Can bone metabolism markers be adopted as an alternative to scintigraphic imaging in monitoring bone metastases from breast cancer?

Emilio Bombardieri, Antonia Martinetti, Rosalba Miceli, Luigi Mariani, Maria Rita Castellani, Ettore Seregni

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Abstract

Bone scintigraphy plays a major role in the diagnosis of bone metastases. The clinical utility of new biochemical markers of bone metabolism has recently been investigated in various bone diseases. This study evaluated the role of some bone metabolism markers in comparison with bone scan in the follow-up of breast cancer patients. We studied 149 patients with breast cancer, 33 (22%) of whom had bone metastases. IRMAs were used for the evaluation of blood levels of osteocalcin, bone alkaline phosphatase (BAP), the C-terminal propeptide of type I procollagen and the C-terminal cross-linked telopeptide of type I collagen (ICTP). Multivariate regression analysis showed that menopausal status (P = 0.007) and metastatic bone lesions (P = 0.001) affected bone marker levels. When considering postmenopausal women, the only subset in which bone metabolism marker behaviour could be reliably investigated, we found a high degree of overlap in marker distribution for scan-positive and scan-negative patients. Discrimination between scan-negative and scan-positive patients based on the above markers, taken singly or jointly, was assessed by means of logistic discriminant analysis. The best discrimination was achieved with BAP, closely followed by ICTP. BAP and ICTP together gave a slight improvement over the use of the two markers separately. However, even in this case the degree of discrimination was poor and its clinical utility was limited. In fact, to achieve a specificity of 95%, the sensitivity of the test was about 20%; conversely, with a sensitivity of 95%, the specificity was below 10%. In conclusion, based on our findings, we believe that blood levels of the investigated markers cannot replace bone scintigraphy in the follow-up of breast cancer patients for the early detection of bone metastases.

Original languageEnglish
Pages (from-to)1349-1355
Number of pages7
JournalEuropean Journal Of Nuclear Medicine
Volume24
Issue number11
DOIs
Publication statusPublished - 1997

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Breast Neoplasms
Neoplasm Metastasis
Bone and Bones
Alkaline Phosphatase
Radionuclide Imaging
Sensitivity and Specificity
Bone Diseases
Osteocalcin
Discriminant Analysis
Collagen Type I
Multivariate Analysis
Biomarkers
Regression Analysis

Keywords

  • Bone alkaline phosphatase
  • Bone metabolism
  • Bone scintigraphy
  • C-terminal cross-linked telopeptide of type I collagen
  • C-terminal propeptide type I procollagen
  • Osteocalcin

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

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title = "Can bone metabolism markers be adopted as an alternative to scintigraphic imaging in monitoring bone metastases from breast cancer?",
abstract = "Bone scintigraphy plays a major role in the diagnosis of bone metastases. The clinical utility of new biochemical markers of bone metabolism has recently been investigated in various bone diseases. This study evaluated the role of some bone metabolism markers in comparison with bone scan in the follow-up of breast cancer patients. We studied 149 patients with breast cancer, 33 (22{\%}) of whom had bone metastases. IRMAs were used for the evaluation of blood levels of osteocalcin, bone alkaline phosphatase (BAP), the C-terminal propeptide of type I procollagen and the C-terminal cross-linked telopeptide of type I collagen (ICTP). Multivariate regression analysis showed that menopausal status (P = 0.007) and metastatic bone lesions (P = 0.001) affected bone marker levels. When considering postmenopausal women, the only subset in which bone metabolism marker behaviour could be reliably investigated, we found a high degree of overlap in marker distribution for scan-positive and scan-negative patients. Discrimination between scan-negative and scan-positive patients based on the above markers, taken singly or jointly, was assessed by means of logistic discriminant analysis. The best discrimination was achieved with BAP, closely followed by ICTP. BAP and ICTP together gave a slight improvement over the use of the two markers separately. However, even in this case the degree of discrimination was poor and its clinical utility was limited. In fact, to achieve a specificity of 95{\%}, the sensitivity of the test was about 20{\%}; conversely, with a sensitivity of 95{\%}, the specificity was below 10{\%}. In conclusion, based on our findings, we believe that blood levels of the investigated markers cannot replace bone scintigraphy in the follow-up of breast cancer patients for the early detection of bone metastases.",
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author = "Emilio Bombardieri and Antonia Martinetti and Rosalba Miceli and Luigi Mariani and Castellani, {Maria Rita} and Ettore Seregni",
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AU - Bombardieri, Emilio

AU - Martinetti, Antonia

AU - Miceli, Rosalba

AU - Mariani, Luigi

AU - Castellani, Maria Rita

AU - Seregni, Ettore

PY - 1997

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N2 - Bone scintigraphy plays a major role in the diagnosis of bone metastases. The clinical utility of new biochemical markers of bone metabolism has recently been investigated in various bone diseases. This study evaluated the role of some bone metabolism markers in comparison with bone scan in the follow-up of breast cancer patients. We studied 149 patients with breast cancer, 33 (22%) of whom had bone metastases. IRMAs were used for the evaluation of blood levels of osteocalcin, bone alkaline phosphatase (BAP), the C-terminal propeptide of type I procollagen and the C-terminal cross-linked telopeptide of type I collagen (ICTP). Multivariate regression analysis showed that menopausal status (P = 0.007) and metastatic bone lesions (P = 0.001) affected bone marker levels. When considering postmenopausal women, the only subset in which bone metabolism marker behaviour could be reliably investigated, we found a high degree of overlap in marker distribution for scan-positive and scan-negative patients. Discrimination between scan-negative and scan-positive patients based on the above markers, taken singly or jointly, was assessed by means of logistic discriminant analysis. The best discrimination was achieved with BAP, closely followed by ICTP. BAP and ICTP together gave a slight improvement over the use of the two markers separately. However, even in this case the degree of discrimination was poor and its clinical utility was limited. In fact, to achieve a specificity of 95%, the sensitivity of the test was about 20%; conversely, with a sensitivity of 95%, the specificity was below 10%. In conclusion, based on our findings, we believe that blood levels of the investigated markers cannot replace bone scintigraphy in the follow-up of breast cancer patients for the early detection of bone metastases.

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