Article

F-18 NaF PET for detection of bone metastases in lung cancer: accuracy, cost-effectiveness, and impact on patient management.

Department of Internal Medicine II, University of Ulm, Ulm, Germany.
Journal of Bone and Mineral Research (impact factor: 6.37). 01/2004; 18(12):2206-14. DOI:10.1359/jbmr.2003.18.12.2206 pp.2206-14
Source: PubMed

ABSTRACT As bone metastases might be present in lung cancer despite a normal bone scan, we examined various alternatives prospectively. Positron emission tomography using F-18 sodium fluoride (PET) and single photon emission tomography (SPECT) were more sensitive than a planar bone scan. PET was more accurate with a shorter examination time than SPECT but had higher incremental costs.
Previous studies have shown that vertebral bone metastases not seen on planar bone scans may be present on F-18 fluoride positron emission tomography (PET) scan or single photon emission computed tomography (SPECT). The purpose of this study was to measure the accuracy, clinical value and cost-effectiveness of tomographic bone imaging.
A total of 103 patients with initial diagnosis of lung cancer was prospectively examined with planar bone scintigraphy (BS), SPECT of the vertebral column and PET using F-18 sodium fluoride (F-18 PET). Receiver operating characteristic (ROC) curve analysis was used for determination of the diagnostic accuracy. A decision-analysis model and the national charge schedule of the German Hospital Association were used for determination of the cost-effectiveness.
Thirteen of 33 patients with bone metastases were false negative on BS, 4 on SPECT, and 2 on F-18 PET. The area under the ROC curve was 0.771 for BS, 0.875 for SPECT, and 0.989 for F-18 PET (p < 0.05). As a result of SPECT and F-18 PET imaging, clinical management was changed in 8 (7.8%) and 10 (9.7%) patients. Compared with BS, the costs per additional correctly diagnosed patient were 1272 Euro with SPECT and 2861 Euro with F-18 PET. The threshold for the costs of F-18 PET being more cost-effective than SPECT was 345 EUR.
Routine performance of tomographic bone imaging improves the therapeutic strategy because of detection of otherwise missed metastases. F-18 PET is more effective than SPECT but is associated with higher incremental costs.

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Keywords

clinical management
 
diagnostic accuracy
 
F-18 fluoride positron emission tomography
 
F-18 PET imaging
 
F-18 sodium fluoride
 
German Hospital Association
 
higher incremental costs
 
lung cancer
 
national charge schedule
 
normal bone scan
 
planar bone scan
 
planar bone scans
 
planar bone scintigraphy
 
Positron emission tomography
 
shorter examination time
 
single photon emission computed tomography
 
single photon emission tomography
 
tomographic bone imaging
 
various alternatives prospectively
 
vertebral bone metastases