The Role of Whole-Body Bone Scanning and Clinical Factors in Detecting Bone Metastases in Patients With Non-small Cell Lung Cancer

Machine learning approaches for prediction of early death among lung cancer patients with bone metastases using routine clinical characteristics: An analysis of 19,887 patients

Purpose

Bone is one of the most common sites for the spread of malignant tumors. Patients with bone metastases whose prognosis was shorter than 3 months (early death) were considered as surgical contraindications. However, the information currently available in the literature limits our capacity to assess the risk likelihood of 3 month mortality. As a result, the study's objective is to create an accurate prediction model utilizing machine-learning techniques to predict 3 month mortality specifically among lung cancer patients with bone metastases according to easily available clinical data.

Methods

This study enrolled 19,887 lung cancer patients with bone metastases between 2010 and 2018 from a large oncologic database in the United States. According to a ratio of 8:2, the entire patient cohort was randomly assigned to a training (n = 15881, 80%) and validation (n = 4,006, 20%) group. In the training group, prediction models were trained and optimized using six approaches, including logistic regression, XGBoosting machine, random forest, neural network, gradient boosting machine, and decision tree. There were 13 metrics, including the Brier score, calibration slope, intercept-in-large, area under the curve (AUC), and sensitivity, used to assess the model's prediction performance in the validation group. In each metric, the best prediction effectiveness was assigned six points, while the worst was given one point. The model with the highest sum score of the 13 measures was optimal. The model's explainability was performed using the local interpretable model-agnostic explanation (LIME) according to the optimal model. Predictor importance was assessed using H₂O automatic machine learning. Risk stratification was also evaluated based on the optimal threshold.

Results

Among all recruited patients, the 3 month mortality was 48.5%. Twelve variables, including age, primary site, histology, race, sex, tumor (T) stage, node (N) stage, brain metastasis, liver metastasis, cancer-directed surgery, radiation, and chemotherapy, were significantly associated with 3 month mortality based on multivariate analysis, and these variables were included for developing prediction models. With the highest sum score of all the measurements, the gradient boosting machine approach outperformed all the other models (62 points), followed by the XGBooting machine approach (59 points) and logistic regression (53). The area under the curve (AUC) was 0.820 (95% confident interval [CI]: 0.807-0.833), 0.820 (95% CI: 0.807-0.833), and 0.815 (95% CI: 0.801-0.828), respectively, calibration slope was 0.97, 0.95, and 0.96, respectively, and accuracy was all 0.772. Explainability of models was conducted to rank the predictors and visualize their contributions to an individual's mortality outcome. The top four important predictors in the population according to H₂O automatic machine learning were chemotherapy, followed by liver metastasis, radiation, and brain metastasis. Compared to patients in the low-risk group, patients in the high-risk group were more than three times the odds of dying within 3 months (P < 0.001).

Conclusions

Using machine learning techniques, this study offers a number of models, and the optimal model is found after thoroughly assessing and contrasting the prediction performance of each model. The optimal model can be a pragmatic risk prediction tool and is capable of identifying lung cancer patients with bone metastases who are at high risk for 3 month mortality, informing risk counseling, and aiding clinical treatment decision-making. It is better advised for patients in the high-risk group to have radiotherapy alone, the best supportive care, or minimally invasive procedures like cementoplasty.

Significance of the Expression of TC and TG Levels in the Initial Diagnosis and Treatment of SCLC Patients and Their Tie-In with Prognosis

The article examines the expression of TC and TG levels in the initial diagnosis and treatment of SCLC patients and their tie-in with prognosis. Patients with SCLC are included in the case set, who are initially treated in the tumor center of our hospital from January 2020 to January 2021 and are confirmed by histopathology or cytology as the research subjects. 80 healthy volunteers are included in the control set, who received physical examination. All the enrolled patients received the first-line standard treatment plan, and the clinical data of all SCLC patients are inquired through the medical record file system of the hospital. At the initial diagnosis and treatment, the TG and TC levels of all patients and healthy persons are measured and recorded by blood biochemistry. For SCLC patients, the risk factors affecting the prognosis of patients with progression-free survival include newly diagnosed TC, TG levels, and tumor stage. Combined TC and TG detection can be used as indicators to predict the prognosis of the patients. TC and TG are significantly correlated with the prognosis of the patients with progression-free survival time. It is worthy of clinical application.

