title: Bone scintigraphy in breast cancer:  added value of hybrid SPECT-CT and its impact on patient management.
abstract: OBJECTIVE
  To evaluate the incremental value of single-photon emission computed tomography-computed tomography (SPECT-CT) over planar scintigraphy and SPECT alone for equivocal bone scintigraphy lesions in patients with breast cancer and to assess its impact on patient management.
  
  
  METHODS
  A total of 102 patients with 115 equivocal lesions on planar scintigraphy underwent SPECT and SPECT-CT of selected volume. Images were evaluated in separate sessions to minimize recall bias. A scoring scale of 1-5 was used, where 1 is definitely metastatic, 2 is probably metastatic, 3 is indeterminate, 4 is probably benign, and 5 is definitely benign. With receiver operating characteristic analysis, area under the curves was constructed for each modality. Clinical/imaging follow-up and/or histopathology were taken as the reference standard.
  
  
  RESULTS
  There were 52 indeterminate lesions on planar scintigraphy, 15 on SPECT, and three on SPECT-CT. Area under the curve for SPECT-CT was significantly larger compared with planar scintigraphy (P<0.001) and SPECT (P=0.033). This improvement was mostly for lytic lesions (P<0.0001). In patients (n=67) in whom the lesions under evaluation were the only lesions and hence whose management was decided, SPECT-CT was superior to SPECT (P=0.045) and planar scintigraphy (P <0.001).
  
  
  CONCLUSIONS
  SPECT-CT is better than planar scintigraphy and SPECT alone for characterizing equivocal bone scintigraphy lesions in patients with breast cancer and can have a significant impact on patient management.
authors.affiliation: Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Punit
authors.initials: P
authors.lastname: Sharma
authors.forename: Harmandeep
authors.initials: H
authors.lastname: Singh
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kumar
authors.forename: Chandrasekhar
authors.initials: C
authors.lastname: Bal
authors.forename: Sanjay
authors.initials: S
authors.lastname: Thulkar
authors.forename: Vulatheru
authors.initials: V
authors.lastname: Seenu
authors.forename: Arun
authors.initials: A
authors.lastname: Malhotra
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D001943:Breast Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013669:Technetium Tc 99m Medronate; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D051598:Whole Body Imaging / Q000379:methods
chemical_list: D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate