Diagnosis of bone metastases in breast cancer: Lesion-based sensitivity of dual-time-point FDG-PET/CT compared to low-dose CT and bone scintigraphy

We compared lesion-based sensitivity of dual-time-point FDG-PET/CT, bone scintigraphy (BS), and low-dose CT (LDCT) for detection of various types of bone metastases in patients with metastatic breast cancer. Prospectively, we included 18 patients with recurrent breast cancer who underwent dual-time-point FDG-PET/CT with LDCT and BS within a median time interval of three days. A total of 488 bone lesions were detected on any of the modalities and were categorized by the LDCT into osteolytic, osteosclerotic, mixed morphologic, and CT-negative lesions. Lesion-based sensitivity was 98.2% (95.4–99.3) and 98.8% (96.8–99.5) for early and delayed FDG-PET/CT, respectively, compared with 79.9% (51.1–93.8) for LDCT, 76.0% (36.3–94.6) for BS, and 98.6% (95.4–99.6) for the combined BS+LDCT. BS detected only 51.2% of osteolytic lesions which was significantly lower than other metastatic types. SUVs were significantly higher for all lesion types on delayed scans than on early scans (P<0.0001). Osteolytic and mixed-type lesions had higher SUVs than osteosclerotic and CT-negative metastases at both time-points. FDG-PET/CT had significantly higher lesion-based sensitivity than LDCT and BS, while a combination of the two yielded sensitivity comparable to that of FDG-PET/CT. Therefore, FDG-PET/CT could be considered as a sensitive one-stop-shop in case of clinical suspicion of bone metastases in breast cancer patients.

Download Full-text

Retention index of early delayed dual-time-point FDG PET/CT on primary tumor correlates with prognostic factors of invasive breast cancer

European Journal of Cancer ◽

10.1016/s0959-8049(18)30704-4 ◽

2018 ◽

Vol 92 ◽

pp. S159

Author(s):

H. Song

Keyword(s):

Breast Cancer ◽

Prognostic Factors ◽

Retention Index ◽

Invasive Breast Cancer ◽

Primary Tumor ◽

Fdg Pet ◽

Pet Ct ◽

Dual Time Point ◽

Fdg Pet Ct ◽

Time Point

Download Full-text

Breast cancer with low FDG uptake: Characterization by means of dual-time point FDG-PET/CT

European Journal of Radiology ◽

10.1016/j.ejrad.2008.01.045 ◽

2009 ◽

Vol 70 (3) ◽

pp. 530-538 ◽

Cited By ~ 21

Author(s):

Ashraf Anas Zytoon ◽

Koji Murakami ◽

Mohamed Ramdan El-Kholy ◽

Emad El-Shorbagy ◽

Osama Ebied

Keyword(s):

Breast Cancer ◽

Fdg Pet ◽

Fdg Uptake ◽

Pet Ct ◽

Dual Time Point ◽

Fdg Pet Ct ◽

Time Point

Download Full-text

Comparison of FDG-PET/CT and bone scintigraphy for detection of bone metastases in breast cancer

Acta Radiologica ◽

10.1258/ar.2011.100507 ◽

2011 ◽

Vol 52 (9) ◽

pp. 1009-1014 ◽

Cited By ~ 46

Author(s):

Steffen Hahn ◽

Till Heusner ◽

Sherko Kümmel ◽

Angelika Köninger ◽

James Nagarajah ◽

...

Keyword(s):

