title: Detection of bone metastases in breast cancer patients in the PET/CT era: Do we still need the bone scan?
abstract: OBJECTIVE
  To examine the value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for the detection of bone metastasis in breast cancer patients and assess whether whole body bone scan (BS) with (99m)Tc-methylene diphosphonate provides any additional information.
  
  
  METHODS
  Study group comprised 150 patients, mean age 52 years (range 27-85) with breast cancer, suspected of having bone metastases. All patients had undergone both FDG-PET/CT and BS with or without single photon emission tomography/computed tomography (SPECT/CT) within a period of 6 weeks. The final diagnosis of bone metastasis was established by histopathological findings, additional imaging, or clinical follow-up longer than 10 months. Cancer antigen 15-3 (CA15-3) and carcinoembryogenic antigen (CEA) were measured in all patients.
  
  
  RESULTS
  Histologically 83%, 7% and 10% had infiltrating ductal, lobular and mixed carcinoma respectively. Confirmed bone metastases were present in 86 patients (57.3%) and absent in 64 (42.7%). Mean CA15-3 and CEA values in patients with bone metastases were 74.6ng/mL and 60.4U/mL respectively, compared to 21.3ng/mL and 3.2U/mL without metastases (p<0.001). The sensitivity of FDG-PET/CT for the detection of bone metastases was 97.6% compared to 89.5% with SPECT/CT. In 57 patients, FDG-PET/CT correctly identified additional pulmonary, hepatic, nodal and other soft tissue metastases, not detected by BS.
  
  
  CONCLUSIONS
  Our findings suggest that FDG-PET/CT is superior to BS with or without SPECT/CT.
authors.affiliation: Hacettepe University Medical Faculty, Department of Nuclear Medicine, Sihhiye, Ankara 06100, Turkey. Electronic address: mcaglart@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Caglar
authors.affiliation: Hacettepe University Medical Faculty, Department of Nuclear Medicine, Sihhiye, Ankara 06100, Turkey.
authors.forename: O
authors.initials: O
authors.lastname: Kupik
authors.affiliation: Hacettepe University Medical Faculty, Department of Biostatistics, Sihhiye, Ankara 06100, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Karabulut
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, 5000 Odense C, Denmark.
authors.forename: P F
authors.initials: PF
authors.lastname: Høilund-Carlsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D001859:Bone Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology*; D002272:Carcinoembryonic Antigen / Q000097:blood; D018270:Carcinoma, Ductal, Breast / Q000097:blood / Q000000981:diagnostic imaging* / Q000556:secondary*; D018275:Carcinoma, Lobular / Q000097:blood / Q000000981:diagnostic imaging / Q000556:secondary; D005260:Female; D005462:Fluorine Radioisotopes / Q000032:analysis; D019788:Fluorodeoxyglucose F18 / Q000032:analysis; D006801:Humans; D008875:Middle Aged; D018396:Mucin-1 / Q000097:blood; D000072078:Positron Emission Tomography Computed Tomography; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals / Q000032:analysis; D012189:Retrospective Studies; D000072098:Single Photon Emission Computed Tomography Computed Tomography; D013669:Technetium Tc 99m Medronate / Q000032:analysis; D051598:Whole Body Imaging
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D005462:Fluorine Radioisotopes; C060192:MUC1 protein, human; D018396:Mucin-1; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D013669:Technetium Tc 99m Medronate
keywords: Bone metastasis; Bone scintigraphy; Breast cancer; Cáncer de mama; FDG; Gammagrafía ósea; Imaging; Imágenes; Metástasis ósea; PET/CT; PET/TAC