title: Usefulness of (18)F-fluoride PET/CT in Breast Cancer Patients with Osteosclerotic Bone Metastases.
abstract: OBJECTIVE
  Bone metastasis is an important factor for the treatment and prognosis of breast cancer patients. Whole-body bone scintigraphy (WBBS) can evaluate skeletal metastases, and (18)F-FDG PET/CT seems to exhibit high specificity and accuracy in detecting bone metastases. However, there is a limitation of (18)F-FDG PET in assessing sclerotic bone metastases because some lesions may be undetectable. Recent studies showed that (18)F-fluoride PET/CT is more sensitive than WBBS in detecting bone metastases. This study aims to evaluate the usefulness of (18)F-fluoride PET/CT by comparing it with WBBS and (18)F-FDG PET/CT in breast cancer patients with osteosclerotic skeletal metastases.
  
  
  METHODS
  Nine breast cancer patients with suspected bone metastases (9 females; mean age ± SD, 55.6 ± 10.0 years) underwent (99m)Tc-MDP WBBS, (18)F-FDG PET/CT and (18)F-fluoride PET/CT. Lesion-based analysis of five regions of the skeletons (skull, vertebral column, thoracic cage, pelvic bones and long bones of extremities) and patient-based analysis were performed.
  
  
  RESULTS
  (18)F-fluoride PET/CT, (18)F-FDG PET/CT and WBBS detected 49, 20 and 25 true metastases, respectively. Sensitivity, specificity, positive predictive value and negative predictive value of (18)F-fluoride PET/CT were 94.2 %, 46.3 %, 57.7 % and 91.2 %, respectively. Most true metastatic lesions on (18)F-fluoride PET/CT had osteosclerotic change (45/49, 91.8 %), and only four lesions showed osteolytic change. Most lesions on (18)F-FDG PET/CT also demonstrated osteosclerotic change (17/20, 85.0 %) with three osteolytic lesions. All true metastatic lesions detected on WBBS and (18)F-FDG PET/CT were identified on (18)F-fluoride PET/CT.
  
  
  CONCLUSIONS
  (18)F-fluoride PET/CT is superior to WBBS or (18)F-FDG PET/CT in detecting osteosclerotic metastatic lesions. (18)F-fluoride PET/CT might be useful in evaluating osteosclerotic metastases in breast cancer patients.
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, San 5, Wonchon-dong, Yeongtong-gu, Suwon, Kyunggi-do Republic of Korea 443-721.
authors.forename: Seok-Ho
authors.initials: SH
authors.lastname: Yoon
authors.affiliation: Department of Surgery, Ajou University School of Medicine, San 5, Wonchon-dong, Yeongtong-gu, Suwon, Kyunggi-do Republic of Korea 443-721.
authors.forename: Ku Sang
authors.initials: KS
authors.lastname: Kim
authors.affiliation: Department of Hematology-Oncology, Ajou University School of Medicine, San 5, Wonchon-dong, Yeongtong-gu, Suwon, Kyunggi-do Republic of Korea 443-721.
authors.forename: Seok Yun
authors.initials: SY
authors.lastname: Kang
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, San 5, Wonchon-dong, Yeongtong-gu, Suwon, Kyunggi-do Republic of Korea 443-721.
authors.forename: Hee-Sung
authors.initials: HS
authors.lastname: Song
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, San 5, Wonchon-dong, Yeongtong-gu, Suwon, Kyunggi-do Republic of Korea 443-721.
authors.forename: Kyung Sook
authors.initials: KS
authors.lastname: Jo
authors.affiliation: Clinical Research Institute, Gyeongsang National University Hospital, Chiram-dong, Jinju Si, Gyeongsangnam-Do Republic of Korea 660-702.
authors.forename: Bong-Hoi
authors.initials: BH
authors.lastname: Choi
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, San 5, Wonchon-dong, Yeongtong-gu, Suwon, Kyunggi-do Republic of Korea 443-721.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, San 5, Wonchon-dong, Yeongtong-gu, Suwon, Kyunggi-do Republic of Korea 443-721.
authors.forename: Joon-Kee
authors.initials: JK
authors.lastname: Yoon
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, San 5, Wonchon-dong, Yeongtong-gu, Suwon, Kyunggi-do Republic of Korea 443-721.
authors.forename: Young-Sil
authors.initials: YS
authors.lastname: An
keywords: 18F-NaF; 18F-fluoride; Breast cancer; PET/CT; Skeletal metastases