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Prospective comparison of whole-body bone SPECT and sodium 18F-fluoride PET in the detection of bone metastases from breast cancer

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Gad Abikhzer, Saher Srour, Georgeta Fried, Karen Drumea, Ela Kozlener, Alex Frenkel, Ora Israel, Ignac Fogelman, Olga Kagna

Original languageEnglish
Pages (from-to)1160-1168
Number of pages9
JournalNuclear Medicine Communications
Volume37
Issue number11
DOIs
Publication statusPublished - 1 Nov 2016

King's Authors

Abstract

Objective The superiority of sodium 18F-fluoride PET (18F-PET)/computed tomography (CT) over planar and single field-of-view single-photon emission computed tomography (SPECT) bone scintigraphy with 99mTc-methylene diphosphonate in bone metastases detection has been established. The present study prospectively compares whole-body 99mTc-methylene diphosphonate SPECT (WB-SPECT) and 18F-PET performance indices for the detection of bone metastases in breast cancer. Methods A total of 41 pairs of studies in female breast cancer patients (average age 58 years, range 30-75) were included. Half-time WB-SPECT and 18F-PET/CT were performed at a 4-day average interval (range 0-36 days), with subsequent fusion of CT to WB-SPECT. Two readers independently interpreted the studies, with differences resolved by consensus. Composite gold standard included the CT component of the 18F-PET/CT study with follow-up CT, MRI, 18F-fluoro-deoxyglucose-PET/CT, and bone scans. Results On patient-based analysis, metastases were diagnosed in 21 patients, with 19 patients detected by WB-SPECT and 21 with 18F-PET, the latter being the only modality to detect a single metastasis in two patients. The sensitivity of WB-SPECT and 18F-PET was 90 and 100% (P=NS), and the specificity were 95 and 85%, respectively (P=NS). On lesion-based analysis, 284 total sites of increased uptake were found. WB-SPECT detected 171/284 (60%) and 18F-PET 268/284 (94%) lesions, with good interobserver agreement for WB-SPECT (κ=0.679) and excellent agreement for 18F-PET (κ=0.798). The final analysis classified 204 lesions as benign and 80 as metastases. WB-SPECT identified 121 benign and 50 malignant sites compared with 192 and 76, respectively, for 18F-PET. WB-SPECT and 18F-PET had a sensitivity of 63 vs. 95%, P-value of less than 0.001, and a specificity of 97 vs. 96% (P=NS), respectively, on lesion-based analysis. Conclusion 18F-PET had higher sensitivity for the diagnosis of bone metastases from breast cancer compared with WB-SPECT, showing a statistically significant 32% increase on lesion-based analysis.

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