Risk factors and prognostic factors for inflammatory breast cancer with bone metastasis: A population-based study

PURPOSE

Inflammatory breast cancer (IBC) is a rare type of breast cancer with poor prognosis. IBC patients with bone metastasis (BM) often suffer from many complications. This study was performed to identify risk factors with strong capability of predicting high BM risk for IBC patients and find prognostic factors for those patients.

METHODS

The Surveillance, Epidemiology and End Results (SEER) database was used to collect the clinicopathological and survival information of IBC patients. 966 IBC patients diagnosed between 2010 and 2015 were included to study the risk factors for developing BM by using Multivariable logistic regression. A total of 194 and 176 patients were included to analyze independent prognostic factors for overall survival (OS) and cancer specific survival (CSS) of IBC patients with BM respectively.

RESULTS

Of the 966 IBC patients, 194 (20.1%) patients were with BM. The risk factors for developing BM in IBC patients included unmarried marital status, double breast tumor, N1 stage, N3 stage, and liver metastases had higher risk of BM, while those of uninsured status and triple negative breast cancer (TNBC) were less likely to have BM. Analysis of prognostic factors for OS and CSS of IBC patients with BM showed that TNBC subtype and liver metastases were independently significantly associated with poorer OS and CSS of BM patients, while chemotherapy could serve as an independent prognostic factor for better OS and CSS of BM patients.

CONCLUSION

Marital status, double breast tumor, N1 stage, N3 stage, and liver metastases should be considered for prediction of BM in IBC patients. TNBC subtype and liver metastases may indicate poor survival and chemotherapy can indicate improved survival for IBC patients with BM.

Clinical utility of dual-energy CT used as an add-on to 18F FDG PET/CT in the preoperative staging of resectable NSCLC with suspected single osteolytic metastases

OBJECTIVE

To determine the clinical value of ¹⁸F-FDG-PET/CT and dual-energy virtual noncalcium CT to detect and identify single osteolytic metastases (SOM) in participants with non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS

Forty-two participants (mean age, 63.5 years ± 10.1; range, 41-81 years) with suspected SOM diagnosed by whole-body ¹⁸F-FDG-PET/CT underwent non-enhanced dual-energy CT. All images were visually and quantitatively evaluated by two nuclear medicine physicians (R1 and R2) and two radiologists (R3 and R4) independently. The results of visual and quantitative analysis of ¹⁸F-FDG-PET/CT and dual-energy CT were compared with pathological results.

RESULTS

In the visual analysis, the specificity and positive predictive value of dual-energy CT for reader 1 and reader 2 is larger than the corresponding figures of¹⁸F-FDG-PET/CT for reader 3 and reader 4 (94.1% each vs 82.4%/76.5%; 95.2%/95.0% vs 88.9%/86.2%). The sensitivity and negative predictive value of dual-energy CT is relatively lower than the number of ¹⁸F-FDG-PET/CT for readers (80.0%/76.0% vs 96.0%/100.0%; 76.2%/72.7% vs 93.3%/100.0%, respectively). ROI-based analysis of SUV_max on PET/CT images and CT numbers on VNCa images showed a significant difference between metastases and non-metastases (P < 0.001 each).

CONCLUSIONS

Pre-surgical evaluation by combination of whole-body ¹⁸F-FDG-PET/CT and dual-energy CT could improve the classification of SOM and may further guide the surgical decision-making in participants with NSCLC.

