Abstract
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Introduction: Detection of skeletal metastases in prostate and breast cancer patients remains a major clinical challenge. This study aimed to compare the diagnostic performance of technetium methylene-diphosphonate single photon emission computed tomography (99mTc-MDP SPECT) and 18F-sodium fluoride positron emission tomography/computed tomography (18F-NaF PET/CT) for the detection of osseous metastases in patients with high-risk prostate or breast cancer.
Methods: This prospective multicenter single-cohort study enrolled 288 participants diagnosed with high-risk breast (n=64) or prostate (n=224) cancer referred for evaluation of skeletal metastases. 18F-NaF PET/CT and 99mTc-MDP SPECT were subsequently performed within 14 days for each participant. Two independent reviewers interpreted each individual modality without knowledge of other imaging findings. Consensus reading, magnetic resonance imaging (MRI), and clinical and imaging follow-up for up to 24 months were used as reference methods.
Results: 261 subjects underwent both 18F-NaF PET/CT and 99mTc-MDP SPECT and completed the required follow-up for statistical analysis. Based on the reference methods used, 41.8% of patients had bone metastases. In the patient-based analysis, 18F-NaF PET/CT was more accurate (84.3% vs. 77.4%, p=0.016) and more sensitive (78.9% vs. 63.3%, p=0.0007) than 99mTc-MDP SPECT. The negative predictive value was also higher for 18F-NaF PET/CT (85.4% for PET/CT vs. 76.9% for 99mTc-MDP SPECT, p=0.0006). Furthermore, according to the lesion-based analysis, 18F-NaF PET/CT detected a significantly greater number of lesions than 99mTc-MDP SPECT (p<0.0001). No adverse events occurred following 18F-NaF administration.
Conclusions: In this prospective, blinded, intra-individual multicenter study of imaging for bone metastases in high-risk breast and prostate cancer patients, 18F-NaF PET/CT was more sensitive and accurate than 99mTc-MDP SPECT.
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