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Cases presenting to orthopedists with manifestations of lung cancer on skeletal radiographs

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Abstract

The value of cervical spine or shoulder radiography has been established for the detection of Pancoast tumors. However, for the detection of lung cancers other than Pancoast tumors, the value of these skeletal radiographies has not been assessed. The aim of our study was to determine how many patients first presented to orthopedists with manifestations of lung cancer on skeletal radiographs and to present several cases for illustration. From the registry of the pathology department of our hospital, we identified 345 lung cancer patients diagnosed histologically over 10 years. From these patients, we selected 310 who had no previous history of malignancies at histological diagnosis of lung cancer. The study population consisted of individuals from the selected patients who had presented once or more to orthopedists at our hospital for any reason, at up to 2 years prior to histological diagnosis of lung cancer. For the study population, all radiological examinations performed by the orthopedists were reviewed by radiologists. The study population included 46 patients constituting 14.8 % (46/310) of the selected patients. Of these 46 patients, 37 (80.4 %) received 97 skeletal radiographies. Reviewing these skeletal radiographies disclosed lung tumors on 13 in 11 (11/46, 23.9 %) of the patients. We found that more than 10 % of lung cancer patients with no previous history of malignancies had presented to orthopedists on one or more occasions, at up to 2 years before histological diagnosis, and that approximately 25 % of these patients had manifestations of lung cancer on skeletal radiographs.

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References

  1. Alberg AJ, Ford JG, Samet JM (2007) Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132:29S–55S

    Article  PubMed  CAS  Google Scholar 

  2. Rigler LG (1966) The earliest roentgenographic signs of carcinoma of the lung. JAMA 21(8):655–657

    Article  Google Scholar 

  3. Rogers TK (2010) Primary care radiography in the early diagnosis of lung cancer. Cancer Imaging 10:73–76

    Article  PubMed  Google Scholar 

  4. Söderlund V (1996) Radiological diagnosis of skeletal metastases. Eur Radiol 6:587–595

    Article  PubMed  Google Scholar 

  5. Hage WD, Aboulafia AJ, Aboulafia DM (2000) Incidence, location, and diagnostic evaluation of metastatic bone disease. Orthop Clin North Am 31:515–528

    Article  PubMed  CAS  Google Scholar 

  6. Balducci L (2005) Epidemiology of cancer and aging. J Oncol Manag 14(2):47–50

    PubMed  Google Scholar 

  7. Loeser RF (2010) Age-related changes in the musculoskeletal system and the development of osteoarthritis. Clin Geriatr Med 26:371–386

    Article  PubMed  Google Scholar 

  8. Whitley AS, Sloane C, Hoadley G, Moore AD, Alsop CW (2005) Clark’s positioning in radiography (12th ed). Hodder Arnold, London

  9. Spengler DM, Kirsh MM, Kaufer H (1973) Orthopaedic aspects and early diagnosis of superior sulcus tumor of lung (Pancoast). J Bone Joint Surg Ann 55A:1645–1650

    Google Scholar 

  10. Bisbinas I, Langkamer VG (1999) Pitfalls and delay in the diagnosis of Pancoast tumour presenting in orthopaedic units. Ann R Coll Surg Engl 81:291–295

    PubMed  CAS  Google Scholar 

  11. Villas C, Collía A, Aquerreta JD et al (2004) Cervicobrachialgia and Pancoast tumor: value of standard anteroposterior cervical radiographs in early diagnosis. Orthopedics 27:1092–1095

    PubMed  CAS  Google Scholar 

  12. Lababede O, Meziane M, Rice T (2011) Seventh edition of the cancer staging manual and stage grouping of lung cancer. Chest 139:183–189

    Article  PubMed  Google Scholar 

  13. Jacobsen S, Stephensen SL, Paaske BP et al (1997) Skeletal metastases of unknown origin: a retrospective analysis of 29 cases. Acta Orthop Belg 63:15–22

    PubMed  CAS  Google Scholar 

  14. Rougraff BT, Kneisl JS, Smon MA (1993) Skeletal metastases of unknown origin. A prospective study of a diagnostic strategy. J Bone Surg Am 75(9):1276–1281

    Google Scholar 

  15. Byers TE, Vena JE, Rzepka TF (1984) Predilection of lung cancer for the upper lobes: an epidemiologic inquiry. J Natl Cancer Inst 72:1271–1275

    PubMed  CAS  Google Scholar 

  16. Friberg S, Mattson S (1997) On the growth rates of human malignant tumors: implications for medical decision making. J Surg Oncol 65:284–297

    Article  PubMed  CAS  Google Scholar 

  17. Rigler LG, O’Loughlin BJ, Tucker RC (1953) The duration of carcinoma of the lung. Chest 23:50–71

    Article  CAS  Google Scholar 

  18. Mattoon JS (2006) Digital radiography. Vet Comp Orthop Traumatol 19:123–132

    PubMed  CAS  Google Scholar 

  19. Forrest JV, Friedman PJ (1981) Radiologic errors in patients with lung cancer. West J Med 134:485–490

    PubMed  CAS  Google Scholar 

  20. Woodring JH (1990) Pitfalls in the radiologic diagnosis of lung cancer. AJR 154:1165–1175

    Article  PubMed  CAS  Google Scholar 

  21. Turkington PM, Kennan N, Greenstone MA (2002) Misinterpretation of the chest x ray as a factor in the delayed diagnosis of lung cancer. Postgrad Med J 78:158–160

    Article  PubMed  CAS  Google Scholar 

  22. Bjerager M, Palshof T, Dahl R et al (2006) Delay in diagnosis of lung cancer in general practice. Br J Gen Pract 56:863–868

    PubMed  Google Scholar 

  23. Ehara S, Nakajima Y, Matsui O (2008) Radiology in Japan in 2008. AJR 191(2):328–329

    Article  PubMed  Google Scholar 

  24. Turen CH, Mark JB, Bozman R (1995) Comparative analysis of radiographic interpretation of orthopedic films: is there redundancy? J Trauma 39:720–721

    Article  PubMed  CAS  Google Scholar 

  25. Anglen J, Marberry K, Gehrke J (1997) The clinical utility of duplicate readings for musculoskeletal radiographs. Orthopedics 20:1015–1019

    PubMed  CAS  Google Scholar 

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Acknowledgments

We wish to thank Mrs. Masako Mochizuki, secretary of Fukuroi Municipal Hospital, Fukuroi, Shizuoka, Japan, for helping with the preparation of the figures used in this manuscript.

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We declare there are no conflicts of interest.

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Correspondence to Kenji Ichinohe.

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Ichinohe, K., Ushio, T., Ookawa, Y. et al. Cases presenting to orthopedists with manifestations of lung cancer on skeletal radiographs. Eur J Orthop Surg Traumatol 23, 273–279 (2013). https://doi.org/10.1007/s00590-012-0984-1

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  • DOI: https://doi.org/10.1007/s00590-012-0984-1

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