Advantages of systematic trunk SPECT/CT to planar bone scan (PBS) in more than 300 patients with breast or prostate cancer
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Vincent Fleury1, Ludovic Ferrer2,4, Mathilde Colombié1, Daniéla Rusu1, Maëlle Le Thiec1, Françoise Kraeber-Bodéré1,2, Loïc Campion2,3 and Caroline Rousseau1,2
1Nuclear Medicine Unit, ICO Cancer Center, Saint Herblain, France
2Nantes-Angers Cancer Research Center, INSERM U892, CNRS UMR 6299, University of Nantes, Nantes, France
3Biometrics Unit, ICO Gauducheau Cancer Center, Saint Herblain, France
4Medical Physics Unit, ICO Cancer Center, Saint Herblain, France
Vincent Fleury, email: [email protected]
Keywords: SPECT/CT; bone scan; bone metastases; bone index; prostate cancer
Received: March 29, 2018 Accepted: July 18, 2018 Published: August 03, 2018
Propose: The aim of our study was to evaluate the potential benefit of a systematic trunk SPECT/CT associated with a Planar Bone Scan (PBS) in breast cancer (BC) and prostate cancer (PCa) patients at initial staging or recurrence.
Results: In 328 patients, sensitivities and specificities were between 74.4–93% and 78.8–97.5% for PBS and 97.7–100% and 96.8–98.6% for SPECT/CT respectively. PBS was considered equivocal for 67 compared to only 6 patients for trunk SPECT/CT. Regardless of “optimistic” or “pessimistic” analysis of equivocal trunk SPECT/CT lesions, the trunk SPECT/CT was almost perfect, allowing to rely on this result for excluding metastatic disease which was corroborated by ROC curve analysis. The trunk SPECT/CT allowed downstaging for 62 patients (19%) and upstaging for 11 patients.
Materials and Methods: PBS and a trunk SPECT/CT were systematically performed in all patients. Independent review of PBS and trunk SPECT/CT was performed for each patient and an abnormality interpretative score (Sc) with 3 levels was built: Sc 1: metastatic or probably metastatic pattern, Sc 2: equivocal pattern, Sc 3: benign or probably benign pattern or no abnormality. The bone pattern status was defined by at least 1 year follow-up. The clinical impact was evaluated in terms of down and upstaging in patient analysis.
Conclusions: Trunk SPECT/CT improves the performance of PBS in BC and PCa assessments and results in improvements in both the detection performance of bone metastases as well as a better characterization of equivocal lesions.
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