Nicole Zulauf, Ingo Marzi and Gerhard M Oremek
Background: This study investigated the usefulness of bone markers Alkaline Phosphatase (AP) and Beta- Crosslaps (ß-CTx) to diagnose, treat and monitor patients with breast carcinoma. AP is a marker of bone formation, while ß-CTx are markers of bone resorption. ß-CTx are expressed as degradation products of collagen type I and can be measured in blood and urine.
Objectives: The aim of this project was to evaluate the significance of bone markers ß-CTx and AP with regard to their usage for early diagnostics of bone metastases and pathological bone metabolism in pre- and postmenopausal patients with known breast cancer.
Materials and Methods: Peripheral blood samples of patients with mammarial diseases (benign and malign) were collected and the bone markers AP and ß-CTx determined. A total number of 110 patients had benign mammarial diseases, BMD (30 fibroadenoma, 50 mastopathy and 30 hypertrophy patients). 30 patients were suffering from a malignant breast cancer without bone metastases. 50 patients had known bone metastases. The determination of ß-CTx was conducted based on the Immunoassay “ECLIA”, the analysis approach Elecsys 2010 and cobase by Roche Diagnostics (Mannheim, Germany). The analysis of AP was performed with the HYDRAGEL ISO-PAL kits and HYDRASYS electrophoresis system of Sebia (Fulda, Germany).
Results: For the detection of bone metastases, the study showed a sensitivity of 94.0% with 86.67% specificity for AP. Results for ß-CTx had a sensitivity and specificity of 100.0%. An elevated ß-CTx activity was associated significantly with bone metastases in the study groups (p=0.000000). Furthermore there were significant differences (p=0.000000) due to the menopausal status of patients.
Conclusion: In conclusion ß-CTx are more sensitive and specific to detect bone metastases and bone turnover than AP. In patients with multimorbidity the origin of AP is not clear due to its multi-organic appearance. Hence ß- CTx are considered to be helpful in the diagnostic procedure of breast cancer-patients to detect bone metastases. Moreover they can be utilized to indicate patients with early dysfunctions in bone metabolism and allow inducing early treatment. ß-CTx as indicators of bone resorption are capable to provide a significant differentiation between mamma-carcinoma patients with and without bone affection.
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