UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

骨肿瘤的诊断与活检技术

Authors
Daniel Rosenthal, MD
Francis J Hornicek, MD, PhD
Section Editors
Thomas F DeLaney, MD
Alberto S Pappo, MD
Deputy Editor
Diane MF Savarese, MD
Translators
翟墨, 主治医师

引言

多数骨肿瘤呈良性，但良性骨肿瘤的真实发病率尚不明确，因为大部分良性骨肿瘤无症状，且通常是偶然被发现的。据粗略估计，良性骨肿瘤的发病率可能是原发性恶性骨肿瘤的100倍以上。 (参见“Benign bone tumors in children and adolescents”)

原发性恶性骨肿瘤并不常见，但却是癌症相关并发症和死亡的一个重要原因，尤其是对于年轻人群。原发性恶性骨肿瘤虽然在儿童期相对少见，但却是儿童中第6大最常见肿瘤，而在青少年和年轻成人中是第3大最常见肿瘤，仅次于白血病和淋巴瘤[1,2]。据估计，美国每年确诊约3000例原发性恶性骨肿瘤(起源于骨髓的恶性肿瘤除外)，约半数致死[3]。

原发性恶性骨肿瘤的分类依据是细胞学特征和细胞产物(表 1)。对于许多这些肿瘤，最主要是骨肉瘤和尤文肉瘤肿瘤家族(Ewing sarcoma family of tumor, EFT)，过去40年里在外科技术和多学科治疗领域取得了长足进步，因而显著提高了治愈和保肢的可能性。

对于疑似原发性骨肿瘤患者，初始诊断性检查和分期评估(特别是诊断性活检)是治疗成功的关键。本文将讨论原发性骨肿瘤的诊断性评估和活检技术。各类具体骨肿瘤的分型、流行病学和临床特征，以及在转移性骨肿瘤、骨髓瘤和淋巴瘤情况下针对完全或濒临病理性骨折患者的评估和处理参见其他专题。

●(参见“骨源性肉瘤：术前评估、组织学分型和外科治疗原则”)

                       