Impact of the homogeneous and heterogeneous risk factors on the incidence and survival outcome of bone metastasis in NSCLC patients

PURPOSE

Bone metastases (BM) is reported as the most frequent distant metastasis in non-small cell lung cancer (NSCLC), but the risk factors for the incidence and prognosis of BM patients in NSCLC have not been extensively elucidated. This study aimed to find risk factors to predict BM patients' morbidity and survival outcome in NSCLC.

METHODS

63,505 patients of NSCLC in the Surveillance, Epidemiology and End Results database diagnosed from 2010 to 2015 were used to analyze risk factors for developing BM by conducting multivariable logistic regression. Of these patients, 6152 and 5664 BM patients diagnosed between 2010 and 2014 were selected to investigate predictive factors for BM overall survival (OS) and cancer-specific survival (CSS) using the multivariable Cox proportional hazards regression.

RESULTS

There were overall 7486 (11.79%) BM patients in NSCLC. The homogeneous risk factors for BM patients' morbidity and survival outcome included male, higher T stage, lymph node involvement, poor differentiation grade, brain metastases, and liver metastases. Married status, adenocarcinoma type and lung metastases were positively correlated with BM incidence, while older age, white race, unmarried status, and SCC and other NSCLC types could predict poor OS and CSS of BM in NSCLC.

CONCLUSIONS

The homogeneous and heterogeneous risk factors for morbidity and survival outcome of BM patients could help physicians in more precise and individualized screening and therapies for BM patients in NSCLC.

[Correlation of the levels of the bone turnover markers BAP and β-CTX with bone metastasis progress in lung cancer patients]

背景与目的

肺癌易发生骨转移，Ⅰ型胶原羧基端肽β特殊序列（β isomer of C-terminal telopeptide of type Ⅰ collagen, β-CTX）和骨源性碱性磷酸酶（bone-specific alkaline phosphates, BAP）在骨质代谢中是重要的生化标记物，本研究旨在探讨骨代谢生化指标和肺癌骨转移进展程度的相关性，有助于早期判断是否有肺癌骨转移的发生。

方法

天津市人民医院2009年7月-2012年7月共收治92例肺癌并发生骨转移患者，全部病例其原发灶均经细胞学检查证实，骨转移灶的数目及类型经ECT结合X线片、CT证实，采用ELISA方法检测血β-CTX、BAP的浓度水平。

结果

收集的92例肺癌伴骨转移的患者中，转移灶 < 3处为58例，≥3处为34例；溶骨型68例，成骨型9例，混合型15例。血β-CTX、BAP水平在不同的骨转移数目组间差异有统计学意义（P < 0.05），β-CTX在肺癌溶骨型骨转移患者中具有较高的敏感性。

结论

骨代谢生化指标β-CTX、BAP对肺癌骨转移具有辅助诊断意义，是判断转移进展程度的良好指标。

Differences in clinical presentation of non-small cell lung cancer in never-smokers versus smokers

OBJECTIVES

This study was conducted to evaluate whether or not tumor spread and the diagnostic process in non-small cell lung cancer (NSCLC) is different based on smoking history.

METHODS

Associations between smoking status and clinical presentation were evaluated controlling for the effect of histology. Lung cancer with delayed diagnosis (LCDD) and incidental detection (LCID) were determined based on medical records.

RESULTS

Of 914 patients, frequency of distant metastases was more common in never-smokers than in smokers (59% and 36%, respectively; P<0.001). Although never-smokers were more likely to have LCDD than smokers (18% and 11%, respectively; P=0.038), LCDD were not significantly associated with frequency of distant metastases [49% (LCDD) vs. 42% (non-LCDD); P=0.189] as well as tumor [29% (T3-4) vs. 24% (T1-2); P=0.134] and node [43% (N2-3) vs. 44% (N0-1); P=0.838] stage. Interestingly, never-smokers are more likely to have LCID than smokers (31% and 19%, respectively; P=0.010). In survival analysis, LCID (P=0.001; HR, 0.63) remained a prognostic factor, while LCDD did not.

