Ab0793 contribution of Investigations for the Quest of Primitive Cancer in Front of Bone Metastasis

Abstract

Background:Bone metastases (OM) or secondary cancers bones are bony locations of tumor cells, away from a primary malignant tumor. The Bone metastases are the most common metastases. They can be revealing in 20 to 30% cases or complicate the course of a known cancer. The bone metastases are a pejorative prognostic factor.Objectives:The aim of this study was to identify the Contribution of diagnostic methods for the quest of primitive cancer in presence of bone metastasis.Methods:We conduct a retrospective study of 35 files of patients who were hospitalized in the rheumatology department. All patients underwent a questionnaire and a clinical examination. Additional radiological assessment, bone biopsies, biopsies of other sites, bone scintigraphy and tumor markers were carried out on a case-by-case basis.Results:Thirty-five cases (25 men and 10 women) were analysed. The average age was 61 years [45-85]. Seven patients had a known history of neoplasia. One or more bone biopsies were performed in 8 cases. The vertebrae were the most biopsied bone site (6 cases). The bone biopsies were in favour of carcinoma (3 cases), adenocarcinoma (2 cases), squamous cell carcinoma (1 case) and inconclusive (2 cases). Non bony biopsies (2 pulmonary, 2 prostatic, 1 mammary) concluded to an adenocarcinoma (3 cases) and a carcinoma (2 cases). Bone scintigraphy was carried out in 7 cases and showed in all cases diffuse or localized hyperfixation. The localized value of tumor markers appeared relatively low except for Prostate Specific Antigen (PSA). Other metastatic localisations were identified: hepatic (6 cases) and pulmonary (1 case). The primary cancer identified was pulmonary for 11 patients, prostatic for 7, gynaecological for 4 and digestive for 3. One patient had Otorhinolaryngological cancer and another had bone cancer. Bone biopsy allowed the diagnosis in 6 cases (17%). The primary cancer was discovered by a biopsy of other non-bone sites in 5 cases (14%). Neoplastic antecedents and clinical context were considered sufficient in 16 cases (45%). Primary cancer remained undetermined in 8 cases (22%).Conclusion:Bone biopsy, as well as non-bone biopsy, remains an essential tool in the etiological diagnosis of bone metastases. They are very contributive in the same proportions. PSA is a major diagnostic asset in the search for primary cancer.Disclosure of Interests:None declared