Nucl Med Mol Imaging.  2013 Mar;47(1):27-35.

Usefulness of 18F-fluoride PET/CT in Breast Cancer Patients with Osteosclerotic Bone Metastases

• Yoon SH
• Kim KS
• Kang SY
• Song HS
• Jo KS
• Choi BH
• Lee SJ
• Yoon JK
• An YS

Abstract

PURPOSE
Bone metastasis is an important factor for the treatment and prognosis of breast cancer patients. Whole-body bone scintigraphy (WBBS) can evaluate skeletal metastases, and 18F-FDG PET/CT seems to exhibit high specificity and accuracy in detecting bone metastases. However, there is a limitation of 18F-FDG PET in assessing sclerotic bone metastases because some lesions may be undetectable. Recent studies showed that 18F-fluoride PET/CT is more sensitive than WBBS in detecting bone metastases. This study aims to evaluate the usefulness of 18F-fluoride PET/CT by comparing it with WBBS and 18F-FDG PET/CT in breast cancer patients with osteosclerotic skeletal metastases.
MATERIALS AND METHODS
Nine breast cancer patients with suspected bone metastases (9 females; mean age +/- SD, 55.6 +/- 10.0 years) underwent 99mTc-MDP WBBS, 18F-FDG PET/CT and 18F-fluoride PET/CT. Lesion-based analysis of five regions of the skeletons (skull, vertebral column, thoracic cage, pelvic bones and long bones of extremities) and patient-based analysis were performed.
RESULTS
18F-fluoride PET/CT, 18F-FDG PET/CT and WBBS detected 49, 20 and 25 true metastases, respectively. Sensitivity, specificity, positive predictive value and negative predictive value of 18F-fluoride PET/CT were 94.2 %, 46.3 %, 57.7 % and 91.2 %, respectively. Most true metastatic lesions on 18F-fluoride PET/CT had osteosclerotic change (45/49, 91.8 %), and only four lesions showed osteolytic change. Most lesions on 18F-FDG PET/CT also demonstrated osteosclerotic change (17/20, 85.0 %) with three osteolytic lesions. All true metastatic lesions detected on WBBS and 18F-FDG PET/CT were identified on 18F-fluoride PET/CT.
CONCLUSION
18F-fluoride PET/CT is superior to WBBS or 18F-FDG PET/CT in detecting osteosclerotic metastatic lesions. 18F-fluoride PET/CT might be useful in evaluating osteosclerotic metastases in breast cancer patients.

Keyword

18F-fluoride; 18F-NaF; PET/CT; Breast cancer; Skeletal metastases

MeSH Terms

Breast
Breast Neoplasms
Fluorodeoxyglucose F18
Humans
Neoplasm Metastasis
Pelvic Bones
Prognosis
Sensitivity and Specificity
Skeleton
Spine
Technetium Tc 99m Medronate
Fluorodeoxyglucose F18
Technetium Tc 99m Medronate