Bone metastases in carcinoid tumors: clinical features, imaging characteristics, and markers of bone metabolism.
The purpose of this study was to describe the clinical presentation of bone metastases in patients with carcinoid tumors and to determine the diagnostic value of imaging techniques and markers of bone metabolism.


METHODS
This retrospective study was performed on the entire group of patients with carcinoid tumors treated in our hospital from January 1992 to May 1999. Only patients with metastasized tumors were included.


RESULTS
Eleven of 90 patients (12%) (95% confidence interval [CI], 5%-19%) with a metastasized carcinoid tumor had symptomatic bone metastases. All bone metastases occurred in 55 patients with midgut carcinoids (20%; 95% CI, 9%-31%). Plain radiography had a sensitivity of 44% (95% CI, 12%-76%); MRI, 100% (95% CI, 61%-100%); bone scintigraphy, 90% (95% CI, 72%-100%); and octreotide scintigraphy, 60% (95% CI, 35%-93%). In 9 patients, both octreotide scintigraphy and bone scintigraphy were performed. Of 45 bone lesions, 22 (49%) were visualized by both modalities, 13 (29%) were visualized with octreotide scintigraphy but not with bone scintigraphy, and 10 (22%) were visualized with bone scintigraphy but not with octreotide scintigraphy. In 2 patients, octreotide scintigraphy and bone scintigraphy provided complementary results. Markers of bone metabolism could not discriminate carcinoid patients from those without bone metastases. The markers of bone metabolism did not reflect the osteolytic or osteoblastic appearance of metastases.


CONCLUSIONS
Pain is the principal symptom of bone metastases in patients with carcinoid tumors. Plain radiography and markers of bone metabolism do not contribute to the diagnosis of bone metastases. MRI has a high sensitivity for bone metastases. Both bone scintigraphy and octreotide scintigraphy have acceptable sensitivity and can provide complementary results.
Meijer
Wim G
WG
Department of Medical Oncology, University Hospital Groningen, Groningen, The Netherlands.
van der Veer
Eveline
E
Jager
Piet L
PL
van der Jagt
Erik J
EJ
Piers
Bert A
BA
Kema
Ido P
IP
de Vries
Elisabeth G E
EG
Willemse
Pax H B
PH
D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood* / Q000378:metabolism / Q000652:urine*; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000556:secondary*; D002276:Carcinoid Tumor / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000556:secondary*; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012701:Serotonin / Q000097:blood / Q000652:urine
D014408:Biomarkers, Tumor; D012701:Serotonin