Multiple bone scintigraphy metastatic lesions in correlation with breast carcinoma human epidermal growth factor receptor 2 neu and hormone receptor expression

Abstract

Aim/Introduction: Bone scintigraphy is a useful tool for the accurate diagnosis of skeletal metastatic lesions among oncological patients. Several factors have been proposed for the prediction of osseous and/or visceral metastatic disease onset in breast cancer patients. The aim of our study was to determine the correlation between multiple bone metastatic lesions initially diagnosed with bone scintigraphy and tumor receptor characteristics of breast cancer patients. Materials and Methods: We performed a monocentric (University Clinic ``Mother Theresa``), retrospective, observational study at the Institute of Pathophysiology and Nuclear Medicine and the Institute for Radiotherapy and Oncology in Skopje. Between January 2013 and December 2018, 66 female breast cancer patients (mean age 52,51 ± 10,64 years) who underwent initial 99mTc-MDP bone scintigraphy procedure and were diagnosed with multiple skeletal metastatic lesions were included in the study. Primary tumor characteristics regarding the human epidermal growth factor receptor 2 neu - HER2neu and hormone receptor - HR (estrogen receptor - ER and/or progesterone receptor - PR) expression of each patient were evaluated for association with multifocal osseous metastasis. Results: Bone metastatic lesions were initially detected 5,59 ± 2,72 years after the breast cancer diagnosis confirmation. The axial skeleton was affected in 29% of patients and in 71% the affection was both axial and appendicular. In our study cohort, the spine (predominantly the thoracic segment), the ribs and the pelvis were the most common sites of metastatic involvement (p = 0.013). ER+ were 86% (57/66) of the patients, PR+ were 74% (49/66) and HER2neu+ were 35% (23/66). HR+/HER2neu- were 65% (43/66) of the patients, HR+/HER2neu+ were 29% (19/66) and HR-/HE2neu+ were 6% (4/66). Multiple bone scintigraphy metastatic lesions significantly correlated with HR+ status of breast cancer patients (p = 0.021). Conclusion: Breast cancer patients with hormone receptor-positive status present significant predilection for skeletal metastatic patterns.