Objective
Determination of the accuracy of sodium fluorine-18-fluoride (18F-NaF) PET/computed tomography (CT) for the evaluation of bone metastases, and the impact on patient management in breast cancer patients.
Patients and methods
Patients with breast cancer, referred for 18F-NaF PET/CT between February 2014 and June 2016, were included in a database. Baseline characteristics, clinical indication, definitive diagnosis according to follow-up data, as well as changes in patient management were recorded. Follow-up was performed during a period of at least 6 months using histopathologic, medical imaging, biochemical, and clinical data.
Results
A total of 118 patients were included in the study. Indications for 18F-NaF PET/CT included primary staging (12%), follow-up (31%), bone pain (52%), abnormal laboratory findings (5%), and evaluation of equivocal osseous lesions on other imaging modalities (3%). Bone metastases were found in 42%, whereas 53% of the scans were negative and 5% yielded equivocal results. Correlation with the reference standard yielded a sensitivity of 0.96, a specificity of 0.91, a positive predictive value of 0.89, a negative predictive value of 0.97, and an accuracy of 0.93. In 25% of the patients, the scan results led to alterations in patient management. 18F-NaF PET/CT for the evaluation of bone pain showed no explanation in 29%, benign pathology in 66%, and bone metastases in 5%.
Conclusion
In the present cohort of patients with breast cancer, 18F-NaF PET/CT detected bone metastases in 42% with an accuracy of 0.93. The scan results led to a change in patient management in 25%. In the evaluation of bone pain, an explanation for pain was found in 71% of the scans.
