PET CT outperforms Computed Tomography Scan in determining suspected Bone metastasis: Study
A recent study found that fluorodeoxyglucose positron emission tomography/computed tomography ([18F] FDG PET/CT) was better for determining bone biopsy sites and identifying bone metastasis. It was also more cost-effective than computed tomography, as per the trial results published in the Cancer Imaging journal
More than half of all cancers develop metastasis, and bone is the most common site of metastasis after the lungs and liver. This metastasis often leads to the development of complicated skeletal-related events like fractures, spinal cord compression, etc, affecting the quality of life and survival rates. Hence, early diagnosis is essential in cancers. Bone biopsy of the suspected tissue is the gold standard test. Imaging techniques like scintigraphy, computed tomography scans, and [18F] FDG PET/CT are essential for guiding bone biopsies. Even though [18F] FDG PET/CT offers high accuracy, its accessibility is limited in certain areas. Hence, researchers conducted a study to determine whether [18F] FDG PET/CT could more accurately determine a puncture site than CT to improve the diagnostic accuracy of biopsy. They also determined the best cutoff value of clinical indicators for differentiating malignant bone metastases using a noninvasive examination and [18F] FDG PET/CT.
A prospective, single-center, comparative imaging study compared the performance of [18F] FDG PET/CT with CT in detecting bone metastases. Between 2020 and 2021, about 273 patients with bone lesions were enrolled and treated. Patients were randomly assigned to undergo the scans before biopsy to determine the puncture site. The two imaging tests' accuracy, sensitivity, specificity, second biopsy rate, diagnostic time, and cost-effectiveness were compared.
Findings:
- The [18F] FDG PET/CT group showed a significantly higher accuracy and sensitivity in detecting bone metastases than the CT group.
- The need for a second biopsy was also significantly lower in the [18F] FDG PET/CT group.
- The [18F] FDG PET/CT group showed a lesser diagnostic time of 18.33 ± 2.08 days than 21.28 ± 1.25 days in the CT group ( P < 0.05).
- The cost of [18F] FDG PETCT is 11428.35 yuan, and the cost of CT is 13287.52 yuan; the incremental cost is 1859.17 yuan.
- SUVmax > 6.3 combined with ALP > 103 U/L demonstrated a strong association for tumor metastases with an AUC of 0.901.
Thus, the researchers concluded that [18F] FDG PET/CT is better suited and cost-effective than CT for localizing the bone biopsy site for suspect bone metastases. The authors also recommended [18F] FDG PET/CT as an imaging test for localizing the site of bone biopsy.
Further reading: Chang, Y., Gu, Y., Ruan, S. et al. [18F]FDG PET/CT performs better than CT in determining the bone biopsy site : randomized controlled clinical trial. Cancer Imaging 24, 160 (2024). https://doi.org/10.1186/s40644-024-00804-6.