CONCLUSIONS

This study suggests distinct metastatic pattern and diagnostic processes of never-smokers. The link between survival and incidental detection was also indicated.

Is there a role of whole-body bone scan in patients with esophageal squamous cell carcinoma

Background

Correct detection of bone metastases in patients with esophageal squamous cell carcinoma is pivotal for prognosis and selection of an appropriate treatment regimen. Whole-body bone scan for staging is not routinely recommended in patients with esophageal squamous cell carcinoma. The aim of this study was to investigate the role of bone scan in detecting bone metastases in patients with esophageal squamous cell carcinoma.

Methods

We retrospectively evaluated the radiographic and scintigraphic images of 360 esophageal squamous cell carcinoma patients between 1999 and 2008. Of these 360 patients, 288 patients received bone scan during pretreatment staging, and sensitivity, specificity, positive predictive value, and negative predictive value of bone scan were determined. Of these 360 patients, surgery was performed in 161 patients including 119 patients with preoperative bone scan and 42 patients without preoperative bone scan. Among these 161 patients receiving surgery, 133 patients had stages II + III disease, including 99 patients with preoperative bone scan and 34 patients without preoperative bone scan. Bone recurrence-free survival and overall survival were compared in all 161 patients and 133 stages II + III patients, respectively.

Results

The diagnostic performance for bone metastasis was as follows: sensitivity, 80%; specificity, 90.1%; positive predictive value, 43.5%; and negative predictive value, 97.9%. In all 161 patients receiving surgery, absence of preoperative bone scan was significantly associated with inferior bone recurrence-free survival (P = 0.009, univariately). In multivariate comparison, absence of preoperative bone scan (P = 0.012, odds ratio: 5.053) represented the independent adverse prognosticator for bone recurrence-free survival. In 133 stages II + III patients receiving surgery, absence of preoperative bone scan was significantly associated with inferior bone recurrence-free survival (P = 0.003, univariately) and overall survival (P = 0.037, univariately). In multivariate comparison, absence of preoperative bone scan was independently associated with inferior bone recurrence-free survival (P = 0.009, odds ratio: 5.832) and overall survival (P = 0.029, odds ratio: 1.603).

Conclusions

Absence of preoperative bone scan was significantly associated with inferior bone recurrence-free survival, suggesting that whole-body bone scan should be performed before esophagectomy in patients with esophageal squamous cell carcinoma, especially in patients with advanced stages.

A meta-analysis of ¹⁸FDG-PET-CT, ¹⁸FDG-PET, MRI and bone scintigraphy for diagnosis of bone metastases in patients with lung cancer

BACKGROUND AND PURPOSE

Lung cancer is the most common cause of cancer related death among both men and women worldwide. The skeleton is the most common site of cancer metastasis. Early detection is crucial for prognosis. To evaluate and compare the capability for bone metastasis assessment of [(18)F] fluoro-2-d-glucose positron emission tomography with computed tomography ((18)FDG-PET-CT), [(18)F] fluoro-2-d-glucose positron emission tomography ((18)FDG-PET), magnetic resonance imaging (MRI) and bone scintigraphy (BS) in lung cancer patients, a meta-analysis is preformed.

METHODS

We searched MEDLINE, OVID, EMBASE and the Cochrane Library for studies evaluating diagnosis validity of (18)FDG-PET-CT, (18)FDG-PET, MRI and BS between January 1990 and August 2010. Meta-analysis methods were used to pool sensitivity, specificity, diagnostic odd ratios (DORs) and to construct a summary receiver-operating characteristic curve (SROC).

