and CT-guided biopsy) were included in this study. We retrospectively assessed the diagnostic usefulness of those 3 tests in the 27 patients. In 27 patients, the final diagnosis was obtained in 26 patients. Myeloma was the most common malignancy followed by lung carcinoma. M protein was positive in all 7 patients with myeloma and negative in patients with other malignancies. The level of tumor markers was elevated in 16 of 17 patients with a solid tumor and in all 3 with lymphoma. CA15-3 was elevated in 4 of 27 patients, CA19-9 in 5 of 27 patients, CA125 in 2 of 27 patients, CEA in 6 of 27 patients, SCC in 2 of 27 patients, NSE in 7 of 27 patients, AFP in 1 of 27 patients, PIVKA-II in 1 of 27 patients, TPA in 6 of 27 patients, IAP in 3 of 12 patients, thyroglobulin in 2 of 27 patients, sIL-2R in 3 of 24 patients, and PSA in 5 of 17 male patients. Myeloma, lymphoma and prostate carcinoma had a marker with high sensitivity and specificity (M protein, sIL-2R and PSA). Eleven primary tumor sites (40.7%) were detected (6 lung, 1 prostate, 1 kidney, 1 thyroid, 1 liver, and 1 pancreas) by chest, abdominal and CT scanning. Biopsy led to determination of the final diagnosis in 12 (44.4%) of 27 patients (5 myelomas, 3 lymphomas, 2 prostate carcinomas, 1 renal-cell carcinoma, 1 thyroid carcinoma). In the remaining 15 patients, biopsy did not lead to determination of the final diagnosis, because the histological diagnosis was either an adenocarcinoma or an undifferentiated carcinoma, the tissue sample was not diagnostic. A laboratory analysis limited to specific tumor markers such as PSA and protein electrophoresis is considered to be useful in making a final diagnosis. Chest, abdominal and pelvic CT is considered to be useful for making a final diagnosis in solid tumors, but not for hematologic tumors. A CT-guided biopsy had a low determination rate in the final diagnosis in comparison to a laboratory analysis and CT scanning for solid tumors and it is not considered to be essential for the diagnosis of hematologic tumors.