title: Whole-body bone SPECT in breast cancer patients: the future bone scan protocol?
abstract: OBJECTIVE
  The aim of the study was to compare the detectability rate of bone metastases in breast cancer patients using whole-body single-photon emission computed tomography (WB-SPECT) performed with a half-time acquisition algorithm with that of planar ± selected field-of-view SPECT [standard bone scintigraphy (BS)].
  
  
  METHODS
  Ninety-two consecutive breast cancer patients (age range 35-74 years) underwent planar BS followed by WB-SPECT (acquisition time 28 min). Clinical and imaging follow-up data from BS, 18F-FDG-PET/CT and CT were used as composite reference standards. Institutional review board approval was obtained. For a review of standard BS results, data from a selected SPECT field-of-view were extracted from the WB-SPECT when requested by the readers. Diagnostic confidence of interpretation criteria were defined using a five-point level-of-confidence grading scale of lesions.
  
  
  RESULTS
  Bone metastases were diagnosed in 34 of 92 studies (37%). On patient-based analysis, the detectability rate of standard BS was 97% (33/34 patients) as compared with 100% for WB-SPECT (P=NS). On a lesion-based analysis, 268 foci were detected, including 124 metastases. Standard BS detected 195 lesions (73%; 99 metastases and 96 benign) and missed 73 lesions (25 metastases and 48 benign). WB-SPECT detected 266 lesions (99%; 124 metastases and 142 benign) and missed two benign foci because of SPECT reconstruction artefacts. The lesion-based detectability rate of metastases for standard BS was 80% compared with 100% for WB-SPECT (P<0.001). WB-SPECT was associated with a higher level of confidence compared with standard BS for both benign (P<0.01) and malignant lesions (P<0.05).
  
  
  CONCLUSIONS
  WB-SPECT is a useful tool for skeletal assessment, showing good performance in comparison with standard BS in breast cancer patients, and may eliminate the need for an initial planar scan.
authors.affiliation: aDepartment of Nuclear Medicine, Rambam Health Care Campus bB. and R. Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Abikhzer
authors.forename: Kosta
authors.initials: K
authors.lastname: Gourevich
authors.forename: Olga
authors.initials: O
authors.lastname: Kagna
authors.forename: Ora
authors.initials: O
authors.lastname: Israel
authors.forename: Alex
authors.initials: A
authors.lastname: Frenkel
authors.forename: Zohar
authors.initials: Z
authors.lastname: Keidar
mesh_terms: D000328:Adult; D000368:Aged; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D015899:Tomography, Emission-Computed, Single-Photon; D051598:Whole Body Imaging