title: Prospective comparison of whole-body bone SPECT and sodium 18F-fluoride PET in the detection of bone metastases from breast cancer.
abstract: OBJECTIVE
  The superiority of sodium F-fluoride PET (F-PET)/computed tomography (CT) over planar and single field-of-view single-photon emission computed tomography (SPECT) bone scintigraphy with Tc-methylene diphosphonate in bone metastases detection has been established. The present study prospectively compares whole-body Tc-methylene diphosphonate SPECT (WB-SPECT) and F-PET performance indices for the detection of bone metastases in breast cancer.
  
  
  METHODS
  A total of 41 pairs of studies in female breast cancer patients (average age 58 years, range 30-75) were included. Half-time WB-SPECT and F-PET/CT were performed at a 4-day average interval (range 0-36 days), with subsequent fusion of CT to WB-SPECT. Two readers independently interpreted the studies, with differences resolved by consensus. Composite gold standard included the CT component of the F-PET/CT study with follow-up CT, MRI, F-fluoro-deoxyglucose-PET/CT, and bone scans.
  
  
  RESULTS
  On patient-based analysis, metastases were diagnosed in 21 patients, with 19 patients detected by WB-SPECT and 21 with F-PET, the latter being the only modality to detect a single metastasis in two patients. The sensitivity of WB-SPECT and F-PET was 90 and 100% (P=NS), and the specificity were 95 and 85%, respectively (P=NS). On lesion-based analysis, 284 total sites of increased uptake were found. WB-SPECT detected 171/284 (60%) and F-PET 268/284 (94%) lesions, with good interobserver agreement for WB-SPECT (κ=0.679) and excellent agreement for F-PET (κ=0.798). The final analysis classified 204 lesions as benign and 80 as metastases. WB-SPECT identified 121 benign and 50 malignant sites compared with 192 and 76, respectively, for F-PET. WB-SPECT and F-PET had a sensitivity of 63 vs. 95%, P-value of less than 0.001, and a specificity of 97 vs. 96% (P=NS), respectively, on lesion-based analysis.
  
  
  CONCLUSIONS
  F-PET had higher sensitivity for the diagnosis of bone metastases from breast cancer compared with WB-SPECT, showing a statistically significant 32% increase on lesion-based analysis.
authors.affiliation: Departments of aNuclear Medicine bRadiology cOncology, Rambam Health Care Campus dTechnion - Israel Institute of Technology, B. and R. Rapaport Faculty of Medicine, Haifa eDepartment of Radiology, MRI Unit, Ziv Medical Center fFaculty of Medicine in the Galilee, Bar Ilan University, Zefat, Israel gDepartment of Nuclear Medicine, McGill University Health Centre hFaculty of Medicine, McGill University, Montreal, Quebec, Canada iDepartment of Nuclear Medicine, Guy's Hospital, King's College, London, UK.
authors.forename: Gad
authors.initials: G
authors.lastname: Abikhzer
authors.forename: Saher
authors.initials: S
authors.lastname: Srour
authors.forename: Georgeta
authors.initials: G
authors.lastname: Fried
authors.forename: Karen
authors.initials: K
authors.lastname: Drumea
authors.forename: Ela
authors.initials: E
authors.lastname: Kozlener
authors.forename: Alex
authors.initials: A
authors.lastname: Frenkel
authors.forename: Ora
authors.initials: O
authors.lastname: Israel
authors.forename: Ignac
authors.initials: I
authors.lastname: Fogelman
authors.forename: Olga
authors.initials: O
authors.lastname: Kagna
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D005462:Fluorine Radioisotopes; D006801:Humans; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012969:Sodium Fluoride; D013669:Technetium Tc 99m Medronate; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D012969:Sodium Fluoride; D013669:Technetium Tc 99m Medronate