Abstract
PurposeThe computer-assisted diagnostic system for bone scintigraphy (BS) BONENAVI is used to evaluate skeletal metastasis. We investigated its diagnostic performance in prostate cancer patients with and without skeletal metastasis and searched for the problems.MethodsAn artificial neural network (ANN) value was calculated in 226 prostate cancer patients (124 with skeletal metastasis and 101 without) using BS. Receiver operating characteristic curve analysis was performed and the sensitivity and specificity determined (cutoff ANN = 0.5). Patient’s situation at the time of diagnosis of skeletal metastasis, computed tomography (CT) type, extent of disease (EOD), and BS uptake grade were analyzed. False-negative and false-positive results were recorded.ResultsBONENAVI showed 82% (102/124) of sensitivity and 83% (84/101) specificity for metastasis detection. There were no significant differences among CT types, although low EOD and faint BS uptake were associated with low ANN values and low sensitivity. Patients showed lower sensitivity during the follow-up period than staging work-up. False-negative lesions were often located in the pelvis or adjacent to it. They comprised not only solitary, faint BS lesions but also overlaying to urinary excretion.ConclusionsBONENAVI with BS has good sensitivity and specificity for detecting prostate cancer’s osseous metastasis. Low EOD and faint BS uptake are associated with low sensitivity but not the CT type. Prostate cancer patients likely to have false-negative results during the follow-up period had a solitary lesion in the pelvis with faint BS uptake or lesions overlaying to urinary excretion.
Highlights
Prostate cancer is the most common solid cancer in men in the US [1] and the third most common in Japan, and its incidence is increasing [2]
We investigated its diagnostic performance in prostate cancer patients with and without skeletal metastasis and searched for the problems
There were no significant differences among computed tomography (CT) types, low extent of disease (EOD) and faint bone scintigraphy (BS) uptake were associated with low artificial neural network (ANN) values and low sensitivity
Summary
Prostate cancer is the most common solid cancer in men in the US [1] and the third most common in Japan, and its incidence is increasing [2]. Bone is the most common site of distant metastases of prostate cancer [3]. These skeletal metastases are usually osteoblastic in contrast to those from other cancers, which are mostly osteolytic [4]. Bone scintigraphy (BS) is used to diagnose skeletal metastasis from prostate cancer. We formally published the development and clinical evaluation of a revised version, called BONENAVI II [9]. Skeletal metastases of prostate cancer are mostly osteoblastic, other types of skeletal metastasis exist. Our clinical questions concerned the performance of BONENAVI with the various types of skeletal metastasis and what factors, if any, caused the failures (false-negative and false-positive results) to diagnose skeletal metastases from prostate cancer
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