Association between bone scintigraphy and serum levels of tumor markers in the detection of bone disease in breast cancer patients.
OBJECTIVE
To evaluate the diagnostic value of bone scan in association with measurements of serum CEA, CA 15-3 and TPA levels in breast cancer (BC) patients.


METHODS
From September 1999 to January 2005, 89 women with BC who had undergone bone scintigraphy as part of their follow-up were retrospectively evaluated. Serum tumor markers levels were compared with the results of bone scintigraphy. Patients with positive bone scans were divided into 3 groups: group 1: 1-3, group 2: 4-5, group 3: >5 bone lesions. Serum CEA, CA 15-3 and TPA levels of 7 ng/ml, 35 U/ml and 90 U/I, respectively, were adopted as the upper limit of normal.


RESULTS
Serum CA 15-3 was significantly higher in patients with a positive bone scan (p=0.017). For CEA and TPA, no significant difference was found between patients with and without bone metastases. Twenty-five of 70 patients (36%) with normal CEA had bone metastases. Four of 50 (8%) patients with normal CA 15-3 and 15 of 51 (29%) patients with normal TPA had a positive bone scan. The combination of CA 15-3 with TPA showed 100% sensitivity in detecting bone metastases in all patient subgroups. In all 42 patients without bone metastases, CA 15-3 and/or TPA levels were normal.


CONCLUSIONS
CA 15-3 but not CEA or TPA is sensitive and specific for the correct determination of bone scintigraphy. CA 15-3 plus TPA represent the best combination in association with bone scanning. However, due to frequent false negative results of all tumor markers, it is not recommended to reject a bone scan on the basis of tumor markers levels.
Zissimopoulos
A
A
Department of Nuclear Medicine, University General Hospital of Alexandroupolis, Alexandroupolis, Greece. azissim@yahoo.gr
Matthaios
D
D
Matthaiou
E
E
Mantadakis
E
E
Karaitianos
I
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D001859:Bone Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D014408:Biomarkers, Tumor