F-18 NaF PET for Detection of Bone Metastases in Lung Cancer: Accuracy, Cost-Effectiveness, and Impact on Patient Management

• Martin Hetzel

  Department of Internal Medicine II, University of Ulm, Ulm, Germany

• Coskun Arslandemir

  Department of Nuclear Medicine, University of Ulm, Ulm, Germany

• Hans-Helmut König

  Health Economics Research Unit, University of Leipzig, Leipzig, Germany

• Andreas K Buck

  Department of Nuclear Medicine, University of Ulm, Ulm, Germany

• Karin Nüssle

  Department of Diagnostic Radiology, University of Ulm, Ulm, Germany

• Gerhard Glatting

  Department of Nuclear Medicine, University of Ulm, Ulm, Germany

• Andreas Gabelmann

  Department of Diagnostic Radiology, University of Ulm, Ulm, Germany

• JÜRgen Hetzel

  Department of Internal Medicine II, University of Ulm, Ulm, Germany

• Vinzenz Hombach

  Department of Internal Medicine II, University of Ulm, Ulm, Germany

• Holger Schirrmeister

  Department of Nuclear Medicine, University of Ulm, Ulm, Germany

抄録

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.

収録刊行物

• Journal of Bone and Mineral Research

  Journal of Bone and Mineral Research 18 (12), 2206-2214, 2003-12-01

  Oxford University Press (OUP)

キーワード

• Orthopedics and Sports Medicine
• Endocrinology, Diabetes and Metabolism

詳細情報

• CRID: 1362825894455855872
• NII論文ID: 30021657478
• DOI: 10.1359/jbmr.2003.18.12.2206
• ISSN: 15234681
• ISSN: 08840431
• Web Site: https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1359%2Fjbmr.2003.18.12.2206
• Web Site: https://academic.oup.com/jbmr/article-pdf/18/12/2206/56470319/5650181214.pdf
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