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. 2020 Jun 21;11(17):4989-4995.
doi: 10.7150/jca.45096. eCollection 2020.

A Retrospective Study of predicting risk of Metastasis among FDG-avid Bone Lesions in 18F-FDG PET/CT

Guangyu Yao  1 , Yiyi Zhou  1 , Yifeng Gu  2 , Zhiyu Wang  1 , Mengdi Yang  1 , Jing Sun  1 , Quanyong Luo  3 , Hui Zhao  1
Affiliations

A Retrospective Study of predicting risk of Metastasis among FDG-avid Bone Lesions in 18F-FDG PET/CT

Guangyu Yao et al. J Cancer. .

Abstract

Purpose: We evaluated the imaging and clinical features for discriminating the possibility of metastasis among FDG-avid bone lesions in 18F-FDG PET/CT in patients who have received bone biopsy. Methods: The retrospective study included patients who underwent both 18F-FDG PET/CT and bone biopsy for FDG-avid bone lesions. Bone lesions maximum standardized uptake value (SUVmax), CT findings, alongside with common clinical features were analyzed. Results: From the 338 patients enrolled in the final study, all of them were received bone biopsy. Biopsies confirm metastasis in 256 cases (75.74%) and benign tissue in 82 cases (24.26%). Metastasis group had higher bone SUVmax than benign group (median 7.9 vs 4.5, p <0.001). A cutoff bone SUVmax of 5 achieved an AUC of 0.748 in all patients. Lytic CT feature and higher age were more likely frequent in metastasis group. Moreover, in patients without obvious CT abnormality (45, 13.31%), the AUC was 0.743 by a SUVmax cutoff of 5.38, whilst in patients with a solitary bone lesion (74, 21.89%), the AUC was 0.803 by a SUVmax cutoff of 4.3. Conclusions: SUVmax is a promising and valuable metabolic indicator for predicting risk of metastasis among FDG-avid bone lesions in 18F-FDG PET/CT, ancillary clinical and imaging features may increase the probability of a metastatic bone lesion.

Keywords: Biopsy; Bone metastasis; PET/CT; SUVmax.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
A 44-year-old man presented with back pain, suspected of lung cancer with bone metastasis by PET/CT. A The coronal maximum intensity projection FDG PET image shows multiple FDG-avid lesions in the lung, a mediastinal lymph node and in L1. B,C The axial FDG PET image (B) and fusion images (C) show a FDG-avid lesion (SUVmax 6.7) in L1. D,E The corresponding CT image (D) and the biopsy under CT guidance (E). Histological examination confirmed that the bone lesion was metastatic lung adenocarcinoma. EGFR and ALK were detected as wild and negative, respectively.
Figure 2
Figure 2
A 75-year-old man presented with hoarseness and hypochondriac pain, suspected of laryngocarcinoma with bone metastasis by PET/CT. A The coronal maximum intensity projection FDG PET image shows multiple FDG-avid lesions in the larynx, lung, extensive lesions in lymph nodes and multiple bone lesions. B,C The fusion images show FDG-avid lesions (SUVmax 13.6) in the larynx, lymph nodes and bone lesions. D,E The corresponding CT image of the 8th rib on the right hand side (D) and the biopsy under CT guidance (E).Histological examination confirmed that the bone lesion was bone tuberculosis, consistent with laryngeal histology.
Figure 3
Figure 3
The flowchart of this retrospective study.
Figure 4
Figure 4
ROC of SUV. A Using a SUVmax threshold of 5, the AUC of predicting bone metastasis is 0.748 (all patients). B Using a SUVmax threshold of 5.38, the AUC of predicting bone metastasis is 0.743 (45 patients with normal CT features). C Using a SUVmax threshold of 4.3, the AUC of predicting bone metastasis is 0.803 (74 patients with a solitary bone lesion). D Using a SUVmax threshold of 5, the AUC of predicting bone metastasis is 0.724 (264 patients with multiple bone lesions).
See this image and copyright information in PMC

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