Clinical decision-making in bone cancer care management and forecast of ICU needs based on computed tomography

Huan Xu; Qunfang Zhao; Xiaoyan Miao; Lijun Zhu; Junping Wang

doi:10.1016/j.jbo.2024.100646

Clinical decision-making in bone cancer care management and forecast of ICU needs based on computed tomography

J Bone Oncol. 2024 Nov 2:49:100646. doi: 10.1016/j.jbo.2024.100646. eCollection 2024 Dec.

Authors

Huan Xu¹, Qunfang Zhao², Xiaoyan Miao³, Lijun Zhu⁴, Junping Wang¹

Affiliations

¹ Department of Hospital Infection Management, The First People's Hospital of Fuyang, Hangzhou 311400, China.
² Department of Renal and Endocrinology, The First People's Hospital of Fuyang, Hangzhou 311400, China.
³ Radiation Oncology Center, The First People's Hospital of Fuyang, Hangzhou 311400, China.
⁴ Department of Critical Care Medicine, The First People's Hospital of Fuyang, Hangzhou 311400, China.

Abstract

Objective: This study aimed to evaluate the role of computed tomography (CT) imaging in the diagnosis and management of bone cancer during periods of limited access to histopathological testing. We aimed to determine the correlation between CT severity levels and subsequent patient management and care decisions, adhering to established oncological CT reporting guidelines.

Methodology: A retrospective analysis was conducted on 60 symptomatic patients from January 2021 to January 2024. The cohort included patients aged between 50 and 86 years, with a mean age of 68 years, and 75 % were male. All patients had their bone cancer diagnosis confirmed through histopathological examination, and CT imaging was used as the reference method. The analysis involved assessing the correlation between CT severity scores and patient management, including ICU admissions.

Results: The study found that CT imaging demonstrated a sensitivity of 92.6% in diagnosing bone cancer, with accuracy increasing to 97.6% in cases with high-probability CT characteristics. CT specificity also showed a consistent rise. Osteolytic lesions were the predominant finding, detected in 85.9% of cases. Among these, 88% exhibited engagement across multiple skeletal regions, 92.8% showed bilateral distribution, and 92.8% presented with peripheral involvement. In ICU patients, bone consolidation was observed in 81.5% of cases and was predominant in 66.7% of the ICU cohort. Additionally, ICU patients had significantly higher CT severity scores, with scores exceeding 14 being notably prevalent.

Conclusions: During the management period of bone cancer at our hospital, characteristic features on CT imaging facilitated swift and sensitive investigation. Two distinct CT phenotypes, associated with the primary osteolytic phenotype and severity score, emerged as valuable indicators for assessing the severity of the disease, particularly during ICU care. These findings highlight the diverse manifestations and severity levels encountered in bone cancer patients and underscore the importance of CT imaging in their diagnosis and management.

Keywords: Bone cancer; CT severity score; Computed tomography; Histopathological testing; ICU admissions; Osteolytic lesions.