Elsevier

Academic Radiology

Volume 13, Issue 8, August 2006, Pages 1011-1015
Academic Radiology

Original investigation
Usefulness of 18F-FDG PET–Directed Skeletal Biopsy for Metastatic Neoplasm

https://doi.org/10.1016/j.acra.2006.05.005Get rights and content

Rationale and Objectives

Technium-99m methylene diphosphonate (99mTc-MDP) bone scintigraphy and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) are useful imaging modalities to detect skeletal metastases. Several other conditions such as infection, fractures, and arthritis can cause false-positive results with either modality. However, PET is felt to be more specific than bone scintigraphy for malignancy. Our objective was to investigate the value of PET scan compared with bone scintigraphy for directing biopsies in patients with suspected metastatic bone lesions.

Materials and Methods

Retrospective case series of subjects with undergoing skeletal biopsy of suspected metastases detected by 99mTc-MDP scintigraphy or 18F-FDG PET scan. Reference standards were pathologic reports and follow-up for 6 months. The diagnostic test performance measures of true positive (TP), false positive (FP), and positive predictive value (PPV) were calculated for each group. The PPV with 95% confidence intervals (CI) was compared using the Fisher exact test.

Results

There were a total of 68 subjects. PET-directed skeletal biopsies (n = 39) showed 35 TP, 4 FP, and an 89.7% PPV (95% CI: 75.7–97.1%). Bone scintigraphy directed biopsies (n = 29) had 21 TP, 8 FP, and 72.4 % PPV (95% CI: 52.7–82.7%). The PPV was not significantly different between the groups (P = .10).

Conclusion

This study supports that PET can be used to effectively direct bone biopsies to confirm metastatic neoplasm and suggests that PET may provide incremental improvement to diagnostic yield over bone scintigraphy. The role of PET compared with bone scintigraphy for directing skeletal biopsies warrants further verification.

Section snippets

Materials and methods

Human Subjects Committee Institution Review Board approval was obtained for this investigation. Between 2000 and 2004, we reviewed a series of patients with history of a primary malignancy that had undergone bone biopsy for suspected metastases. In one group of subjects, PET scan had been used to direct bone biopsy (PET-directed group), whereas in the other group bone scintigraphy was applied for that purpose (bone scintigraphy–directed group) as documented by the indication in the image-guided

Results

Of the population studied, 62 subjects were enrolled. The PET-directed group consisted of 34 subjects with a mean age of 60.5 ± 12.3 years including 53% (18/34) females. The bone scintigraphy directed–group consisted of 28 subjects with a mean age of 58 ± 14.7 years including 61% (17/28) females. Table 1 lists the prevalence of primary malignancy types in each group. There was no significant difference between the two groups with regard to the frequency of the primary malignancy. The frequency

Discussion

This retrospective investigation compared PET-directed with bone scintigraphy–directed skeletal biopsies for patients with a suspected bone metastases showed that both result in a high diagnostic yield with a nonsignificant trend for improved performance using PET as the directing modality.

PET imaging, which is based on the uptake of 18F-FDG in cells proportional to their glycolytic rate, is considered to be the “gold” standard in metabolic imaging. 18F-FDG also provides a quantitative means of

References (11)

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