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2016-12-01.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Gurney JG, Swensen AR, Bulterys M. Malignant bone tumors. In: Cancer Incidence and Survival Among Children and Adolescents: United States SEER Program 1975-1995, Ries LA, Smith MAS, Gurney JG, et al (Eds), SEER program, National Cancer Institute, Bethesda MD 1999. p.99. (Pub #99-4649).
  2. Smith MA, Gurney JG, Ries LA. Cancer in adolescents 15 to 19 years old. In: Cancer incidence and Survival Among Children and Adolescents: United States SEER Program 1975-1995, Ries LA, Smith MAS, Gurney JG, et al (Eds), SEER program, National Cancer Institute, Bethesda MD 1999. (Pub #99-4649).
  3. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015; 65:5.
  4. Ferguson WS, Goorin AM. Current treatment of osteosarcoma. Cancer Invest 2001; 19:292.
  5. Jeffree GM, Price CH, Sissons HA. The metastatic patterns of osteosarcoma. Br J Cancer 1975; 32:87.
  6. Sajadi KR, Heck RK, Neel MD, et al. The incidence and prognosis of osteosarcoma skip metastases. Clin Orthop Relat Res 2004; :92.
  7. Kager L, Zoubek A, Kastner U, et al. Skip metastases in osteosarcoma: experience of the Cooperative Osteosarcoma Study Group. J Clin Oncol 2006; 24:1535.
  8. Schirrmeister H, Glatting G, Hetzel J, et al. Prospective evaluation of the clinical value of planar bone scans, SPECT, and (18)F-labeled NaF PET in newly diagnosed lung cancer. J Nucl Med 2001; 42:1800.
  9. Bhagia SM, Grimer RJ, Davies AM, Mangham DC. Scintigraphically negative skip metastasis in osteosarcoma. Eur Radiol 1997; 7:1446.
  10. Savelli G, Maffioli L, Maccauro M, et al. Bone scintigraphy and the added value of SPECT (single photon emission tomography) in detecting skeletal lesions. Q J Nucl Med 2001; 45:27.
  11. Ryan PJ, Fogelman I. The bone scan: where are we now? Semin Nucl Med 1995; 25:76.
  12. Jacobson AF, Stomper PC, Jochelson MS, et al. Association between number and sites of new bone scan abnormalities and presence of skeletal metastases in patients with breast cancer. J Nucl Med 1990; 31:387.
  13. Franzius C, Sciuk J, Daldrup-Link HE, et al. FDG-PET for detection of osseous metastases from malignant primary bone tumours: comparison with bone scintigraphy. Eur J Nucl Med 2000; 27:1305.
  14. Völker T, Denecke T, Steffen I, et al. Positron emission tomography for staging of pediatric sarcoma patients: results of a prospective multicenter trial. J Clin Oncol 2007; 25:5435.
  15. Peterson JJ. F-18 FDG-PET for detection of osseous metastatic disease and staging, restaging, and monitoring response to therapy of musculoskeletal tumors. Semin Musculoskelet Radiol 2007; 11:246.
  16. Enneking WF. A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res 1986; :9.
  17. American Joint Committee on Cancer Staging Manual, 6th, Greene FL, Page DL, Fleming ID, et al (Eds), Springer Verlag, New York 2002. p.187.
  18. Mankin HJ, Mankin CJ, Simon MA. The hazards of the biopsy, revisited. Members of the Musculoskeletal Tumor Society. J Bone Joint Surg Am 1996; 78:656.
  19. Peabody TD, Simon MA. Making the diagnosis: keys to a successful biopsy in children with bone and soft-tissue tumors. Orthop Clin North Am 1996; 27:453.
  20. Simon MA, Biermann JS. Biopsy of bone and soft-tissue lesions. J Bone Joint Surg Am 1993; 75:616.
  21. Davies NM, Livesley PJ, Cannon SR. Recurrence of an osteosarcoma in a needle biopsy track. J Bone Joint Surg Br 1993; 75:977.
  22. Schwartz HS, Spengler DM. Needle tract recurrences after closed biopsy for sarcoma: three cases and review of the literature. Ann Surg Oncol 1997; 4:228.
  23. Skrzynski MC, Biermann JS, Montag A, Simon MA. Diagnostic accuracy and charge-savings of outpatient core needle biopsy compared with open biopsy of musculoskeletal tumors. J Bone Joint Surg Am 1996; 78:644.
  24. Saifuddin A, Mitchell R, Burnett SJ, et al. Ultrasound-guided needle biopsy of primary bone tumours. J Bone Joint Surg Br 2000; 82:50.
  25. Jelinek JS, Murphey MD, Welker JA, et al. Diagnosis of primary bone tumors with image-guided percutaneous biopsy: experience with 110 tumors. Radiology 2002; 223:731.
  26. Hau A, Kim I, Kattapuram S, et al. Accuracy of CT-guided biopsies in 359 patients with musculoskeletal lesions. Skeletal Radiol 2002; 31:349.
  27. Leffler SG, Chew FS. CT-guided percutaneous biopsy of sclerotic bone lesions: diagnostic yield and accuracy. AJR Am J Roentgenol 1999; 172:1389.
  28. Dupuy DE, Rosenberg AE, Punyaratabandhu T, et al. Accuracy of CT-guided needle biopsy of musculoskeletal neoplasms. AJR Am J Roentgenol 1998; 171:759.
  29. Appelbaum AH, Kamba TT, Cohen AS, et al. Effectiveness and safety of image-directed biopsies: coaxial technique versus conventional fine-needle aspiration. South Med J 2002; 95:212.
  30. Ahlström KH, Aström KG. CT-guided bone biopsy performed by means of a coaxial biopsy system with an eccentric drill. Radiology 1993; 188:549.
  31. Blanco Sequeiros R, Klemola R, Ojala R, et al. MRI-guided trephine biopsy and fine-needle aspiration in the diagnosis of bone lesions in low-field (0.23 T) MRI system using optical instrument tracking. Eur Radiol 2002; 12:830.
  32. Parkkola RK, Mattila KT, Heikkilä JT, et al. Dynamic contrast-enhanced MR imaging and MR-guided bone biopsy on a 0.23 T open imager. Skeletal Radiol 2001; 30:620.
  33. Hopper KD, Abendroth CS, Sturtz KW, et al. Automated biopsy devices: a blinded evaluation. Radiology 1993; 187:653.
  34. Kattapuram SV, Rosenthal DI, Phillips WC. Trephine biopsy of the skeleton with the aid of a hand drill. Radiology 1984; 152:231.
  35. Aström KG, Sundström JC, Lindgren PG, Ahlström KH. Automatic biopsy instruments used through a coaxial bone biopsy system with an eccentric drill tip. Acta Radiol 1995; 36:237.
  36. Jelinek JS, Kransdorf MJ, Gray R, et al. Percutaneous transpedicular biopsy of vertebral body lesions. Spine (Phila Pa 1976) 1996; 21:2035.
  37. Stringham DR, Hadjipavlou A, Dzioba RB, Lander P. Percutaneous transpedicular biopsy of the spine. Spine (Phila Pa 1976) 1994; 19:1985.
  38. Kruyt RH, Oudkerk M, van Sluis D. CT-guided bone biopsy in a cancer center: experience with a new apple corer-shaped device. J Comput Assist Tomogr 1998; 22:276.
  39. Yao L, Nelson SD, Seeger LL, et al. Primary musculoskeletal neoplasms: effectiveness of core-needle biopsy. Radiology 1999; 212:682.
  40. Kattapuram SV, Khurana JS, Rosenthal DI. Percutaneous needle biopsy of the spine. Spine (Phila Pa 1976) 1992; 17:561.
  41. Babu NV, Titus VT, Chittaranjan S, et al. Computed tomographically guided biopsy of the spine. Spine (Phila Pa 1976) 1994; 19:2436.
  42. Bommer KK, Ramzy I, Mody D. Fine-needle aspiration biopsy in the diagnosis and management of bone lesions: a study of 450 cases. Cancer 1997; 81:148.
  43. Kornblum MB, Wesolowski DP, Fischgrund JS, Herkowitz HN. Computed tomography-guided biopsy of the spine. A review of 103 patients. Spine (Phila Pa 1976) 1998; 23:81.
  44. Fraser-Hill MA, Renfrew DL. Percutaneous needle biopsy of musculoskeletal lesions. 1. Effective accuracy and diagnostic utility. AJR Am J Roentgenol 1992; 158:809.
  45. Olscamp A, Rollins J, Tao SS, Ebraheim NA. Complications of CT-guided biopsy of the spine and sacrum. Orthopedics 1997; 20:1149.