Prevalence of Bone Metastases Detected by Bone Scan in Patients with Hepatocellular Carcinoma

Ratanapoom Songsermsawad; Nantaporn Wongsurawat; Daris Theerakulpisut; Anucha Ahooja

Authors

Ratanapoom Songsermsawad Department of Radiology, Faculty of Medicine, Srinakharinwirot University
Nantaporn Wongsurawat Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Khon Kaen University
Daris Theerakulpisut Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Khon Kaen University
Anucha Ahooja Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Khon Kaen University

Keywords:

hepatocellular carcinoma, bone metastasis, bone scan, liver transplantation

Abstract

Early-stage hepatocellular carcinoma (HCC) is curable by liver transplantation (LTx). However, donor scarcity necessitates a meticulous selection via Milan criteria. Although updated guidelines omit routine bone scans (BS) for staging, most Thai tertiary care centers still standardly perform them for LTx candidates with HCC. The aim of this study was to determine the prevalence of bone metastasis (BM) detected by BS among patients with HCC in northeastern Thailand and to assess the potential role of BS in the preoperative evaluation for LTx. This was a retrospective cross-sectional descriptive study of BS images of 101 patients with HCC who were referred to the Division of Nuclear Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. The prevalence of BS positivity and its potential associated factors were analyzed. A total of 16 patients had a positive BS (15.8%; 95% CI: 8.6–23.1) across multiple Barcelona Clinic Liver Cancer (BCLC) stages, including one patient in the very early stage (14.3%; 95% CI: 1.6–62.8). Among the 43 patients meeting the Milan criteria for LTx, three were found with positive BS (7.0%; 95% CI: 2.2–20.0). Bivariate analyses to determine the association between BS positivity and BCLC stage, Milan criteria, macrovascular invasion, largest tumor size, lymph node metastasis, and alpha-fetoprotein (AFP) level were performed, and tumors beyond the Milan criteria (crude OR 3.85; 95% CI: 1.02–14.5; p=0.046), the presence of macrovascular invasion (crude OR 3.05; 95% CI: 1.02–14.5; p=0.046), and N1 stage (crude OR 9.11; 95% CI: 1.81–45.8; p=0.007) demonstrated a statistically significant association with BS positivity. However, upon further evaluation using multivariable logistic regression to adjust for potential confounders, no factors remained statistically significant in association with positive BS. These findings suggest that BS may still have a role in the preoperative evaluation of patients with HCC being considered for LTx.

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