Is response assessment of breast cancer bone metastases better with measurement of                          
                        18
                                                 F-fluoride metabolic flux than with measurement of                          
                        18
                                                 F-fluoride PET/CT SUV?

Gurdip K. Azad; Musib Siddique; Benjamin Taylor; Adrian Green; Jim O’Doherty; Joanna Gariani; Glen M. Blake; Janine Mansi; Vicky Goh; Gary J.R. Cook

doi:10.2967/jnumed.118.208710

Is response assessment of breast cancer bone metastases better with measurement of ¹⁸ F-fluoride metabolic flux than with measurement of ¹⁸ F-fluoride PET/CT SUV?

Gurdip K. Azad, Musib Siddique, Benjamin Taylor, Adrian Green, Jim O’Doherty, Joanna Gariani, Glen M. Blake, Janine Mansi, Vicky Goh, Gary J.R. Cook^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

17 Citations (Scopus)

170 Downloads (Pure)

Abstract

Our purpose was to establish whether noninvasive measurement of changes in ¹⁸ F-fluoride metabolic flux to bone mineral (K _i ) by PET/ CT can provide incremental value in response assessment of bone metastases in breast cancer compared with SUV _max and SUV _mean . Methods: Twelve breast cancer patients starting endocrine treatment for de novo or progressive bone metastases were included. Static ¹⁸ F-fluoride PET/CT scans were acquired 60 min after injection, before and 8 wk after commencing treatment. Venous blood samples were taken at 55 and 85 min after injection to measure plasma ¹⁸ F-fluoride activity concentrations, and K _i in individual bone metastases was calculated using a previously validated method. Percentage changes in K _i , SUV _max , and SUV _mean were calculated from the same index lesions (#5 lesions) from each patient. Clinical response up to 24 wk, assessed in consensus by 2 experienced oncologists masked to PET imaging findings, was used as a reference standard. Results: Of the 4 patients with clinically progressive disease (PD), mean K _i significantly increased (.25%) in all, SUV _max in 3, and SUV _mean in 2. Of the 8 non-PD patients, K _i decreased or remained stable in 7, SUV _max in 5, and SUV _mean in 6. A significant mean percentage increase from baseline for K _i , compared with SUV _max and SUV _mean , occurred in the 4 patients with PD (89.7% vs. 41.8% and 43.5%, respectively; P, 0.001). Conclusion: After 8 wk of endocrine treatment for bone-predominant metastatic breast cancer, K _i more reliably differentiated PD from non-PD than did SUV _max and SUV _mean , probably because measurement of SUV underestimates fluoride clearance by not considering changes in input function.

Original language	English
Pages (from-to)	322-327
Number of pages	6
Journal	Journal of Nuclear Medicine
Volume	60
Issue number	3
DOIs	https://doi.org/10.2967/jnumed.118.208710
Publication status	Published - 1 Mar 2019

Keywords

F-fluoride PET/CT
Bone metastases
Breast cancer
Heterogeneity

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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Is Response Assessment of Breast_AZAD_Accepted18June2018_GOLD VoR (CC BY)Final published version, 1.06 MBLicence: CC BY

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Azad, G. K., Siddique, M., Taylor, B., Green, A., O’Doherty, J., Gariani, J., Blake, G. M., Mansi, J., Goh, V., & Cook, G. J. R. (2019). Is response assessment of breast cancer bone metastases better with measurement of ¹⁸ F-fluoride metabolic flux than with measurement of ¹⁸ F-fluoride PET/CT SUV? Journal of Nuclear Medicine, 60(3), 322-327. https://doi.org/10.2967/jnumed.118.208710

Azad, Gurdip K. ; Siddique, Musib ; Taylor, Benjamin et al. / Is response assessment of breast cancer bone metastases better with measurement of ¹⁸ F-fluoride metabolic flux than with measurement of ¹⁸ F-fluoride PET/CT SUV?. In: Journal of Nuclear Medicine. 2019 ; Vol. 60, No. 3. pp. 322-327.

@article{81b50aeef14c4cd392d74c33d99748c8,

title = "Is response assessment of breast cancer bone metastases better with measurement of 18 F-fluoride metabolic flux than with measurement of 18 F-fluoride PET/CT SUV?",

abstract = " Our purpose was to establish whether noninvasive measurement of changes in 18 F-fluoride metabolic flux to bone mineral (K i ) by PET/ CT can provide incremental value in response assessment of bone metastases in breast cancer compared with SUV max and SUV mean . Methods: Twelve breast cancer patients starting endocrine treatment for de novo or progressive bone metastases were included. Static 18 F-fluoride PET/CT scans were acquired 60 min after injection, before and 8 wk after commencing treatment. Venous blood samples were taken at 55 and 85 min after injection to measure plasma 18 F-fluoride activity concentrations, and K i in individual bone metastases was calculated using a previously validated method. Percentage changes in K i , SUV max , and SUV mean were calculated from the same index lesions (#5 lesions) from each patient. Clinical response up to 24 wk, assessed in consensus by 2 experienced oncologists masked to PET imaging findings, was used as a reference standard. Results: Of the 4 patients with clinically progressive disease (PD), mean K i significantly increased (.25%) in all, SUV max in 3, and SUV mean in 2. Of the 8 non-PD patients, K i decreased or remained stable in 7, SUV max in 5, and SUV mean in 6. A significant mean percentage increase from baseline for K i , compared with SUV max and SUV mean , occurred in the 4 patients with PD (89.7% vs. 41.8% and 43.5%, respectively; P, 0.001). Conclusion: After 8 wk of endocrine treatment for bone-predominant metastatic breast cancer, K i more reliably differentiated PD from non-PD than did SUV max and SUV mean , probably because measurement of SUV underestimates fluoride clearance by not considering changes in input function. ",

