摘要
AIM: To compare 2-deoxy-2-(^(18)F)fluoro-D-glucose(^(18)FFDG) and ^(18)F-sodium(^(18)F-NaF) positron emission tomography/computed tomography(PET/CT) accuracy in breast cancer patients with clinically/radiologically suspected or known bone metastases.METHODS: A total of 45 consecutive patients with breast cancer and the presence or clinical/biochemical or radiological suspicion of bone metastatic disease underwent ^(18)F-FDG and ^(18)F-fluoride PET/CT. Imaging results were compared with histopathology when available, or clinical and radiological follow-up of at least 1 year. For each technique we calculated: Sensitivity(Se), specificity(Sp), overall accuracy, positive and negative predictive values, error rate, and Youden's index. Mc Nemar's χ~2 test was used to test the difference in sensitivity and specificity between the two diagnostic methods. All analyses were computed on a patient basis, and then on a lesion basis, with consideration ofthe density of independent lesions on the coregistered CT(sclerotic, lytic, mixed, no-lesions) and the divergent site of disease(skull, spine, ribs, extremities, pelvis). The impact of adding ^(18)F-Na F PET/CT to the work-up of patients was also measured in terms of change in their management due to ^(18)F-Na F PET/CT findings. RESULTS: The two imaging methods of ^(18)F-FDG and ^(18)F-fluoride PET/CT were significantly different at the patient-based analysis: Accuracy was 86.7% and 84.4%, respectively(Mc Nemar's χ~2 = 6.23, df = 1, P = 0.01). Overall, 244 bone lesions were detected in our analysis. The overall accuracy of the two methods was significantly different at lesion-based analysis(Mc Nemar's χ~2 = 93.4, df = 1, P < 0.0001). In the lesion density-based and site-based analysis, ^(18)F-FDG PET/CT provided more accurate results in the detection of CT-negative metastasis(P < 0.002) and vertebral localizations(P < 0.002); ^(18)F-Na F PET/CT was more accurate in detecting sclerotic(P < 0.005) and rib lesions(P < 0.04). ^(18)F-Na F PET/CT led to a change of management in 3 of the 45 patients(6.6%) by revealing findings that were not detected at ^(18)F-FDG PET/CT. CONCLUSION: ^(18)F-FDG PET/CT is a reliable imaging tool in the detection of bone metastasis in most cases, with a diagnostic accuracy that is slightly, but significantly, superior to that of ^(18)F-Na F PET/CT in the general population of breast cancer patients. However, the extremely high sensitivity of ^(18)F-fluoride PET/CT can exploit its diagnostic potential in specific clinical settings(i.e., small CT-evident sclerotic lesions, high clinical suspicious of relapse, and negative ^(18)F-FDG PET and conventional imaging).
AIM: To compare 2-deoxy-2-(<sup>18</sup>F)fluoro-D-glucose(<sup>18</sup>F-FDG) and <sup>18</sup>F-sodium (<sup>18</sup>F-NaF) positron emission tomography/computed tomography (PET/CT) accuracy in breast cancer patients with clinically/radiologically suspected or known bone metastases.METHODS: A total of 45 consecutive patients with breast cancer and the presence or clinical/biochemical or radiological suspicion of bone metastatic disease underwent <sup>18</sup>F-FDG and <sup>18</sup>F-fluoride PET/CT. Imaging results were compared with histopathology when available, or clinical and radiological follow-up of at least 1 year. For each technique we calculated: Sensitivity (Se), specificity (Sp), overall accuracy, positive and negative predictive values, error rate, and Youden’s index. McNemar’s χ<sup>2</sup> test was used to test the difference in sensitivity and specificity between the two diagnostic methods. All analyses were computed on a patient basis, and then on a lesion basis, with consideration ofthe density of independent lesions on the co-registered CT (sclerotic, lytic, mixed, no-lesions) and the divergent site of disease (skull, spine, ribs, extremities, pelvis). The impact of adding <sup>18</sup>F-NaF PET/CT to the work-up of patients was also measured in terms of change in their management due to <sup>18</sup>F-NaF PET/CT findings.RESULTS: The two imaging methods of <sup>18</sup>F-FDG and <sup>18</sup>F-fluoride PET/CT were significantly different at the patient-based analysis: Accuracy was 86.7% and 84.4%, respectively (McNemar’s χ<sup>2</sup> = 6.23, df = 1, P = 0.01). Overall, 244 bone lesions were detected in our analysis. The overall accuracy of the two methods was significantly different at lesion-based analysis (McNemar’s χ<sup>2</sup> = 93.4, df = 1, P < 0.0001). In the lesion density-based and site-based analysis, <sup>18</sup>F-FDG PET/CT provided more accurate results in the detection of CT-negative metastasis (P < 0.002) and vertebral localizations (P < 0.002); <sup>18</sup>F-NaF PET/CT was more accurate in detecting sclerotic (P < 0.005) and rib lesions (P < 0.04). <sup>18</sup>F-NaF PET/CT led to a change of management in 3 of the 45 patients (6.6%) by revealing findings that were not detected at <sup>18</sup>F-FDG PET/CT.CONCLUSION: <sup>18</sup>F-FDG PET/CT is a reliable imaging tool in the detection of bone metastasis in most cases, with a diagnostic accuracy that is slightly, but significantly, superior to that of <sup>18</sup>F-NaF PET/CT in the general population of breast cancer patients. However, the extremely high sensitivity of <sup>18</sup>F-fluoride PET/CT can exploit its diagnostic potential in specific clinical settings (i.e., small CT-evident sclerotic lesions, high clinical suspicious of relapse, and negative <sup>18</sup>F-FDG PET and conventional imaging).
