Efficacy comparison between 18F-FDG PET/CT and bone scintigraphy in detecting bony metastases of non-small-cell lung cancer
Introduction
For the management of non-small-cell lung cancer (NSCLC), accurate staging of the disease is essential [1]. Tumors are staged using a series of diagnostic imaging methods, including computed tomography (CT) of the thorax that also images the liver and adrenal glands, magnetic resonance imaging (MRI) of the head, and/or radionuclide bone scintigraphy (bone scan). Recently, positron emission tomography (PET) using the glucose analogue 18F-fluorodeoxy-glucose (FDG) was shown to provide a more accurate and efficient diagnostic approach than the conventional methods [2]. Since PET can accurately detect osseous metastases, this method may obviate the need for a bone scan [3], [4].
Although PET is sensitive in detecting malignancies, it has relatively poor spatial resolution, thus limiting its anatomical localization of disease. The recently developed combination of PET and CT in a single device (PET/CT), however, can overcome these limitations [5]. The advantages of PET/CT, over PET or CT alone, have increasingly established PET/CT as an imaging technique in the management of many cancers. The purpose of this study was to compare 18F-FDG PET/CT with bone scan in the detection of distant bone metastases of NSCLC.
Section snippets
Study subjects
This study was approved by the Institutional Review Board of the Asan Medical Center. The database at our institution was retrospectively reviewed to identify all patients with newly diagnosed with NSCLC who were staged by both integrated whole-body PET/CT and bone scan prior to the initiation of therapy between April 2004 and May 2007. All available clinical and pathologic information from patient records were analyzed to determine the presence or absence of osseous metastatic disease at the
Demographic features of the subjects
Of the 1000 patients identified, 229 patients (22.9%) presented with stage IV disease, and 105 patients (10.5%) had osseous metastases by clinical–pathologic correlation. The patients with bone metastases was younger, included more females, had greater proportion of adenocarcinoma as the histologic type and more advanced T and N stage compared to those without bone metastases (Table 1).
Integrated 18F-FDG PET/CT
PET/CT scan was considered positive for bone metastases in 110 (11%) patients and negative in 890 (89%)
Discussion
Our results indicate that PET/CT imaging can be used to assess metastatic bone involvement in patients recently diagnosed with NSCLC. We found that the sensitivity, and specificity of PET/CT were significantly higher than those of bone scintigraphy and that the agreement between these two methods was good. In addition, PET/CT had a lower incidence of false-positive as well as false-negative results than bone scintigraphy in the detection of bone metastases of NSCLC.
Accurate staging of patients
Summary
In the detection of bone metastases of non-small-cell lung cancer, PET/CT was superior and showed higher sensitivity, specificity and accuracy than bone scan. Agreement between PET/CT and bone scan findings was good.
Conflict of interest statement
All authors contributed substantially to this work and all are responsible for the content of the manuscript. None of the authors has any academic conflicts of interest in association with this manuscript.
Acknowledgements
This study was supported by a grant of the Korean Healthcare technology R&D Project, Ministry of Health, Welfare & Family Affairs, Republic of Korea (No. A060775).
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2019, Joint Bone SpineCitation Excerpt :This recommendation relies on several studies comparing bone scan and 18-FDG PET-CT in non-metastatic lung cancer. These studies showed that 18-FDG PET-CT has a higher sensibility and specificity than bone scan to detect bone metastases [23–28]. Nevertheless, in metastatic lung cancer, there is currently no recommendation to perform 18-FDG PET-CT instead of bone scan.