RESULTS

A total of 17 articles (9 (18)FDG-PET-CT studies, 9 (18)FDG-PET studies, 6 MRI studies and 16 BS studies) that included 2940 patients who fulfilled all of the inclusion criteria were considered for inclusion in the analysis. The pooled sensitivity for the detection of bone metastasis in lung cancer using (18)FDG-PET-CT, (18)FDG-PET, MRI and BS were 0.92 (95% CI, 0.88-0.95), 0.87 (95% CI, 0.81-0.92), 0.77 (95% CI, 0.65-0.87) and 0.86 (95% CI, 0.82-0.89), respectively. The pooled specificity for the detection of bone metastasis from lung cancer using (18)FDG-PET-CT, (18)FDG-PET, MRI and BS were 0.98 (95% CI, 0.97-0.98), 0.94 (95% CI, 0.92-0.96), 0.92 (95% CI, 0.88-0.95), 0.88 (95% CI, 0.86-0.89), respectively. The pooled DORs estimates for (18)FDG-PET-CT 449.17 were significantly higher than for (18)FDG-PET (118.25, P<0.001), MRI (38.27, P<0.001) and BS (63.37, P<0.001). The pooled sensitivity of BS was not correlated with the prevalence of bone metastasis.

CONCLUSION

The results showed that both (18)FDG-PET-CT and (18)FDG-PET were better imaging methods for diagnosing bone metastasis from lung cancer than MRI and BS. (18)FDG-PET-CT has higher diagnostic value (sensitivity, specificity and DORs) for diagnosing bone metastasis from lung cancer than any other imaging methods.

ACR appropriateness criteria on metastatic bone disease

Appropriate imaging modalities for screening, staging, and surveillance of patients with suspected and documented metastatic disease to bone include (99m)Tc bone scanning, MRI, CT, radiography, and 2-[(18)F]fluoro-2-deoxyglucose-PET. Clinical scenarios reviewed include asymptomatic stage 1 breast carcinoma, symptomatic stage 2 breast carcinoma, abnormal bone scan results with breast carcinoma, pathologic fracture with known metastatic breast carcinoma, asymptomatic well-differentiated and poorly differentiated prostate carcinoma, vertebral fracture with history of malignancy, non-small-cell lung carcinoma staging, symptomatic multiple myeloma, osteosarcoma staging and surveillance, and suspected bone metastasis in a pregnant patient. No single imaging modality is consistently best for the assessment of metastatic bone disease across all tumor types and clinical situations. In some cases, no imaging is indicated. The recommendations contained herein are the result of evidence-based consensus by the ACR Appropriateness Criteria((R)) Expert Panel on Musculoskeletal Radiology.

Surgical treatment of bone metastases in patients with lung cancer

Lung cancer is the leading cause of cancer mortality. Bone metastases are a common complication in lung cancer. The therapeutic approach and the type of surgical treatment of these lesions have not been clearly defined. Outcome and prognosis of patients with bony metastases and a variety of surgical interventions were analysed retrospectively. In 58 patients we performed 62 surgeries. The most common locations of metastases were the spine (32 patients), the proximal femur (10) and the pelvis (11). Twenty-one patients had a singular and 20 had multiple osseous lesions; 17 showed additional visceral involvement. Nine patients had a local progression of their disease and 49 a systemic progression. Patients with local progression (n = 9) had a better prognosis than the patients with systemic progression (p = 0.0083). Fracture (p = 0.0017) worsened prognosis, whereas the number of bone lesions or the presence of a visceral lesion did not. Patients with small lesions showed a better survival than patients with large lesions (p = 0.02). Ten percent of the patients died within 30 days and 78% within one year after surgery. Fracture of bone due to metastatic lung cancer worsens the prognosis whereas the number of bone lesions, the presence of a visceral lesion and the surgical approach do not.

