Prospective study of Na[18F]F PET/CT for cancer staging in morbidly obese patients compared with [99mTc]Tc-MDP whole-body planar, SPECT and SPECT/CT. (3rd October 2022)

• Record Type: Journal Article
• Authors: Usmani, Sharjeel; Ahmed, Najeeb; Gnanasegaran, Gopinath; Al kandari, Fareeda; Marafi, Fahad; Bani-Mustafa, Ahmed; Musbah, Ahmed; Jassem Almashmoum, Maryam; Van den Wyngaert, Tim
• Is Part Of: Acta oncologica. Volume 61:Number 10(2022)
• Page Start: 1230
• Page End: 1239
• Publication Date: 2022-10-03
• Subjects: 18F-NaF PET-CT -- obesity -- metastatic bone disease -- 99mTc-MDP -- SPECT/CT; Oncology -- Periodicals; Cancer -- Treatment -- Periodicals; 616.992
• DOI: 10.1080/0284186X.2022.2101899
• Languages: English
• ISSNs: 0284-186X

Abstract

Abstract: Purpose: This prospective study aims to assess the diagnostic test characteristics of Na[ 18 F]F PET/CT for the skeletal staging of cancer in morbidly obese patients compared with 99m Tc-methylene diphosphonate (MDP), whole-body planar (WBS), SPECT, and SPECT/CT acquisitions. Material and methods: One hundred seventeen obese patients (BMI 46.5 ± 6.1 kg/m 2 and mean age, 59.0 years; range 32–89 years) with BMI > 40 kg/m 2 were prospectively enrolled and underwent [ 99m Tc]Tc-MDP WBS, SPECT, SPECT/CT, and Na[ 18 F]F PET/CT within two weeks for the osseous staging of a malignancy. Images were assessed qualitatively using a 3-point scale. Patient and lesion-based diagnostic test characteristics were estimated using an optimistic and pessimistic dichotomization method. Results: Bone metastases were confirmed in 44 patients. Patient-based optimistic diagnostic test characteristics were (sensitivity, specificity, overall accuracy): Na[ 18 F]F PET/CT (95.5%, 95.9%, 95.7%), [ 99m Tc]Tc-MDP WBS (52.3%, 71.2%, 64.1%), SPECT (61.4%, 80.8%, 73.5%) and SPECT/CT (65.9%, 91.8%, 82.1%). Lesion-based optimistic diagnostic test characteristics were: Na[ 18 F]F PET/CT (97.7%, 97.9%, 97.7%), [ 99m Tc]Tc-MDP WBS (39%, 67%, 48.9%), SPECT (52.9%, 93.6%, 67.3%) and SPECT/CT (65.9%, 91.8%, 82.1%). There was no significant difference in the specificity of Na[ 18 F]F and SPECT/CT. All other pairwise comparisons were significant ( p <.001). ROC curve analysis showed a high overall accuracy of Na[ 18 F]F with significantly higher AUCs for Na[ 18 F]F PET/CT compared to [ 99m Tc]Tc-MDP WBS, SPECT, and SPECT/CT on both patient and lesion-based analysis ( p <.001). Moreover, Na[ 18 F]F PET/CT changed patient management in 38% of patients. Conclusions: Na[ 18 F]F PET/CT may be the preferred imaging modality for skeletal staging in morbidly obese patients. The technique provides excellent diagnostic test characteristics superior to [ 99m Tc]Tc-MDP bone scan (including SPECT/CT), impacts patient management, has an acceptable radiation exposure profile, and is well-tolerated. Further cost-effectiveness evaluations are warranted.