Elsevier

Lung Cancer

Volume 65, Issue 3, September 2009, Pages 333-338
Lung Cancer

Efficacy comparison between 18F-FDG PET/CT and bone scintigraphy in detecting bony metastases of non-small-cell lung cancer

https://doi.org/10.1016/j.lungcan.2008.12.004Get rights and content

Summary

Background

We compared the efficacies of integrated whole-body 18F-FDG PET/CT (PET/CT) and 99mTc-DPD bone scintigraphy (bone scan) for the detection of bone metastases in patients with non-small-cell lung cancer (NSCLC).

Patients and methods

Between April 2004 and May 2007, the database at our institution was retrospectively reviewed to identify all patients with newly diagnosed NSCLC and who underwent staging with both PET/CT and bone scan prior to the initiation of therapy. Presence of bone metastases was confirmed by considering all available clinical information. This search identified 1000 patients, 265 women and 735 men (age range, 18–89 years; median age, 65 years).

Results

Bone metastases were confirmed in 105 (10.5%) patients. The respective accuracy, sensitivity, and specificity of PET/CT and bone scan in detecting bone metastases were 98.3% and 95.1% (p < 0.001), 94.3% and 78.1% (p = 0.001), and 98.8% and 97.4% (p = 0.006). PET/CT also showed lower incidence of false positive (1.2% vs. 2.9%) and false-negative results (5.7% vs. 21.9%) than bone scan. Agreement between PET/CT and bone scan findings was good with calculated κ = 0.732.

Conclusions

PET/CT was superior to bone scan in the detection of bone metastases of NSCLC with the lower incidence of false-positive as well as false-negative results.

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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