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Pitfalls of FDG-PET for the diagnosis of osteoblastic bone metastases in patients with breast cancer

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to investigate the pitfalls of using 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) for the evaluation of osteoblastic bone metastases in patients with breast cancer by comparing it with 99mTc-hydroxymethylene diphosphonate bone scintigraphy.

Methods

Among the 89 breast cancer patients (mean age 59±15 years) who had undergone both FDG-PET and bone scintigraphy within 1 month between September 2003 and December 2004, 55 with bone metastases were studied. The bone metastases were visually classified by multi-slice CT into four types according to their degree of osteosclerosis and osteolysis—osteoblastic, osteolytic, mixed and invisible—and compared in terms of tracer uptake on FDG-PET or bone scintigraphy and SUVmean on FDG-PET. Differences in the rate of detection on bone scintigraphy and FDG-PET were analysed for significance by the McNemar test.

Results

The sensitivity, specificity and accuracy of bone scintigraphy were 78.2%, 82.4% and 79.8% respectively, and those of FDG-PET were 80.0%, 88.2% and 83.1%, respectively, revealing no significant differences. According to the CT image type, the visualisation rate of bone scintigraphy/FDG-PET was 100%/55.6% for the blastic type, 70.0%/100.0% for the lytic type, 84.2%/94.7% for the mixed type and 25.0%/87.5% for the invisible type. The visualisation rates of bone scintigraphy for the blastic type and FDG-PET for the invisible type were significantly higher. The SUVmean of the blastic, lytic, mixed and invisible types were 1.72±0.28, 4.14±2.20, 2.97±1.98 and 2.25±0.80, respectively, showing that the SUVmean tended to be higher for the lytic type than for the blastic type.

Conclusion

FDG-PET showed a low visualisation rate in respect of osteoblastic bone metastases. Although FDG-PET is useful for detection of bone metastases from breast cancer, it is apparent that it suffers from some limitations in depicting metastases of the osteoblastic type.

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References

  1. Merrick MV. Review article—bone scanning. Br J Radiol 1975;48(569):327–51

    Article  CAS  PubMed  Google Scholar 

  2. Bury T, Barreto A, Daenen F, Barthelemy N, Ghaye B, Rigo P, et al. Fluorine-18 deoxyglucose positron emission tomography for the detection of bone metastases in patients with non-small cell lung cancer. Eur J Nucl Med 1998;25:1244–7

    Article  CAS  PubMed  Google Scholar 

  3. Bender H, Kirst J, Palmedo H, Schomburg A, Wagner U, Ruhlmann J, et al. Value of 18fluoro-deoxyglucose positron emission tomography in the staging of recurrent breast carcinoma. Anticancer Res 1997;17:1687–92

    CAS  PubMed  Google Scholar 

  4. Ohta M, Tokuda Y, Suzuki Y, Kubota M, Makuuchi H, Tajima T, et al. Whole body PET for the evaluation of bony metastases in patients with breast cancer: comparison with 99Tcm-MDP bone scintigraphy. Nucl Med Commun 2001;22:875–9

    Article  CAS  PubMed  Google Scholar 

  5. Peterson JJ, Kransdorf MJ, O’Connor MI. Diagnosis of occult bone metastases: positron emission tomography. Clin Orthop 2003;(415 Suppl):S120–8

    Article  PubMed  Google Scholar 

  6. Galasko CS. Mechanisms of lytic and blastic metastatic disease of bone. Clin Orthop 1982;169:20–7

    PubMed  Google Scholar 

  7. Shreve PD, Grossman HB, Gross MD, Wahl RL. Metastatic prostate cancer: initial findings of PET with 2-deoxy-2-[F-18]fluoro-D-glucose. Radiology 1996;199(3):751–6

    CAS  PubMed  Google Scholar 

  8. Cook GJ, Houston S, Rubens R, Maisey MN, Fogelman I. Detection of bone metastases in breast cancer by 18FDG PET: differing metabolic activity in osteoblastic and osteolytic lesions. J Clin Oncol 1998;16(10):3375–9

    CAS  PubMed  Google Scholar 

  9. Yamaguchi T, Tamai K, Yamato M, Honma K, Ueda Y, Saotome K. Intertrabecular pattern of tumors metastatic to bone. Cancer 1996;78(7):1388–94

    Article  CAS  PubMed  Google Scholar 

  10. Moriwaki A, Mannyo K. Bone marrow metastasis in autopsy cases: histopathologic features from early metastasis to advanced stage. Gan No Rinsyo 2003;49:35–42

    Google Scholar 

  11. Hiraga T,Ozawa H. Microstructure of bone metastasis. Byori to Rinsho 1999;17:35–38

    Google Scholar 

  12. Shon IH, Fogelman I. F-18 FDG positron emission tomography and benign fractures. Clin Nucl Med 2003;28:171–5

    PubMed  Google Scholar 

  13. Ravenel JG, Gordon LL, Pope TL, Reed CE. FDG-PET uptake in occult acute pelvic fracture. Skelet Radiol 2004;33:99–101

    Article  Google Scholar 

Download references

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Correspondence to Takako Nakai.

Additional information

An editorial commentary on this paper is available at http://dx.doi.org/10.1007/s00259-005-1869-x

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Nakai, T., Okuyama, C., Kubota, T. et al. Pitfalls of FDG-PET for the diagnosis of osteoblastic bone metastases in patients with breast cancer. Eur J Nucl Med Mol Imaging 32, 1253–1258 (2005). https://doi.org/10.1007/s00259-005-1842-8

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  • DOI: https://doi.org/10.1007/s00259-005-1842-8

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