The role of 18F-fluoride PET-CT in the detection of bone metastases in patients with breast, lung and prostate carcinoma: a comparison with FDG PET/CT and 99mTc-MDP bone scan |
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Authors: | Nishikant Avinash Damle Chandrasekhar Bal G P Bandopadhyaya Lalit Kumar Praveen Kumar Arun Malhotra Sneh Lata |
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Institution: | 1. Department of Nuclear Medicine, All India Institute of Medical Sciences, Room no. 59 A, New Delhi, 110029, India 2. Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
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Abstract: | Objectives We aimed to compare the role of 18F-fluoride PET/CT, FDG PET/CT and 99mTc-MDP bone scans in the detection of bone metastases in patients with lung, breast and prostate carcinoma. Methods This was a prospective study including patients for staging (S) and restaging (R). Seventy-two patients (23S, 49R) with infiltrating ductal breast carcinoma, 49 patients (25S, 24R) with prostate adenocarcinoma and 30 patients (17S, 13R) with non-small-cell lung carcinoma (NSCLC), without known bone metastases but with high risk/clinical suspicion for the same, underwent a 99mTc-MDP bone scan, FDG PET/CT and 18F-fluoride PET/CT within 2 weeks. All scans were reviewed by two experienced nuclear medicine physicians, and the findings were correlated with MRI/thin-slice CT/skeletal survey. Histological verification was done wherever feasible. Results Sensitivity and negative predictive value (NPV) of 18F-fluoride PET/CT was 100 % in all three malignancies, while that of FDG PET/CT was 79 % and 73 % in NSCLC, 73 % and 80 % in breast cancer and 72 and 65 % in prostate cancer. Specificity and positive predictive value (PPV) of FDG PET/CT were 100 % in NSCLC and prostate and 97 % and 96 % in breast cancer. As compared to the 99mTc-MDP bone scan, all parameters were superior for 18F-fluoride PET/CT in prostate and breast cancer, but sensitivity and NPV were equal in NSCLC. The MDP bone scan had superior sensitivity and NPV compared to FDG PET/CT but had low specificity and PPV. Conclusion To rule out bone metastases in cases where there is a high index of suspicion, 18F-fluoride PET/CT is the most reliable investigation. 18F-fluoride PET/CT has the potential to replace the 99mTc-MDP bone scan for the detection of bone metastases. |
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