Abstract
The aim of our study is to assess the frequency of detection of PET-positive computed tomography (CT)-negative skeletal metastases (SM) and determine the impact of such detection on staging and/or management in patients who had FDG PET/CT as part of the cancer work-up. We retrospectively reviewed 2000 18F-FDG PET/CT scans of known cancer patients. A log was kept to record cases of suspected SM with or without bone changes from the low-dose non-contrast CT. The presence or absence of SM was evaluated based on available pathological and clinical data. The impact of detection of such lesions on cancer staging and/or management was evaluated by a board certified oncologist. Of the 2000 cases, 18F-FDG PET/CT suggested SM in 146/2000 (7.3%). Of those 146 cases, 105 (72%) were positive on both PET and CT. The remaining 41 (28%) had PET-positive CT-negative bone lesions. SM was confirmed in 36/41 (88%) PET-positive/CT-negative cases. This was based on biopsy, imaging, or clinical follow-up. The detection of PET-positive CT-negative SM did not change staging or management in 7/36 (19.4%). However, staging and/or management was affected in 29/36 (80.6%). SM is not uncommon in 18F-FDG PET/CT, as it accounts for 146/2000 (7.3%) of cases. PET demonstrated FDG-avid SM without a CT abnormality in at least 36/146 (25%). Patients staging and/or management changed in 29/36 (80.5%). We concluded that 18F-FDG PET is sensitive in the detection of SM with significant impact on staging and/or management.
Highlights
Diagnosis of cancer remains to be of paramount importance to maximize a patient’s long-term survival and reduce various neurological, hematological, and orthopedic complications that may arise
After obtaining Saint Louis University Institutional Review Board (IRB) approval, we retrospectively reviewed 2000 consecutive 18F-FDG PET/computed tomography (CT) scans of known cancer patients
The change in management was in the form of addition or change in chemotherapy in 16 patients, addition of bone-modifying agents (BMA) in 12 patients, 11 patients received radiotherapy (XRT) to their bone metastasis, 2 patients had orthopedic fixation, and hospice was offered for 4 patients (Figures 4 and 5; Table 1)
Summary
Diagnosis of cancer remains to be of paramount importance to maximize a patient’s long-term survival and reduce various neurological, hematological, and orthopedic complications that may arise. PET Positive CT Negative Skeletal Metastasis in more than 50% of malignant tumors and up to 70% of breast cancer patients [5, 6]. The detection of SM might affect cancer staging and follow-up, as it can affect the treatment plan This is true in breast, prostate, and lung cancer patients, which are the most common malignancies in the United States, with a profound impact on patient prognosis [11,12,13,14,15]. Studies have shown that the higher sensitivity and specificity of 18F-FDG PET/CT in the detection of metastasis as well as the impact on tumor staging makes it superior to other imaging modalities [18, 19]. The purpose of our study is to retrospectively assess the frequency of detection of PET-positive/CT-negative SM and determine the impact of its detection on cancer staging and/or management in patients who had 18F-FDG PET/CT as part of their cancer work-up
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