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Is FDG-PET Superior to Bone Scintigraphy for Detecting Bone Mets?

February 21, 2008
Written by: , Filed in: Nuclear Medicine
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Background
Bone scintigraphy (BS) is a useful modality in the diagnosis of bone metastases from breast cancer. In addition, over the last decade, FDG-PET has emerged as a powerful tool to assess metastases from breast carcinoma.

The objective of a recent study was to determine if BS is superior to FDG-PET for detecting bone metastases from breast cancer.
The study has concluded that neither FDG-PET nor bone scintigraphy was shown to be superior for detecting osseous metastases from breast cancer.

Design
Meta-analysis of published cohort studies performed since January 1995.

Methodology
454 studies were identified in three databases. They were then restricted based on inclusion and exclusion criteria. Papers were chosen dealing with female breast cancer patients of all ages and disease stages in whom bone metastases findings were confirmed with CT, MRI, or bone biopsy and for whom clinical follow-up was >6 months. Both FDG-PET and BS were performed within 6 months of each other.

In total, only six studies were eligible for the study. Meta-analysis of pooled sensitivity and specificity values was conducted using a hierarchical model that enables estimation of a summary ROC curve. Per-patient and per-lesion pooled sensitivity and specificity and ROC curves were calculated.

Results of the Study
The pooled patient-based sensitivity was 81% for FDG and 78% for BS, and the specificity was 93% for FDG and 79% for BS. Based on the stated confidence intervals, differences were not significant between FDG and MDP regarding patient-based sensitivity and specificity.

With respect to lesion-based statistics, the sensitivity and specificity were 69% and 98%, respectively, for FDG PET and were 88% and 87%, respectively, for BS. Again, no significant differences between FDG and MDP were found.

Conclusions
Somewhat surprisingly, the authors state that whether FDG-PET or BS represents superior methods of detecting metastases from breast cancer remains inconclusive. The authors suggest that improved imaging may be obtained with PET-CT scanners (not included in this study) and with bone-SPECT (done in only two of the current studies). For that matter, let me add that SPECT-CT is also becoming more common and may improve these results.

Reviewer’s Comments
These two modalities are evaluating very different aspects of metastases. FDG-PET is visualizing the tumor itself, while MDP is localizing in the normal bone adjacent to the tumor, as part of remodeling and attempted healing. Although not evaluated in this study, I would imagine that the combination of these two tests, by looking at two different aspects of the metastases, would be superior to either one alone.

Author: Lionel S. Zuckier, MD

Reference:
Shie P, Cardarelli R, et al. Meta-Analysis: Comparison of F-18 Fluorodeoxyglucose-Positron Emission Tomography and Bone Scintigraphy in the Detection of Bone Metastases in Patients With Breast Cancer.
Clin Nucl Med; 2008; 33 (February): 97-101

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