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Appearance of untreated bone metastases from breast cancer on FDG PET/CT: importance of histologic subtype

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To determine if the histology of a breast malignancy influences the appearance of untreated osseous metastases on FDG PET/CT.

Methods

This retrospective study was performed under IRB waiver. Our Hospital Information System was screened for breast cancer patients who presented with osseous metastases, who underwent FDG PET/CT prior to systemic therapy or radiotherapy from 2009 to 2012. Patients with invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), or mixed ductal/lobular (MDL) histology were included. Patients with a history of other malignancies were excluded. PET/CT was evaluated, blinded to histology, to classify osseous metastases on a per-patient basis as sclerotic, lytic, mixed lytic/sclerotic, or occult on CT, and to record SUVmax for osseous metastases on PET.

Results

Following screening, 95 patients who met the inclusion criteria (74 IDC, 13 ILC, and 8 MDL) were included. ILC osseous metastases were more commonly sclerotic and demonstrated lower SUVmax than IDC metastases. In all IDC and MDL patients with osseous metastases, at least one was FDG-avid. For ILC, all patients with lytic or mixed osseous metastases demonstrated at least one FDG-avid metastasis; however, in only three of seven patients were sclerotic osseous metastases apparent on FDG PET.

Conclusion

The histologic subtype of breast cancer affects the appearance of untreated osseous metastases on FDG PET/CT. In particular, non-FDG-avid sclerotic osseous metastases were more common in patients with ILC than in patients with IDC. Breast cancer histology should be considered when interpreting non-FDG-avid sclerotic osseous lesions on PET/CT, which may be more suspicious for metastases (rather than benign lesions) in patients with ILC.

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Acknowledgments

We acknowledge the Susan G. Komen for the Career Catalyst Research Grant (G.A.U. and M.G.). We acknowledge the support of the MSKCC Biostatistics Core (P30 CA008748). We thank both Jane Howard and Jonathan Wills for patient database assistance.

Compliance with ethical standards

ᅟ.

Conflicts of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Consent

For this type of study formal consent is not required.

Financial support

This study was partially funded by Susan G. Komen for the Career Catalyst Research Grant KG110441.

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Authors and Affiliations

  1. Department of Radiology, Weill Cornell Medical College, New York, NY, USA

    Brittany Z. Dashevsky, Molly Parsons, Maxine S. Jochelson & Gary A. Ulaner

  2. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Debra A. Goldman & Mithat Gönen

  3. Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Adriana D. Corben

  4. Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Maxine S. Jochelson & Gary A. Ulaner

  5. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Clifford A. Hudis

  6. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Monica Morrow

Authors
  1. Brittany Z. Dashevsky
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  2. Debra A. Goldman
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  9. Gary A. Ulaner
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Correspondence to Gary A. Ulaner.

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Dashevsky, B.Z., Goldman, D.A., Parsons, M. et al. Appearance of untreated bone metastases from breast cancer on FDG PET/CT: importance of histologic subtype. Eur J Nucl Med Mol Imaging 42, 1666–1673 (2015). https://doi.org/10.1007/s00259-015-3080-z

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  • DOI: https://doi.org/10.1007/s00259-015-3080-z

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