Significance of Hormone Receptor Status in Comparison of 18F -FDG-PET/CT and 99mTc-MDP Bone Scintigraphy for Evaluating Bone Metastases in Patients with Breast Cancer: Single Center Experience

  • Teke, Fatma (Department of Radiation Oncology, Medical School, Dicle University) ;
  • Teke, Memik (Department of Radiology, Medical School, Dicle University) ;
  • Inal, Ali (Department of Radiation Oncology, Medical School, Dicle University) ;
  • Kaplan, Muhammed Ali (Department of Radiation Oncology, Medical School, Dicle University) ;
  • Kucukoner, Mehmet (Department of Radiation Oncology, Medical School, Dicle University) ;
  • Aksu, Ramazan (Department of Radiation Oncology, Diyarbakir Training and Research Hospital) ;
  • Urakci, Zuhat (Department of Radiation Oncology, Medical School, Dicle University) ;
  • Tasdemir, Bekir (Department of Nuclear Medicine, Medical School, Dicle University) ;
  • Isikdogan, Abdurrahman (Department of Radiation Oncology, Medical School, Dicle University)
  • Published : 2015.02.04


Background: Fluorine-18 deoxyglucose positron emission tomography computed tomography (18F-FDG-PET/CT) and bone scintigraphy (BS) are widely used for the detection of bone involvement. The optimal imaging modality for the detection of bone metastases in hormone receptor positive (+) and negative (-) groups of breast cancer remains ambiguous. Materials and Methods: Sixty-two patients with breast cancer, who had undergone both 18F-FDG-PET/CT and BS, being eventually diagnosed as having bone metastases, were enrolled in this study. Results: 18F-FDG-PET/CT had higher sensitivity and specificity than BS. Our data showed that 18F-FDGPET/CT had a sensitivity of 93.4% and a specificity of 99.4%, whiel for BS they were 84.5%, and 89.6% in the diagnosis of bone metastases. ${\kappa}$ statistics were calculated for 18F-FDGPET/CT and BS. The ${\kappa}$-value was 0.65 between 18F-FDG-PET/CT and BS in all patients. On the other hand, the ${\kappa}$-values were 0.70 in the hormone receptor (+) group, and 0.51 in hormone receptor (-) group. The ${\kappa}$-values suggested excellent agreement between all patient and hormone receptor (+) groups, while the ${\kappa}$-values suggested good agreement in the hormone receptor (-) group. Conclusions: The sensitivity and specificity for 18F-FDG-PET/CT were higher than BS in the screening of metastatic bone lesions in all patients. Similarly 18F-FDG-PET/CT had higher sensitivity and specificity in hormone receptor (+) and (-) groups.


