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Martin Hetzel, Coskun Arslandemir, Hans‐Helmut König, Andreas K Buck, Karin Nüssle, Gerhard Glatting, Andreas Gabelmann, JÜRgen Hetzel, Vinzenz Hombach, Holger Schirrmeister, F‐18 NaF PET for Detection of Bone Metastases in Lung Cancer: Accuracy, Cost‐Effectiveness, and Impact on Patient Management, Journal of Bone and Mineral Research, Volume 18, Issue 12, 1 December 2003, Pages 2206–2214, https://doi.org/10.1359/jbmr.2003.18.12.2206
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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.
Introduction: 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.
Materials and Methods: 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.
Results: 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.
Conclusion: 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.
