Prospective study evaluating the relative sensitivity of 18F-NaF PET/CT for detecting skeletal metastases from renal cell carcinoma in comparison to multidetector CT and 99mTc-MDP bone scintigraphy, using an adaptive trial design
Annals of Oncology
Oxford University Press
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Gerety, E., Lawrence, E., Wason, J., Yan, H., Hilborne, S., Buscombe, J., Cheow, H., et al. (2015). Prospective study evaluating the relative sensitivity of 18F-NaF PET/CT for detecting skeletal metastases from renal cell carcinoma in comparison to multidetector CT and 99mTc-MDP bone scintigraphy, using an adaptive trial design. Annals of Oncology, 26 2113-2118. https://doi.org/10.1093/annonc/mdv289
Background: The detection of occult bone metastases is a key factor in determining the management of patients with renal cell carcinoma (RCC), especially when curative surgery is considered. This prospective study assessed the sensitivity of 18F-labelled sodium fluoride in conjunction with Positron Emission Tomography/Computed Tomography (18F-NaF PET/CT) for detecting RCC bone metastases, compared to conventional imaging with bone scintigraphy or CT. Patients and methods: An adaptive 2-stage trial design was utilized, which was stopped after the first stage due to statistical efficacy. Ten patients with Stage IV RCC and bone metastases were imaged with 18F-NaF PET/CT and 99mTc-labelled methylene diphosphonate (99mTc-MDP) bone scintigraphy including pelvic Single Photon Emission Computed Tomography (SPECT). Images were reported independently by experienced radiologists and nuclear medicine physicians using a 5-point scoring system. Results: 77 lesions were diagnosed as malignant: 100% were identified by 18F-NaF PET/CT, 46% by CT and 29% by bone scintigraphy/SPECT. Standard-of-care imaging with CT and bone scintigraphy identified 65% of the metastases reported by 18F-NaF PET/CT. On an individual patient basis, 18F-NaF PET/CT detected more RCC metastases than 99mTc-MDP bone scintigraphy/SPECT or CT alone (p=0.007). The metabolic volumes, mean and maximum Standardized Uptake Values (SUVmean and SUVmax) of the malignant lesions were significantly greater than those of the benign lesions (p<0.001). Conclusions: 18F-NaF PET/CT is significantly more sensitive at detecting RCC skeletal metastases than conventional bone scintigraphy or CT. The detection of occult bone metastases could greatly alter patient management, particularly in the context when standard-of-care imaging is negative for skeletal metastases.
renal cell carcinoma, bone metastases, 18F-NaF PET/CT, 99mTc-MDP bone scintigraphy, computed tomography
This work was supported by Cancer Research UK [grant number C19212/A16628]. The authors also received research support from the National Institute of Health Research Cambridge Biomedical Research Centre, Engineering and Physical Sciences Research Council Imaging Centre in Cambridge and Manchester, and the Cambridge Experimental Cancer Medicine Centre. The research has also been partly funded by a generous donation from the family and friends of a patient.
PROSTATE CANCER UK (PA14-012)
External DOI: https://doi.org/10.1093/annonc/mdv289
This record's URL: https://www.repository.cam.ac.uk/handle/1810/248901
Attribution 2.0 UK: England & Wales
Licence URL: http://creativecommons.org/licenses/by/2.0/uk/