  1. Coleman RE, Rubens RD (1987). The clinical course of bone metastases from breast cancer. British J Cancer, 55, 61-6.
  2. Cook GJ, Fogelman I (1999). Skeletal metastases from breast cancer: imaging with nuclear medicine. Seminars Nuclear Med, 29, 69-79.
  3. Deeks JJ (2001). Systematic reviews of evaluations of diagnostic and screening tests. BMJ, 323, 157-62.
  4. Dose J, Bleckmann C, Bachmann S, et al (2002). Comparison of fluorodeoxyglucose positron emission tomography and “conventional diagnostic procedures” for the detection of distant metastases in breast cancer patients. Nuclear Med Comm, 23, 857-64.
  5. Fuster D, Duch J, Paredes P, et al (2008). Preoperative staging of large primary breast cancer with [18F] fluorodeoxyglucose positron emission tomography/computed tomography compared with conventional imaging procedures. J Clin Oncol, 26, 4746-51.
  6. Gallowitsch HJ, Kresnik E, Gasser J, et al (2003). F-18 fluorodeoxyglucose positron-emission tomography in the diagnosis of tumor recurrence and metastases in the follow-up of patients with breast carcinoma: a comparison to conventional imaging. Invest Radiol, 38, 250-6.
  7. Hamaoka T, Madewell JE, Podoloff DA, Hortobagyi N, Ueno NT (2004). Bone imaging in metastatic breast cancer. J Clin Oncol, 22, 2942-53.
  8. Koenders PG, Beex LV, Langens R, et al (1991). Steroid hormone receptor activity of primary human breast cancer and pattern of first metastasis. the breast cancer study group. Breast Cancer Res Treat, 18, 27-32.
  9. Liu T, Cheng T, Xu W, et al (2011). A meta-analysis of 18FDGPET, MRI and bone scintigraphy for diagnosis of bone metastases in patients with breast cancer. Skeletal Radiology, 40, 523-31.
  10. Mahner S, Schirrmacher S, Brenner W, et al (2008). Comparison between positron emission tomography using 2-[fluorine-18] fluoro-2-deoxy-D-glucose, conventional imaging and computed tomography for staging of breast cancer. Ann Oncol, 19, 1249-54.
  11. Abe K, Sasaki M, Kuwabara Y, et al (2005). Comparison of 18FDG-PET with 99mTc-HMDP scintigraphy for the detection of bone metastases in patients with breast cancer. Ann Nuclear Med, 19, 573-9.
  12. American Cancer Society (2006). Cancer facts and figures. Atlanta, GA.
  13. Basu S, Chen W, Tchou J, et al (2008). Comparison of triplenegative and estrogen receptor-positive/progesterone receptor-positive/HER2-negative breast carcinoma using quantitative fluorine-18 fluorodeoxyglucose/positron emission tomography imaging parameters. Cancer, 112, 995-1000.
  14. Morris PG, Lynch C, Feeney JN, et al (2010). Integrated positron emission tomography/computed tomography may render bone scintigraphy unnecessary to investigate suspected metastatic breast cancer. J Clin Oncol, 28, 3154-9.
  15. Nakai T, Okuyama C, Kubota T, et al (2005). Pitfalls of FDGPET for the diagnosis of osteoblastic bone metastases in patients with breast cancer. Eur J Nuclear Med Molecular Imag, 32, 1253-8.
  16. Ohta M, Tokuda Y, Suzuki Y, et al (2001). Whole body PET for the evaluation of bony metastases in patients with breast cancer: comparison with 99Tcm-MDP bone scintigraphy. Nuclear Med Comm, 22, 875-9.
  17. Roodman GD (2004). Mechanisms of bone metastasis. New England J Med, 350, 1655-64.
  18. SN Yang JAL (2002). Comparing whole body (18)F-2-deoxyglucose positron emission tomography and technetium-99m methylene diphosphonate bone scan to detect bone metastases in patients with breast cancer. J Cancer Res Clin Oncol, 128, 325-8.
  19. Sherry MM, Greco FA, Johnson DH, Hainsworth JD (1986). Metastatic breast cancer confined to the skeletal system: An indolent disease. Am J Med, 81, 381-6.
  20. Shie P, Cardarelli R, Brandon D, Erdman W, Abdulrahim N (2008). Meta-analysis: comparison of F-18 fluorodeoxyglucosepositron emission tomography and bone scintigraphy in the detection of bone metastases in patients with breast cancer. Clin Nuclear Med, 33, 97-101.
  21. Singletary SE, Walsh G, Vauthey JN, et al (2003). A role for curative surgery in the treatment of selected patients with metastatic breast cancer. Oncologist, 8, 241-51.
  22. Tsuya A, Kurata T, Tamura K, Fukuoka M, (2007). Skeletal metastases in non-small cell lung cancer: a retrospective study. Lung Cancer, 57, 229-32.
  23. Wei S, Li Y, Siegal G P, Hameed O (2011). Breast Carcinomas with isolated bone metastases have different hormone receptor expression profiles than those with metastases to other sites or multiple organs. Ann Diagnostic Pathol, 15, 79-83.

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