Clinical decision-making in bone cancer care management and forecast of ICU needs based on computed tomography

IF 3.4 2区医学 Q2 Medicine

Journal of Bone Oncology Pub Date : 2024-11-02 DOI:10.1016/j.jbo.2024.100646

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引用次数: 0

Abstract

Objective

This study aimed to evaluate the role of computed tomography (CT) imaging in the diagnosis and management of bone cancer during periods of limited access to histopathological testing. We aimed to determine the correlation between CT severity levels and subsequent patient management and care decisions, adhering to established oncological CT reporting guidelines.

Methodology

A retrospective analysis was conducted on 60 symptomatic patients from January 2021 to January 2024. The cohort included patients aged between 50 and 86 years, with a mean age of 68 years, and 75 % were male. All patients had their bone cancer diagnosis confirmed through histopathological examination, and CT imaging was used as the reference method. The analysis involved assessing the correlation between CT severity scores and patient management, including ICU admissions.

Results

The study found that CT imaging demonstrated a sensitivity of 92.6% in diagnosing bone cancer, with accuracy increasing to 97.6% in cases with high-probability CT characteristics. CT specificity also showed a consistent rise. Osteolytic lesions were the predominant finding, detected in 85.9% of cases. Among these, 88% exhibited engagement across multiple skeletal regions, 92.8% showed bilateral distribution, and 92.8% presented with peripheral involvement. In ICU patients, bone consolidation was observed in 81.5% of cases and was predominant in 66.7% of the ICU cohort. Additionally, ICU patients had significantly higher CT severity scores, with scores exceeding 14 being notably prevalent.

Conclusions

During the management period of bone cancer at our hospital, characteristic features on CT imaging facilitated swift and sensitive investigation. Two distinct CT phenotypes, associated with the primary osteolytic phenotype and severity score, emerged as valuable indicators for assessing the severity of the disease, particularly during ICU care. These findings highlight the diverse manifestations and severity levels encountered in bone cancer patients and underscore the importance of CT imaging in their diagnosis and management.

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骨癌护理管理的临床决策和基于计算机断层扫描的重症监护室需求预测

本研究旨在评估计算机断层扫描（CT）成像在组织病理学检测受限期间骨癌诊断和管理中的作用。我们旨在确定 CT 严重程度与后续患者管理和护理决策之间的相关性，同时遵守既定的肿瘤 CT 报告指南。患者年龄在 50 至 86 岁之间，平均年龄为 68 岁，其中 75% 为男性。所有患者均通过组织病理学检查确诊为骨癌，并以 CT 成像作为参考方法。结果研究发现，CT 成像在诊断骨癌方面的灵敏度为 92.6%，在具有高概率 CT 特征的病例中，准确率上升到 97.6%。CT 特异性也呈持续上升趋势。溶骨性病变是最主要的发现，在 85.9% 的病例中被检测到。其中，88%的病例表现为多个骨骼区域受累，92.8%的病例表现为双侧分布，92.8%的病例表现为外周受累。在重症监护室患者中，81.5%的病例观察到骨质增生，66.7%的重症监护室患者以骨质增生为主。此外，ICU 患者的 CT 严重程度评分明显较高，超过 14 分的患者明显增多。两种不同的 CT 表型与原发性溶骨表型和严重程度评分相关，是评估疾病严重程度的重要指标，尤其是在重症监护室护理期间。这些发现突显了骨癌患者的不同表现和严重程度，并强调了 CT 成像在诊断和管理中的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Bone Oncology ONCOLOGY-

CiteScore

7.20

自引率

2.90%

发文量

审稿时长

34 days

期刊介绍： The Journal of Bone Oncology is a peer-reviewed international journal aimed at presenting basic, translational and clinical high-quality research related to bone and cancer. As the first journal dedicated to cancer induced bone diseases, JBO welcomes original research articles, review articles, editorials and opinion pieces. Case reports will only be considered in exceptional circumstances and only when accompanied by a comprehensive review of the subject. The areas covered by the journal include: Bone metastases (pathophysiology, epidemiology, diagnostics, clinical features, prevention, treatment) Preclinical models of metastasis Bone microenvironment in cancer (stem cell, bone cell and cancer interactions) Bone targeted therapy (pharmacology, therapeutic targets, drug development, clinical trials, side-effects, outcome research, health economics) Cancer treatment induced bone loss (epidemiology, pathophysiology, prevention and management) Bone imaging (clinical and animal, skeletal interventional radiology) Bone biomarkers (clinical and translational applications) Radiotherapy and radio-isotopes Skeletal complications Bone pain (mechanisms and management) Orthopaedic cancer surgery Primary bone tumours Clinical guidelines Multidisciplinary care Keywords: bisphosphonate, bone, breast cancer, cancer, CTIBL, denosumab, metastasis, myeloma, osteoblast, osteoclast, osteooncology, osteo-oncology, prostate cancer, skeleton, tumour.