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

Bone scan (BS) and serum alkaline phosphatase (ALP) concentration are used to detect bone metastasis in malignancy, although whole-body fluoro-D-glucose positron emission tomography computed tomography (FDG PET/CT) is being used increasingly. But BS is still used for the detection of metastatic bone lesion. So we compared the usefulness of PET/CT, BS, and serum ALP in detecting bone metastases in patients with newly diagnosed lung cancer. The medical record database was queried to identify all patients with a new diagnosis of lung cancer between January 2004 and December 2005, who had a PET/CT, BS, and serum ALP before treatment. We retrospectively reviewed all patients' records and radiological reports. One hundred eighty-two patients met the inclusion criteria. Bone metastases were confirmed in 30 patients. The sensitivity values were 93.3% for PET/CT, 93.3% for BS, 26.7% for serum ALP concentration, and 26.7% for BS complemented with serum ALP concentration. The respective specificity values were 94.1%, 44.1%, 94.1%, and 97.3%. The kappa statistic suggested a poor agreement among the three modalities. FDG PET/CT and BS had similar sensitivity, but PET/CT had better specificity and accuracy than BS. PET/CT is more useful than BS for evaluating bone metastasis. However, in the advanced stage, because of its high specificity, BS complemented with serum ALP is a cost-effective modality to avoid having to use PET/CT.

A diagnostic model to detect silent brain metastases in patients with non-small cell lung cancer

We aimed to discriminate subgroups according to the risk of brain metastases in patients with non-small cell lung cancer (NSCLC) lacking neurological symptoms. We performed a retrospective review of 433 patients with NSCLC who underwent chest computed tomography (CT), brain magnetic resonance imaging (MRI) and bone scans at an initial staging work-up between April 2003 and April 2007. Brain metastases were determined by MRI. Patients were stratified into groups according to the number of risk factors (0-3) identified by multivariate analysis. In multivariate analysis, histopathology with non-squamous cell carcinoma, nodal stage 2 on CT and presence of bone metastases were three risk factors for brain metastases. Patients were divided into four groups according to the number (0-3) of these predictive factors. The proportions of patients with brain metastases in the four groups were 2%, 3%, 17% and 35%, respectively, and these differences were significant (P<0.001). When analysis was performed in patients with localised disease, the number of risk factors was correlated with the prevalence of brain metastases (P=0.013) but stage was not (P=0.153). Although this diagnostic model should be validated through further studies, our data suggest that the number of risk factors might be a useful tool to identify silent brain metastases in patients with NSCLC.

Parenchymal-sparing resections: why, when, and how

Although lobectomy should continue to be regarded as the procedure of choice for NSCLC, certain subsets of patients who have favorable characteristics may be treated appropriately with segmentectomy without adversely affecting oncologic outcome as long as an adequate assessment of intraoperative nodal status and surgical margin is performed. The use of anatomic segmentectomy may be particularly useful for small, peripheral tumors less than 2 cm in diameter located within anatomic segmental boundaries, as well as for elderly patients who have impaired cardiopulmonary function. Ground-glass opacities and lesions displaying bronchoalveolar histology also may be appropriate target lesions for segmentectomy because of their low metastatic potential. Prospective, randomized studies (such as the CALGB/Altorki trial and the brachytherapy mesh trial) will be necessary to delineate fully the utility of segmentectomy in patients who have NSCLC.

Perspectives for preventive screening with total body MRI

Radiology has started to increasingly recognise its potential for screening with the advent of "whole-body" imaging techniques. This article briefly reviews prerequisites for successful screening, presents a quick summary of single-organ screening with magnetic resonance (MR) imaging, and introduces how this knowledge can be integrated into whole-body MR (wb-MR) screening. MR colonography has demonstrated its potential for screening. Wb-MR in the form of wb-MR angiography has already entered both clinical and screening settings; also, the search for metastases with wb-MR has been evaluated and has performed well when compared with other imaging modalities. But screening a group of healthy subjects requires more than feasibility and high accuracy of the screening test; thus, technical and ethical considerations are also presented. Wb-MR is only at its beginning and will in the near future certainly inspire many new research activities as well as transform the radiological market.

Detecting extrathoracic metastases in patients with non-small cell lung cancer: Is routine scanning necessary?

