Early detection and accurate description of extent of metastatic bone disease in breast cancer with fluoride ion and positron emission tomography

Purpose: Previous studies have shown that bone metastases are revealed by m agnetic resonance imaging (MRI) or bone marrow scintigraphy several months before they are visible by conventional bone scintigraphy (BS), We present a new approach for detecting bone metastases in patients with breast cancer . We compared findings obtained with fluoride ion (F-18) and positron emiss ion tomography (PET) with those obtained with conventional BS. Patients and Methods: Thirty-four breast cancer patients were prospectively examined using F-18-PET and conventional BS, F-18-PET and BS were performe d within 3 weeks of each other. Metastatic bone disease was previously know n to be present in six patients and was suspected (hone pain or increasing levels of tumor markers, Ca2+, alkaline phosphatase) in 28 patients. Both i maging modalities were compared by patient-by-patient analysis and lesion-b y-lesion analysis, using a five-point scale for receiver operating characte ristic (ROC) curve analysis. A panel of reference methods wets used, includ ing MRI (28 patients), planar x-ray (17 patients), and spiral computed tomo graphy (four patients). Results: With F-18-PET, 64 bone metastases were detected in 17 patients. On ly 29 metastases were detected in 11 patients with BS. As a result of F-18- PET imaging, clinical management was changed in four patients (11.7%). For F-18-PET, the area ender the ROC curve was 0.99 on a lesion basis (for BS, it was 0.74: P < .05) and 1.00 on a patient basis (far BS, if was 0.82; P < .05). Conclusion: F-18-PET demonstrates a very early bone reaction when small bon e marrow metastases are present, allowing accurate detection of breast canc er bone metastases, This accurate detection has a significant effect on cli nical management compared with the effect on management brought about by de tection with conventional BS. (C) 1999 by American Society of Clinical Onco logy.