18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）与骨闪烁显像在乳腺癌骨转移检测中的比较
Comparison of FDG-PET/CT and bone scintigraphy for detection of bone metastases in breast cancer.
作者信息
Hahn Steffen, Heusner Till, Kümmel Sherko, Köninger Angelika, Nagarajah James, Müller Stefan, Boy Christian, Forsting Michael, Bockisch Andreas, Antoch Gerald, Stahl Alexander
机构信息
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
出版信息
Acta Radiol. 2011 Nov 1;52(9):1009-14. doi: 10.1258/ar.2011.100507. Epub 2011 Oct 3.
BACKGROUND
Bone scintigraphy is the standard procedure for the detection of bone metastases in breast cancer patients. FDG-PET/CT has been reported to be a sensitive tool for tumor staging in different malignant diseases. However, its accuracy for the detection of bone metastases has not been compared to bone scintigraphy.
PURPOSE
To compare whole-body FDG-PET/CT and bone scintigraphy for the detection of bone metastases on a lesion basis in breast cancer patients.
MATERIAL AND METHODS
Twenty-nine consecutive women (mean age 58 years, range 35-78 years) with histologically proven breast cancer were assessed with bone scintigraphy and whole-body FDG-PET/CT. Twenty-one patients (72%) were suffering from primary breast cancer and eight patients (28%) were in aftercare with a history of advanced breast cancer. Both imaging procedures were assessed for bone metastases by a radiologist and a nuclear medicine physician. Concordant readings between bone scintigraphy and FDG-PET/CT were taken as true. Discordant readings were verified with additional MRI imaging in all patients and follow-up studies in most patients.
RESULTS
A total of 132 lesions were detected on bone scintigraphy, FDG-PET/CT or both. According to the reference standard, 70/132 lesions (53%) were bone metastases, 59/132 lesions (45%) were benign, and three lesions (2%) remained unclear. The sensitivity of bone scintigraphy was 76% (53/70) compared to 96% (67/70) for FDG-PET/CT. The specificity of bone scintigraphy and FDG-PET/CT was 95% (56/59) and 92% (54/59), respectively. According to the reference standard bone metastases were present in eight out of the 29 patients (28%), whereas 20 patients (69%) were free of bone metastases. One (3%) patient had inconclusive readings on both modalities as well as on MRI and follow-up studies. Bone scintigraphy and FDG-PET/CT correctly identified seven out of eight patients with bone metastases and 20 out of 20 patients free of metastases.
CONCLUSION
On a lesion-basis whole-body FDG-PET/CT is more sensitive and equally specific for the detection of bone metastases compared with bone scintigraphy.
背景
骨闪烁扫描术是检测乳腺癌患者骨转移的标准方法。据报道，氟代脱氧葡萄糖正电子发射断层显像/计算机断层扫描（FDG-PET/CT）是用于不同恶性疾病肿瘤分期的敏感工具。然而，其检测骨转移的准确性尚未与骨闪烁扫描术进行比较。
目的
在乳腺癌患者中，基于病灶比较全身FDG-PET/CT和骨闪烁扫描术检测骨转移的情况。
材料与方法
对29例经组织学证实为乳腺癌的连续女性患者（平均年龄58岁，范围35 - 78岁）进行骨闪烁扫描术和全身FDG-PET/CT检查。21例患者（72%）患有原发性乳腺癌，8例患者（28%）有晚期乳腺癌病史，正在接受后续治疗。由一名放射科医生和一名核医学医生对两种成像检查进行骨转移评估。骨闪烁扫描术和FDG-PET/CT之间一致的读数被视为正确。所有患者对不一致的读数均通过额外的磁共振成像（MRI）进行核实，大多数患者进行了随访研究。
结果
在骨闪烁扫描术、FDG-PET/CT或两者检查中总共检测到132个病灶。根据参考标准，132个病灶中有70个（53%）为骨转移，59个（45%）为良性，3个病灶（2%）情况不明。骨闪烁扫描术的敏感性为76%（53/70），而FDG-PET/CT为96%（67/70）。骨闪烁扫描术和FDG-PET/CT的特异性分别为95%（56/59）和92%（54/59）。根据参考标准，29例患者中有8例（28%）存在骨转移，而20例患者（69%）无骨转移。1例患者（3%）在两种检查方式以及MRI和随访研究中结果均不确定。骨闪烁扫描术和FDG-PET/CT正确识别出了8例骨转移患者中的7例以及20例无转移患者中的20例。
结论
在基于病灶的全身检查中，与骨闪烁扫描术相比，FDG-PET/CT检测骨转移更敏感且特异性相当。
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