Pitfalls of FDG-PET for the diagnosis of osteoblastic bone metastases in patients with breast cancer |
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| Authors: | Takako Nakai Chio Okuyama Takao Kubota Kei Yamada Yo Ushijima Keiko Taniike Takako Suzuki Tsunehiko Nishimura |
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| Institution: | (1) Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan;(2) Nishijin Hospital, Kyoto, Japan;(3) Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajiichyou Kawaramachi-Hirokouji Kamigyou Kyoto, Kyoto 602-8566, Japan |
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| Abstract: | Purpose The purpose of this study was to investigate the pitfalls of using 2-18F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) for the evaluation of osteoblastic bone metastases in patients with breast cancer by comparing it with 99mTc-hydroxymethylene diphosphonate bone scintigraphy.Methods Among the 89 breast cancer patients (mean age 59±15 years) who had undergone both FDG-PET and bone scintigraphy within 1 month between September 2003 and December 2004, 55 with bone metastases were studied. The bone metastases were visually classified by multi-slice CT into four types according to their degree of osteosclerosis and osteolysis—osteoblastic, osteolytic, mixed and invisible—and compared in terms of tracer uptake on FDG-PET or bone scintigraphy and SUVmean on FDG-PET. Differences in the rate of detection on bone scintigraphy and FDG-PET were analysed for significance by the McNemar test.Results The sensitivity, specificity and accuracy of bone scintigraphy were 78.2%, 82.4% and 79.8% respectively, and those of FDG-PET were 80.0%, 88.2% and 83.1%, respectively, revealing no significant differences. According to the CT image type, the visualisation rate of bone scintigraphy/FDG-PET was 100%/55.6% for the blastic type, 70.0%/100.0% for the lytic type, 84.2%/94.7% for the mixed type and 25.0%/87.5% for the invisible type. The visualisation rates of bone scintigraphy for the blastic type and FDG-PET for the invisible type were significantly higher. The SUVmean of the blastic, lytic, mixed and invisible types were 1.72±0.28, 4.14±2.20, 2.97±1.98 and 2.25±0.80, respectively, showing that the SUVmean tended to be higher for the lytic type than for the blastic type.Conclusion FDG-PET showed a low visualisation rate in respect of osteoblastic bone metastases. Although FDG-PET is useful for detection of bone metastases from breast cancer, it is apparent that it suffers from some limitations in depicting metastases of the osteoblastic type.An editorial commentary on this paper is available at |
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| Keywords: | FDG-PET Bone metastases Osteoblastic Bone scintigraphy Breast cancer |
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