Does whole-body bone SPECT/CT provide additional diagnostic information over [18F]-FCH PET/CT for the detection of bone metastases in the setting of prostate cancer biochemical recurrence?

Abstract

Background: To assess whether whole-body (WB) bone SPECT/CT provides additional diagnostic information over [18F]-FCH PET/CT for the detection of bone metastases in the setting of prostate cancer biochemical recurrence (PC-BR). Methods: Patients referred for a PC-BR and whom benefited from a WB bone SPECT/CT and FCH PET/CT were retrospectively included. Tests were classified as positive, equivocal, or negative for bone metastases. A best valuable comparator (BVC) strategy including imaging and follow-up data was used to determine the metastatic status in the absence of systematic histological evaluation. Results: Between January 2011 and November 2017, 115 consecutive patients with a PC-BR were evaluated. According to the BVC, 30 patients had bone metastases and 85 patients did not present with bone lesions. The sensitivity, specificity, positive and negative predictive values were respectively 86.7% [69.3-96.2], 98.8% [93.6-100.0], 96.3% [78.7-99.5], and 95.5% [89.4-98.1] for WB bone SPECT/CT and 93.3% [77.9-99.2], 100.0% [95.8-100.0], 100.0 and 97.7% [91.8-99.4] for FCH PET/CT. There was no significant difference in diagnostic accuracy of bone metastases between WB Bone SPECT/CT (AUC 0.824 [0.74-0.90]) and FCH PET/CT (AUC 0.829 [0.75-0.90], p = 0.41). Conclusion: Despite good performances for the diagnosis of bone metastases in PC-BR, WB bone SPECT/CT does not provide additive diagnostic information over concomitant FCH PET/CT.

Quantitative vs. Qualitative SPECT-CT Diagnostic Accuracy in Bone Lesion Evaluation—A Review of the Literature

“…The two groups concluded that performing [ 68 Ga]-PSMA PET-CT significantly increased the diagnostic accuracy compared to bone SPECT-CT. Regarding 18 Fluorine ([ 18 F])-Choline, a study that included 115 prostate cancer patients, performed in 2020 by Leiris et al [ 29 ], investigated whether bone SPECT-CT provides additional diagnostic information over [ 18 F]-Choline PET-CT for detecting bone metastases in the setting of prostate cancer biochemical recurrence. The authors concluded that bone SPECT-CT does not provide additional diagnostic information over [ 18 F]-Choline PET-CT.…”

“…When comparing bone SPECT-CT diagnostic accuracy to [ 68 Ga-PSMA] or [ 18 F]-Choline, used in prostate cancer patient management (Janssen et al [ 23 ], Dyrberg et al [ 28 ], Leiris et al [ 29 ] and Simsek et al [ 30 ]), the results indicated that the AUC, sensitivity, and specificity of bone SPECT-CT ranged between 0.82 and 0.89, 82 and 100% and 82 and 94%, compared to 0.82 and 1.00, 93 and 100% and 95 and 100%.…”

“…When comparing bone SPECT-CT diagnostic accuracy to [ 68 Ga-PSMA] or [ 18 F]-Choline, used in prostate cancer patient management (Janssen et al [23], Dyrberg et al [28], Leiris et al [29] and Simsek et al [30]), the results indicated that the AUC, sensitivity, and specificity of bone SPECT-CT ranged between 0.82 and 0.89, 82 and 100% and 82 and 94%, compared to 0.82 and 1.00, 93 and 100% and 95 and 100%. The first quantitative study, published in 2017, was retrospectively performed by Kuji et al [34] and aimed to determine the diagnostic accuracy of quantitative SPECT-CT in differentiating between benign and metastatic bone lesions.…”