Analysis of misdiagnosis of bone metastatic tumor / 中华骨科杂志

ABSTRACT

Objective To promote more understanding of bone metastasis and reduce the misdiag-nostic rate of bone metastatic tumor.Methods The mechanism of skeletal metastasis,the spreading pathway of tumor to bone,its frequency and distribution of skeletal metastasis,as well as relative frequency of primary malignant tumor,clinical features,diagnosis and differential diagnosis with bone metastastic tumor were re-viewed.Five misdiagnosed cases as bone metastasis were presented.Results Five cases of patients were ob-tained post-longer time of follow-up examination,ranging from24to96months(average57.6months).Case1was carcinoma of lung,and case2carcinoma of prostatic gland,both were living and well.Case4and case5were tuberculosis of lumbar spine,their conditions were stable and satisfied.A lesion of lum-bo sacral disc in case3was found and diagnosed as infection and kept stable without any back and extremities pain since first attack of disease.The causes of misdiagnosis were analyzed.Conclusion Meticulous review of the history and clinical features as well as proper explanation of the supplemental data from plain X-ray,bone scintigraphy,CT and MRI findings are essential for diagnosis of majority of bone metastatic tumor.Al -though such new imaging devices(as bone scintigraphy,CT and MRI )possess a high sensitivity for early detection of bone metastasis,yet with a poor specificity,hence orthopaedic surgeon have to catch hold of proper understanding about new imaging techniques.In difficult and doubtful cases,the bone biopsy under CT guiding may be needed,the radioisotopic Hawkeye system and diffusion weighted MR imaging are rec-ommended for differential diagnosis of senile acute benign(e.g.osteoporosis)and malignant (e.g.metastasis)vertebral body com pressive fracture.