title: Single photon emission computed tomography (SPECT) and SPECT/low-dose computerized tomography did not increase sensitivity or specificity compared to planar bone scintigraphy for detection of bone metastases in advanced breast cancer.
abstract: OBJECTIVE
  To evaluate and compare the diagnostic performance of whole-body planar bone scintigraphy (WBS), single photon emission computed tomography (SPECT), SPECT/low-dose computerized tomography (SPECT/ldCT) and SPECT/contrast enhanced diagnostic CT (SPECT/cdCT) in the staging of patients with advanced breast cancer.
  
  
  METHODS
  Seventy-eight patients with recurrence of biopsy-proven breast cancer and suspicion of disseminated disease were investigated with WBS, SPECT, SPECT/ldCT, SPECT/cdCT and MRI performed on the same day in this prospective study. Images were separately analysed in a blinded fashion by radiologists and nuclear medicine physicians regarding the presence of pathological findings. MRI served as reference standard.
  
  
  RESULTS
  According to reference standard, 38 of 73 patients had bone metastases. The sensitivity was 87%, 87%, 79%, and 84% and specificity 63%, 71%, 63% and 83% for WBS, SPECT, SPECT/ldCT and SPECT/cdCT. A significantly increased specificity of SPECT/cdCT compared to WBS and SPECT/ldCT was found, and other parameters did not differ significantly between modalities. Additional two patients had bone metastases solely located outside the MRI scan field and seven patients had soft tissue metastases, but no skeletal changes on MRI.
  
  
  CONCLUSIONS
  WBS, SPECT and SPECT/ldCT were less sensitive than MRI and equally specific for the detection of bone metastases in patients with advanced breast cancer. Based on our findings, we suggest that initial staging include WBS, MRI of the spine and CT for soft tissue evaluation. Further studies may clarify the potential benefits of whole-body MRI and 18F-NaF PET/CT or 18F-FDG PET/CT.
authors.affiliation: Nuclear medicine Department & PET Center, Department of Radiology, Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Ate
authors.initials: A
authors.lastname: Haraldsen
authors.affiliation: Nuclear medicine Department & PET Center, Department of Radiology, Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Bluhme
authors.affiliation: Nuclear medicine Department & PET Center, Department of Radiology, Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Røhl
authors.affiliation: Nuclear medicine Department & PET Center, Department of Radiology, Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Erik Morre
authors.initials: EM
authors.lastname: Pedersen
authors.affiliation: Nuclear medicine Department & PET Center, Department of Radiology, Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Anders Bonde
authors.initials: AB
authors.lastname: Jensen
authors.affiliation: Nuclear medicine Department & PET Center, Department of Radiology, Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Eva Boysen
authors.initials: EB
authors.lastname: Hansen
authors.affiliation: Nuclear medicine Department & PET Center, Department of Radiology, Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Hanne
authors.initials: H
authors.lastname: Nellemann
authors.affiliation: Nuclear medicine Department & PET Center, Department of Radiology, Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Finn
authors.initials: F
authors.lastname: Rasmussen
authors.affiliation: Nuclear medicine Department & PET Center, Department of Radiology, Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Anni
authors.initials: A
authors.lastname: Morsing
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000032:analysis / Q000517:prevention & control*; D011835:Radiation Protection / Q000379:methods; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D051598:Whole Body Imaging / Q000379:methods*
keywords: SPECT/CT; bone metastases; bone scintigraphy; breast cancer; magnetic resonance imaging