title: 18F-FDG PET/CT is a prognostic biomarker in patients affected by bone metastases from breast cancer in comparison with 18F-NaF PET/CT.
abstract: OBJECTIVE
  To compare 18F-FDG PET/CT and 18F-NaF PET/CT with respect to disease prognostication and outcome in patients affected by bone metastases from breast cancer (BC).
  
  
  METHODS
  We retrospectively investigated 32 women with BC and documented bone metastases. Semi-quantitative parameters were applied to 18F-FDG PET/CT and 18F-Na PET/CT in order to evaluate disease extent and tumour metabolism. We used time-to-event analyses (Kaplan Meier and COX proportional hazard methods) to estimate progression-free (PFS) and overall survival (OS) in order to assess the independent prognostic value of 18F-FDG PET/CT and 18F-Na PET/CT.
  
  
  RESULTS
  The sensitivity of 18F-NaF PET/CT (100%) was higher (p < 0.05) than that of 18F-FDG PET/CT (72% and 72%). None of the 18F-FDG PET/CT-negative patients showed disease progression at the end of follow-up. After adjustment for age, Ki-67 levels, presence of visceral metastases, hormone therapy, duration of bone disease and response to first-line therapy, only 18F-FDG SUV mean [HR 15.7, 95% confidence interval (CI) 1.15-214.5] and 18F-FDG whole-body bone metabolic burden (WB-B-MB) (HR 16.9; 95%CI 1.87-152.2) were independently and significantly associated with OS. None of the 18F-NaF PET/CT parameters were associated with OS. None of the conventional clinical prognostic parameters remained significantly associated with OS after the inclusion of PET/CT parameters in the model.
  
  
  CONCLUSIONS
  18F-FDG PET/CT is independently associated with OS in BC patients with bone metastases and its prognostic impact seems to be higher than conventional clinical and biological prognostic factors. Although 18F-NaF PET/CT has a higher diagnostic sensitivity than 18F-FDG PET/CT, it is not independently associated with OS.
authors.forename: A
authors.initials: A
authors.lastname: Piccardo
authors.forename: M
authors.initials: M
authors.lastname: Puntoni
authors.forename: S
authors.initials: S
authors.lastname: Morbelli
authors.affiliation: Dr. Michela Massollo, Department of Nuclear Medicine, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa, Italy, Tel. +39/01 05 63 45 42; Fax +39/01 05 63 45 34 E-mail: michela.massollo@galliera.it.
authors.forename: M
authors.initials: M
authors.lastname: Massollo
authors.forename: F
authors.initials: F
authors.lastname: Bongioanni
authors.forename: F
authors.initials: F
authors.lastname: Paparo
authors.forename: V
authors.initials: V
authors.lastname: Altrinetti
authors.forename: R
authors.initials: R
authors.lastname: Gonella
authors.forename: A
authors.initials: A
authors.lastname: Gennari
authors.forename: M
authors.initials: M
authors.lastname: Iacozzi
authors.forename: G
authors.initials: G
authors.lastname: Sambuceti
authors.forename: A
authors.initials: A
authors.lastname: DeCensi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D001943:Breast Neoplasms / Q000175:diagnosis*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012969:Sodium Fluoride; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D015415:Biomarkers; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D012969:Sodium Fluoride
keywords: 18F-FDG; 18F-NaF; PET/CT; Prognostic value; bone metastases; breast cancer