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Review
. 2018 Nov;30(6):630-636.
doi: 10.1097/BOR.0000000000000535.

The diagnostic work-up of cancer-associated myositis

Albert Selva-O'Callaghan  1 , Xavier Martinez-Gómez  2 , Ernesto Trallero-Araguás  3 , Iago Pinal-Fernández  4
Affiliations
Review

The diagnostic work-up of cancer-associated myositis

Albert Selva-O'Callaghan et al. Curr Opin Rheumatol. 2018 Nov.

Abstract

Purpose of review: Despite the well-recognized association between malignancy and myositis, definite data indicating the best strategy for diagnosing cancer in myositis patients is lacking. In this article, we review the data on cancer screening in patients with myositis, and propose an algorithm for this purpose based on recently published data.

Recent findings: Evidence has recently emerged supporting blind screening in patients with certain myositis phenotypes. In addition to the clinical examination, imaging techniques such as PET/computed tomography scanning and whole-body MRI, and determination of the autoantibody profile beyond anti-TIF1γ antibody, the well known cancer biomarker in dermatomyositis, will help the clinician face this complex clinical situation. Molecules related to the checkpoint inhibitor pathway, specifically soluble programmed death 1, may also have a role in the diagnostic work-up of cancer in myositis. In the future, blood tests analysing circulating DNA will certainly help in detecting patients with cancer-associated myositis (CAM).

Summary: A step forward has been achieved in the pathway to establish optimal cancer screening for myositis patients. International consensus guidelines for an effective diagnostic work-up of CAM are in progress and will be of paramount importance to improving the outcome in these patients.

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Conflict of interest statement

Conflicts of interest

There are no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Algorithm for cancer screening in patients with idiopathic inflammatory myopathies. Conventional cancer screening: mammography and gynaecological ultrasound exam in women and whole (chest/abdomen/pelvis) computed tomography scan in all the patients. *Whole-body MRI could assist in cancer screening. †If available. In patients with high risk of cancer (i.e. patients with anti-TIF1γ or anti-NXP2 antibodies or high values of serum soluble programmed death ligand 1), a PET/computed tomography can be considered after a normal conventional screening. ‡Anti-HMGCR, anti-SAE, and ‘no myositis specific antibodies’ association with cancer need further investigation. CAM, cancer-associated myositis; IMNM, immune-mediated necrotizing myopathy; MSA, myositis specific antibodies; PET/computed tomography, [18F] fluorodeoxyglucose PET/computed tomography. HMGCR, 3-hydroxy-3-methylglutaryl coenzyme A reductase; SAE, small ubiquitin-like modifier activating enzyme.
FIGURE 2.
FIGURE 2.
A 57-year-old man was diagnosed with dermatomyositis. Initial screening included a through clinical examination that showed no target signs. Blind screening with [18F] PET/computed tomography disclosed a laterocervical lymphadenopathy with a high-standardized uptake value (SUV max = 8.7). Surgical biopsy of the node showed metastasis from a squamous cell type carcinoma of nasopharyngeal origin.
See this image and copyright information in PMC

References

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    2. In a large cohort of patients with dermatomyositis, the authors confirmed an association between cancer-associated myositis and anti-NXP2 antibody. Presence of anti-NXP2 confers a 3.68-fold increased risk of associated malignancy.

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