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 journalArticlepeer-review

16 Citations (Scopus)
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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 languageEnglish
Pages (from-to)322-327
Number of pages6
JournalJournal of Nuclear Medicine
Volume60
Issue number3
DOIs
Publication statusPublished - 1 Mar 2019

Keywords

  • F-fluoride PET/CT
  • Bone metastases
  • Breast cancer
  • Heterogeneity

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