title: [18F]fluorodeoxyglucose positron emission tomography is more sensitive than skeletal scintigraphy for detecting bone metastasis in endemic nasopharyngeal carcinoma at initial staging.
abstract: OBJECTIVE
  Bone metastasis occurs frequently in patients with endemic nasopharyngeal carcinoma (NPC). The main objective of this study is to evaluate positron emission tomography (PET) using fluorine-18-labeled fluorodeoxyglucose ([18F]FDG) and conventional skeletal scintigraphy (SS) for detecting bone metastasis at initial staging. Auxiliary objectives are to identify risk factors for bone metastasis and features associated with poor survival in patients with bone metastasis.
  
  
  METHODS
  Patients with endemic NPC before initiation of treatment were enrolled. PET and SS were performed at initial staging and compared using McNemar's paired-sample test. Bone metastasis was considered to be present if there was any reliable evidence identified within 1 year after primary diagnosis. Multiple logistic regression and Cox's proportional hazards models were used for auxiliary objectives.
  
  
  RESULTS
  Thirty (15%) of 202 eligible patients were found to have bone metastasis. [18F]FDG PET was found to be more sensitive than SS in the patient-based analysis (P = .006) and in the region-based analysis at the spine (P = .001). Advanced N stage was the only significant risk factor (P < .0001), and the coexistence of hepatic metastasis was a prognosticator of poor survival (P = .017). The survival was not significantly better for patients with bone metastasis undetected at primary staging than for those with initially detectable bone metastasis (P = .620).
  
  
  CONCLUSIONS
  [18F]FDG PET is more sensitive than SS for detecting bone metastasis in endemic NPC at initial staging, whereas SS can be considered as supplementary in this setting.
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Feng-Yuan
authors.initials: FY
authors.lastname: Liu
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Chang
authors.forename: Hung-Ming
authors.initials: HM
authors.lastname: Wang
authors.forename: Chun-Ta
authors.initials: CT
authors.lastname: Liao
authors.forename: Chung-Jan
authors.initials: CJ
authors.lastname: Kang
authors.forename: Shu-Hang
authors.initials: SH
authors.lastname: Ng
authors.forename: Shu-Kung
authors.initials: SK
authors.lastname: Ng
authors.forename: Sheng-Chieh
authors.initials: SC
authors.lastname: Chan
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Yen
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000556:secondary; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000473:pathology*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals; D016019:Survival Analysis
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18