Breast Cancer ◽

Bone Metastases ◽

Bone Scintigraphy ◽

Fdg Pet ◽

Whole Body ◽

Reference Standard ◽

Breast Cancer Patients ◽

Pet Ct ◽

Fdg Pet Ct

Background Bone scintigraphy is the standard procedure for the detection of bone metastases in breast cancer patients. FDG-PET/CT has been reported to be a sensitive tool for tumor staging in different malignant diseases. However, its accuracy for the detection of bone metastases has not been compared to bone scintigraphy. Purpose To compare whole-body FDG-PET/CT and bone scintigraphy for the detection of bone metastases on a lesion basis in breast cancer patients. Material and Methods Twenty-nine consecutive women (mean age 58 years, range 35-78 years) with histologically proven breast cancer were assessed with bone scintigraphy and whole-body FDG-PET/CT. Twenty-one patients (72%) were suffering from primary breast cancer and eight patients (28%) were in aftercare with a history of advanced breast cancer. Both imaging procedures were assessed for bone metastases by a radiologist and a nuclear medicine physician. Concordant readings between bone scintigraphy and FDG-PET/CT were taken as true. Discordant readings were verified with additional MRI imaging in all patients and follow-up studies in most patients. Results A total of 132 lesions were detected on bone scintigraphy, FDG-PET/CT or both. According to the reference standard, 70/132 lesions (53%) were bone metastases, 59/132 lesions (45%) were benign, and three lesions (2%) remained unclear. The sensitivity of bone scintigraphy was 76% (53/70) compared to 96% (67/70) for FDG-PET/CT. The specificity of bone scintigraphy and FDG-PET/CT was 95% (56/59) and 92% (54/59), respectively. According to the reference standard bone metastases were present in eight out of the 29 patients (28%), whereas 20 patients (69%) were free of bone metastases. One (3%) patient had inconclusive readings on both modalities as well as on MRI and follow-up studies. Bone scintigraphy and FDG-PET/CT correctly identified seven out of eight patients with bone metastases and 20 out of 20 patients free of metastases. Conclusion On a lesion-basis whole-body FDG-PET/CT is more sensitive and equally specific for the detection of bone metastases compared with bone scintigraphy.

Download Full-text

Dual time point 18F-fluorodeoxyglucose positron emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) in primary breast cancer

BMC Cancer ◽

10.1186/s12885-019-6315-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Yoji YAMAGISHI ◽

Tomomi KOIWAI ◽

Tamio YAMASAKI ◽

Takahiro EINAMA ◽

Makiko FUKUMURA ◽

...

Keyword(s):

Breast Cancer ◽

Computed Tomography ◽

Fdg Pet ◽

Emission Tomography ◽

Optimal Cutoff ◽

Pet Ct ◽

Dual Time Point ◽

Fdg Pet Ct ◽

Worse Prognosis ◽

Time Point

Abstract Background To evaluate the clinicopathological and prognostic significance of the percentage change between maximum standardized uptake value (SUVmax) at 60 min (SUVmax1) and SUVmax at 120 min (SUVmax2) (ΔSUVmax%) using dual time point 18F-fluorodeoxyglucose emission tomography/computed tomography (18F-FDG PET/CT) in breast cancer. Methods Four hundred and sixty-four patients with primary breast cancer underwent 18F-FDG PET/CT for preoperative staging. ΔSUVmax% was defined as (SUVmax2 − SUVmax1) / SUVmax1 × 100. We explored the optimal cutoff value of SUVmax parameters (SUVmax1 and ΔSUVmax%) referring to the event of relapse by using receiver operator characteristic curves. The clinicopathological and prognostic significances of the SUVmax1 and ΔSUVmax% were analyzed by Cox’s univariate and multivariate analyses. Results The optimal cutoff values of SUVmax1 and ΔSUVmax% were 3.4 and 12.5, respectively. Relapse-free survival (RFS) curves were significantly different between high and low SUVmax1 groups (P = 0.0003) and also between high and low ΔSUVmax% groups (P = 0.0151). In Cox multivariate analysis for RFS, SUVmax1 was an independent prognostic factor (P = 0.0267) but ΔSUVmax% was not (P = 0.152). There was a weak correlation between SUVmax1 and ΔSUVmax% (P < 0.0001, R2 = 0.166). On combining SUVmax1 and ΔSUVmax%, the subgroups of high SUVmax1 and high ΔSUVmax% showed significantly worse prognosis than the other groups in terms of RFS (P = 0.0002). Conclusion Dual time point 18F-FDG PET/CT evaluation can be a useful method for predicting relapse in patients with breast cancer. The combination of SUVmax1 and ΔSUVmax% was able to identify subgroups with worse prognosis more accurately than SUVmax1 alone.

Download Full-text