There is controversy over whether to scan extrathoracic sites for metastases in patients with non-small cell lung cancer (NSCLC). We tested the efficiency of clinical factors to determine whether metastasis has occurred, and whether routine scanning for NSCLC is required. Nine hundred and forty five patients scanned for extrathoracic metasates were included. Clinical factors indicating metastasis were determined using multivariate analysis. Of the 945 cases, 377 (39.9%) had metastasis. Bone metastases were determined by focal skeleton pains, elevated serum alkaline phosphatase levels, adenocarcinoma, KPS</=70, sensitivity of 90.6, specificity of 12.7, PPV of 16.3, NPV of 87.8, and silent metastases rate (SMR) of 9.4%. Brain metastases were determined by neurological symptoms, adenocarcinoma, hematocrite <40 for men and <35 for women, KPS</=70, sensitivity of 89.9, specificity of 7.9, PPV of 9.2, NPV of 88.3, and SMR of 10.1%. Abdominal metastases were determined by abdominal pain/tension, hepatomegaly, elevated GGT levels, serum LDH levels >500 IU, a N2 or N3 case, KPS</=70, sensitivity of 95.9, specificity of 7.1, PPV of 13.3, NPV of 92.1 and SMR of 4.1%. Of the 224 patients with stage I and II disease, 73 had metastasis with a rate of 10.9% silent metastasis. We concluded that routine scanning of NSCLC for staging is necessary.

Can clinical factors be determinants of bone metastases in non-small cell lung cancer?

OBJECTIVE

The aim of this study was to investigate the correlations among symptoms, laboratory findings of bone metastasis and whole body bone scanning (WBBS) and the frequency of occurrence of bone metastases

MATERIALS AND METHODS

Hundred and six patients who were diagnosed with non-small cell lung cancer (NSCLC) between June 2001 and September 2005 were investigated retrospectively. Bone pain, detection of bone tenderness on physical examination, hypercalcemia and increased serum alkaline phosphatase were accepted clinical factors of bone metastases. Presence of multiple asymmetric lesions in WBBS was also accepted as bone metastases. Subjects whose clinical factors and WBBS indicated doubtful bone metastases were evaluated with magnetic resonance and/or biopsy.

RESULTS

Occurrence of bone metastases was 31.1% among all patients. Bone metastases were determined in 21 (52.5%) of 40 patients who had at least one clinical factor. Asymptomatic bone metastases without any clinical factors were established in 11.3% of all NSCLC patients and 15.3% of 26 operable patients. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the clinical factors of bone metastases were 63.6, 73.9, 52.5, 81.8 and 70.7% respectively. There was no significant relationship between histologic type and bone metastases. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of WBBS in detection of bone metastases were 96.9, 86.3, 76.2, 98.4, 89.6% respectively.

CONCLUSION

Sensitivity and specificity of the clinical factors of bone metastases are quite low. Routine WBBS prevented futile thoracotomies. Therefore, routine WBBS should be performed in all NSCLC patients, even in the absence of bone-specific clinical factors.

MRT zum Staging des Lungenkarzinoms

PURPOSE

Overview of magnetic resonance imaging (MRI) in staging of lung cancer.

MATERIAL AND METHODS

Currently available methods of imaging lung cancer, lymph node and distant metastases by MRI are explained. At present, MRI is mainly used in the detection of cerebral metastases and assessment of infiltration of the thoracic wall and of the mediastinum. The capabilities of T2-weighted single-shot TSE (HASTE) and T1-weighted 3D gradient echo techniques (VIBE) are demonstrated.

RESULTS

With the advent of new fast sequences like HASTE and VIBE the spatial resolution comes close to that of computed tomography but with an outstanding soft tissue contrast and without radiation exposure. The introduction of lymph node specific contrast media will improve sensitivity and specificity in N staging. Additionally, whole-body MRI is capable of detecting distant metastases, in particular in the organs at risk, i.e. brain, upper abdomen and musculoskeletal system.

CONCLUSION

MRI is gaining importance as part of a multimodal imaging approach for staging of lung cancer.