The presence of tumor cells in bone marrow at the time of first recurrence of breast cancer

Abstract

The occurrence of bone marrow carcinosis was investigated in 380 patients at the time of first recurrence of breast cancer. Results were related to results from radiographic bone survey, 99mTc MDP bone scintigraphy, clinical examination and serum alkaline phosphatase and serum calcium levels. Eighty-seven patients (23%) had tumor cells in the bone marrow. X-rays showed metastases in 78% of the patients with and in 16% of the patients without bone marrow carcinosis. The diagnostic efficiency of x-rays with bone marrow biopsy as the key diagnostic factor was 83%, and it was superior to that of other investigation methods. Bone tissue biopsies were positive alone in 15 patients (17%) and marrow aspirations were positive alone in seven patients (8%). Imprint preparations were positive alone in 7% of the patients and bone tissue biopsy in 5% of the patients. Heavy tumor infiltration (250%) of the bone marrow was associated with the occurrence of numerous regions of radiographically involved bone lesions and with histopathologic evidence of bone destruction. Furthermore, pronounced bone formation and marrow fibrosis were more commonly seen in patients with osteosclerotic bone metastases than in patients with osteolytic bone metastases. This study provides evidence that the primary soil of meta-static bone disease in human breast cancer is the bone marrow and that radiographic evidence of bone metastases is a result of an invasion and destruction of the bone tissue matrix by tumor cells from the marrow cavity. Cancer 60~306-1312, 1987. TAGING PROCEDURES for patients with first recurS rence of breast cancer are important prerequisites both for determining the clinical course to be followed and for establishing a thorough baseline evaluation before the onset of treatment.'-3 Moreover, the fact that most agents used in the treatment of recurrent breast cancer are myelosuppressive stresses the importance of evaluating the condition of the bone marrow before treatment is started.' Usually, x-rays and/or bone scin-tigraphy are used to evaluate the occurrence of bone metastases. However, histopathologic evidence of bone marrow carcinosis is not always associated with radio-graphic and scintigraphic abn~rmalities.~-' Previous clinical studies have shown a variation of 3% to 40% in the frequency of positive bone marrow exami-From the Departments of *Oncology ONA, ?Pathology, $Radiol-ogy, and §Clinical Physiology,

Oestrogen receptor status of primary breast carcinomas and their metastases. Relation to pattern of spread and survival after recurrence

“…The organisation and results of this study have been published previously (Kamby et al, 1987b obtain tissue for histological verification of metastasis (Kamby et al, 1987a).…”

Clinicopathological characteristics of disseminated carcinomatosis of the bone marrow in breast cancer patients

“…Clinically, it is important to suspect DCBM when a patient with advanced breast cancer manifests a hematological disorder, such as anemia or thrombocytopenia. Diagnostic tools, such as 18 F-fluorodeoxyglucose positron emission tomography/computed tomography and blood smear examination have been proposed for the diagnosis of DCBM (18)(19)(20); however, examination of a BM biopsy and/or aspirate remains the gold standard (3,14). Pathologically, DCBM is characterized by the diffuse infiltrative growth of tumor cells in the BM, and normal components, apart from bone trabeculae, are largely replaced by the tumor infiltrate (Fig.…”

“…Furthermore, the association between isolated tumor cells in the BM and clinically symptomatic BM metastasis has not been fully elucidated (11,14), whereas clinically evident BM metastasis is relatively common and often progresses to DCBM in patients with metastatic or recurrent breast cancer. It was reported that BM metastases were identified in 6-79% of breast cancer patients at autopsy (15)(16)(17), and 27% of autopsy cases were clinically diagnosed with BM metastases prior to autopsy (15).…”

Prognostic factors for bone metastases in breast cancer

“…Tumour cells are found in bone marrow at the time of the recurrence of breast cancer [12] and are found in 23% of patients without detection of metastases by radiographs or bone scans [5]. Bone man'ow scans have been shown to prove bone invasion earlier that routine radiographs [3].…”