Clinical application of SPECT/CT guided targeted bone marrow biopsy in bone metastasis involvement in lung cancer

Abstract

Objective To investigate the feasibility, safety, and clinical application value of single photon emission computed tomography/computed tomography (SPECT/CT)-guided bone marrow biopsy (BMB) in lung cancer (LC) patients with suspected bone metastases (BM) and compare its diagnostic performance for detection of BM with SPECT/CT. Methods The records of lung cancer patients referred for bone scintigraphy (BS), SPECT/CT and SPECT/CT-guided BMB from July of 2020 to July of 2023 in our hospital were retrospectively reviewed. 35 Patients were consecutively included in this study, all 34 specimens were analyzed by pathological and immunohistochemical studies.The biopsy success rate, total examination time, biopsy operation time, complications, CT radiation dose, and pathological and immunohistochemical results were recorded. The diagnostic performance based on SPECT/CT and SPECT/CT-guided BMB were compared with pathological, immunohistochemical examinations and the results of subsequent follow-up. Results Bone samples of the sites with high uptake were obtained in 34 patients under BMB, with a success rate of 97.1%(34/35). No severe postoperative complications occurred. Among all 34 cases, 29 specimens were positive for metastatic lung cancer (85%, 29/34), and positive for benign tissue in 5 cases (15%, 5/34). The average total examination time of 24 patients was (46.2 ± 7.3) minutes, and the biopsy operation time was (31.4 ± 8.2) minutes; The effective radiation dose generated during the entire inspection process is (2.2 ± 0.9) mSv. SPECT/CT-guided BMB demonstrated significantly higher negative predictive value (NPV) when compared to SPECT/CT (p = 0.021 < 0.05). The sensitivity, specificity, and negative predictive value (NPV) of BMB guided by SPECT/CT were significantly higher than those of SPECT/CT (p < 0.05). Conclusion It is insufficient to evaluate BM in LC patients using 99mTC-MDP SPECT/CT imaging. SPECT/CT-guided BMB was safe, accurate, and feasible and provided significantly higher sensitivity and NPV when compared to SPECT/CT for detection of BM in LC patients. In addition, our study initially showed the integrated approach that includes SPECT /CT and SPECT/CT-guided BMB, which can obtain one-stop imaging, pathological and molecular typing diagnosis in nuclear medicine department and offer important opportunities for precision treatment to improve quality of life of LC patients with BM.