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W.X. Zhao
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P1.07 - Poster Session/ Small Cell Lung Cancer (ID 221)
- Event: WCLC 2015
- Type: Poster
- Track: Small Cell Lung Cancer
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.07-016 - Comparison of PET/CT, 99mTc-MDP Bone Scan and Serum Alkaline Phosphatase for Detecting Bony Metastasis in Patients with Small Cell Lung Cancer (ID 2107)
09:30 - 09:30 | Author(s): W.X. Zhao
- Abstract
Background:
The data on the diagnostic ability of 18F-FDG positron emission tomography/computed tomography (PET/CT) compared that of 99mTc-MDP bone scan (BS) or serum alkaline phosphatase (ALP) for the detection of bone metastasis in patients with small cell lung cancer (SCLC) was sparse. The aimed of this study was to compare the diagnostic accuracy and agreement among PET/CT, BS and serum ALP for detecting bone metastasis in SCLC patients.
Methods:
The database at Fudan University Shanghai Cancer Center was retrospectively reviewed to identify all patients with SCLC who underwent both integrated whole-body PET/CT and BS between January 2010 and December 2013. In addition, serum ALP concentration of all eligible patients was recorded. The interval between PET/CT and BS was less than two weeks. Bone metastasis was confirmed if any of the following criteria were met: histology or pathology, concordance between PET/CT and BS, results of supplemental examinations (magnetic resonance imaging) or progression of bony lesions seen on follow-up studies. The sensitivity, specificity and accuracy of each modality were calculated. The overall differences were analyzed using the McNemar’s paired-sample test. The comparison of sensitivity, specificity and accuracy were analyzed with the χ2 test or Fisher exact test. Agreement between PET/CT, BS and ALP was assessed by kappa statistic. The κ-value was categorized as follows: poor (< 0.30), good (0.31–0.60), and excellent (0.61–1.0).
Results:
Of 368 patients with SCLC, a total of 30 patients were enrolled in this retrospective analysis. Six (20%) of thirty eligible patients were confirmed with bone metastasis, while 24 patients (80%) were found free from bone metastasis. The corresponding sensitivity, specificity, accuracy, positive and negative predictive value of PET/CT in detecting bone metastasis were 66.7%, 100%, 93.3%, 100% and 96.2% as compared to those of BS which were 100.0%, 70.8%, 76.7%, 46.2% and 100%, respectively. PET/CT had much higher specificity than BS (p=0.009). No statistically significant differences in sensitivity and accuracy were demonstrated between PET/CT and BS (p=0.455; p=0.145). Elevated serum ALP alone has the lowest sensitivity in detecting bone metastasis (16.7%), with the specificity of 87.5% and the accuracy of 73.3%, respectively. Combining the results of ALP and BS will significantly improve the specificity as compare to BS alone (100% vs 70.8%, p=0.009), while the sensitivity remains low (16.7%) and the accuracy remain unchanged (83.3% vs 76.7%, p=0.519). The κ-values were 0.276 between PET/CT and BS, 0.092 between PET/CT and serum ALP, and 0.099 between BS and serum ALP, indicating poor agreement among the three modalities in detecting bony metastasis.
Conclusion:
PET/CT had statistically higher specificity and numerically higher accuracy than BS in detecting bone metastasis in this group of patients with SCLC. The addition of serum ALP to BS improved the detection specificity comparing BS alone. There was still controversy involving in the use of PET/CT in SCLC. The diagnostic value of PET/CT needed to be validated in prospective and larger clinical trials.
