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.

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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.
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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.

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