keywords = "F-fluoride PET/CT, Bone metastases, Breast cancer, Heterogeneity",

author = "Azad, {Gurdip K.} and Musib Siddique and Benjamin Taylor and Adrian Green and Jim O{\textquoteright}Doherty and Joanna Gariani and Blake, {Glen M.} and Janine Mansi and Vicky Goh and Cook, {Gary J.R.}",

year = "2019",

month = mar,

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doi = "10.2967/jnumed.118.208710",

language = "English",

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Azad, GK, Siddique, M, Taylor, B, Green, A, O’Doherty, J, Gariani, J, Blake, GM, Mansi, J, Goh, V & Cook, GJR 2019, 'Is response assessment of breast cancer bone metastases better with measurement of ¹⁸ F-fluoride metabolic flux than with measurement of ¹⁸ F-fluoride PET/CT SUV?', Journal of Nuclear Medicine, vol. 60, no. 3, pp. 322-327. https://doi.org/10.2967/jnumed.118.208710

Is response assessment of breast cancer bone metastases better with measurement of ¹⁸ F-fluoride metabolic flux than with measurement of ¹⁸ F-fluoride PET/CT SUV? / Azad, Gurdip K.; Siddique, Musib; Taylor, Benjamin et al.
In: Journal of Nuclear Medicine, Vol. 60, No. 3, 01.03.2019, p. 322-327.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Is response assessment of breast cancer bone metastases better with measurement of 18 F-fluoride metabolic flux than with measurement of 18 F-fluoride PET/CT SUV?

AU - Azad, Gurdip K.

AU - Siddique, Musib

AU - Taylor, Benjamin

AU - Green, Adrian

AU - O’Doherty, Jim

AU - Gariani, Joanna

AU - Blake, Glen M.

AU - Mansi, Janine

AU - Goh, Vicky

AU - Cook, Gary J.R.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Our purpose was to establish whether noninvasive measurement of changes in 18 F-fluoride metabolic flux to bone mineral (K i ) by PET/ CT can provide incremental value in response assessment of bone metastases in breast cancer compared with SUV max and SUV mean . Methods: Twelve breast cancer patients starting endocrine treatment for de novo or progressive bone metastases were included. Static 18 F-fluoride PET/CT scans were acquired 60 min after injection, before and 8 wk after commencing treatment. Venous blood samples were taken at 55 and 85 min after injection to measure plasma 18 F-fluoride activity concentrations, and K i in individual bone metastases was calculated using a previously validated method. Percentage changes in K i , SUV max , and SUV mean were calculated from the same index lesions (#5 lesions) from each patient. Clinical response up to 24 wk, assessed in consensus by 2 experienced oncologists masked to PET imaging findings, was used as a reference standard. Results: Of the 4 patients with clinically progressive disease (PD), mean K i significantly increased (.25%) in all, SUV max in 3, and SUV mean in 2. Of the 8 non-PD patients, K i decreased or remained stable in 7, SUV max in 5, and SUV mean in 6. A significant mean percentage increase from baseline for K i , compared with SUV max and SUV mean , occurred in the 4 patients with PD (89.7% vs. 41.8% and 43.5%, respectively; P, 0.001). Conclusion: After 8 wk of endocrine treatment for bone-predominant metastatic breast cancer, K i more reliably differentiated PD from non-PD than did SUV max and SUV mean , probably because measurement of SUV underestimates fluoride clearance by not considering changes in input function.

AB - Our purpose was to establish whether noninvasive measurement of changes in 18 F-fluoride metabolic flux to bone mineral (K i ) by PET/ CT can provide incremental value in response assessment of bone metastases in breast cancer compared with SUV max and SUV mean . Methods: Twelve breast cancer patients starting endocrine treatment for de novo or progressive bone metastases were included. Static 18 F-fluoride PET/CT scans were acquired 60 min after injection, before and 8 wk after commencing treatment. Venous blood samples were taken at 55 and 85 min after injection to measure plasma 18 F-fluoride activity concentrations, and K i in individual bone metastases was calculated using a previously validated method. Percentage changes in K i , SUV max , and SUV mean were calculated from the same index lesions (#5 lesions) from each patient. Clinical response up to 24 wk, assessed in consensus by 2 experienced oncologists masked to PET imaging findings, was used as a reference standard. Results: Of the 4 patients with clinically progressive disease (PD), mean K i significantly increased (.25%) in all, SUV max in 3, and SUV mean in 2. Of the 8 non-PD patients, K i decreased or remained stable in 7, SUV max in 5, and SUV mean in 6. A significant mean percentage increase from baseline for K i , compared with SUV max and SUV mean , occurred in the 4 patients with PD (89.7% vs. 41.8% and 43.5%, respectively; P, 0.001). Conclusion: After 8 wk of endocrine treatment for bone-predominant metastatic breast cancer, K i more reliably differentiated PD from non-PD than did SUV max and SUV mean , probably because measurement of SUV underestimates fluoride clearance by not considering changes in input function.

KW - F-fluoride PET/CT

KW - Bone metastases

KW - Breast cancer

KW - Heterogeneity

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Azad GK, Siddique M, Taylor B, Green A, O’Doherty J, Gariani J et al. Is response assessment of breast cancer bone metastases better with measurement of ¹⁸ F-fluoride metabolic flux than with measurement of ¹⁸ F-fluoride PET/CT SUV? Journal of Nuclear Medicine. 2019 Mar 1;60(3):322-327. doi: 10.2967/jnumed.118.208710