Bone Scan in Gastric Cancer Patients: A Retrospective Review

Background: Bone scans are extremely sensitive when it comes to detecting bone metastases. Bone metastases from stomach cancer is uncommon, and it is associated with a bad prognosis. Gastric cancer bone metastases are primarily osteolytic, disrupting bone integrity and causing bone pain and pathological fractures.

The goal of this study was to look at the incidence, clinical features, and risk factors for bone metastases in individuals who had stomach cancer as their first diagnosis.

Methods: Between 2010 and 2014, at Seoul St. Mary’s hospital, The Catholic University of Korea, we retrospectively analysed all patients who were diagnosed with primary gastric cancer and had initial staging workup with bone scintigraphy. Patients with a primary diagnosis of gastric cancer obtained a bone scan as part of their initial staging workup in 1589/1721 cases (92.33 percent). The occurrence of bone metastases and risk variables for bone metastases were explored after the patients were further assessed using the eligibility criteria we devised.

Only 15 of the 1589 individuals studied had bone metastases that were firmly established (0.8 percent ). The average age of the patients was 59.0 8.6 years (range 24–90), and the majority of them were men (60 percent ). Bormann’s classification type 3 was the most common histological type, which was either weakly differentiated or signet ring cancer. There were no clinical differences in the distribution of the gastric tumour in regard to the upper, middle, and lower thirds. The average tumour size was 3.6 2.3 cm (range 0.6–20 cm) in this cohort. Clinically, all of the patients had advanced gastric cancer, and the median follow-up length was 9 months. Bone metastases were found to be quite common (20 percent ). The majority of patients (80%) had bone metastases as well as other metastases. The majority of the cases, related regional lymph node metastases were discovered. Instead of a single bone lesion, most individuals developed several bone metastases. The majority of patients with bone metastases had advanced gastric malignancies, with the entire skeleton being the most prevalent metastatic location, followed by the combined vertebra, rib, and scapula.

For the most part, bone scintigraphy and PET-CT were employed simultaneously to diagnose bone metastases. Only 5 instances (35.71%) showed elevated serum alkaline phosphatase at the time of diagnosis, while 8 individuals reported clinical complaints of bone pain (53.0 percent ). Anemia, tumour indicators such as carcinoembryonic antigen (CEA) and cancer antigen 19-9 were also not substantially evaluated (CA19-9). Chemotherapy or concurrent chemoradiotherapy were used in 14 of the patients (93.3 percent).

Conclusions: In patients with gastric cancer, the preoperative bone scan revealed bone metastases in 0.8 percent of cases. It is suggested that in patients with stomach cancer, a whole-body bone scan should not be conducted frequently. For a bone scan to be a cost-effective tool, it may be required for a certain group of patients, such as those with advanced stages of stomach cancer or those who are clinically symptomatic. Serum ALK shows a weak connection with the identification of early bone metastases.

Author(S) Details

Bandar Idrees Ali
Seoul St. Mary’s Hospital, The Catholic university of Korea, Seoul, South Korea and Department of Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.

O. Joo Hyun
Seoul St. Mary’s Hospital, The Catholic university of Korea, Seoul, South Korea.

Khuloud Omar Bukhari
Ministry of Health, Saudi Arabia.

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