J Korean Med Sci.  2009 Apr;24(2):275-280. 10.3346/jkms.2009.24.2.275.

The Role of Whole-Body FDG PET/CT, Tc 99m MDP Bone Scintigraphy, and Serum Alkaline Phosphatase in Detecting Bone Metastasis in Patients with Newly Diagnosed Lung Cancer

• Min JW
• Um SW
• Yim JJ
• Yoo CG
• Han SK
• Shim YS
• Kim YW

• KMID: 1779130
• DOI: http://doi.org/10.3346/jkms.2009.24.2.275

Abstract

Bone scan (BS) and serum alkaline phosphatase (ALP) concentration are used to detect bone metastasis in malignancy, although whole-body fluoro-D-glucose positron emission tomography computed tomography (FDG PET/CT) is being used increasingly. But BS is still used for the detection of metastatic bone lesion. So we compared the usefulness of PET/CT, BS, and serum ALP in detecting bone metastases in patients with newly diagnosed lung cancer. The medical record database was queried to identify all patients with a new diagnosis of lung cancer between January 2004 and December 2005, who had a PET/CT, BS, and serum ALP before treatment. We retrospectively reviewed all patients' records and radiological reports. One hundred eighty-two patients met the inclusion criteria. Bone metastases were confirmed in 30 patients. The sensitivity values were 93.3% for PET/CT, 93.3% for BS, 26.7% for serum ALP concentration, and 26.7% for BS complemented with serum ALP concentration. The respective specificity values were 94.1%, 44.1%, 94.1%, and 97.3%. The kappa statistic suggested a poor agreement among the three modalities. FDG PET/CT and BS had similar sensitivity, but PET/CT had better specificity and accuracy than BS. PET/CT is more useful than BS for evaluating bone metastasis. However, in the advanced stage, because of its high specificity, BS complemented with serum ALP is a cost-effective modality to avoid having to use PET/CT.

Keyword

Lung Neoplasms; Bone Metastasis; Fluorodeoxyglucose F18; PET/CT; Bone Scan; Alkaline Phosphatase

MeSH Terms

Aged
Alkaline Phosphatase/*blood
Bone Neoplasms/diagnosis/radionuclide imaging/*secondary
Carcinoma, Non-Small-Cell Lung/diagnosis/pathology
Carcinoma, Small Cell/diagnosis/pathology
Female
Fluorodeoxyglucose F18/*diagnostic use
Humans
Lung Neoplasms/*diagnosis/pathology
Male
Medical Records
Middle Aged
Neoplasm Staging
Positron-Emission Tomography
Radiopharmaceuticals/*diagnostic use
Retrospective Studies
Sensitivity and Specificity
Technetium Tc 99m Medronate/*diagnostic use
Tomography, X-Ray Computed
Whole Body Imaging/methods

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