Repeatability of 18F-FDG uptake in metastatic bone lesions of breast cancer patients and implications for accrual to clinical trials
Abstract Background Standard measures of response such as Response Evaluation Criteria in Solid Tumors are ineffective for bone lesions, often making breast cancer patients that have bone-dominant metastases ineligible for clinical trials with potentially helpful therapies. In this study we prospect...
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| Format: | Article |
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SpringerOpen
2024-03-01
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| Series: | EJNMMI Research |
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| Online Access: | https://doi.org/10.1186/s13550-024-01093-7 |
| _version_ | 1797233250895134720 |
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| author | Mark Muzi Lanell M. Peterson Jennifer M. Specht Daniel S. Hippe Alena Novakova-Jiresova Jean H. Lee Brenda F. Kurland David A. Mankoff Nancy Obuchowski Hannah M. Linden Paul E. Kinahan |
| author_facet | Mark Muzi Lanell M. Peterson Jennifer M. Specht Daniel S. Hippe Alena Novakova-Jiresova Jean H. Lee Brenda F. Kurland David A. Mankoff Nancy Obuchowski Hannah M. Linden Paul E. Kinahan |
| author_sort | Mark Muzi |
| collection | DOAJ |
| description | Abstract Background Standard measures of response such as Response Evaluation Criteria in Solid Tumors are ineffective for bone lesions, often making breast cancer patients that have bone-dominant metastases ineligible for clinical trials with potentially helpful therapies. In this study we prospectively evaluated the test-retest uptake variability of 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) in a cohort of breast cancer patients with bone-dominant metastases to determine response criteria. The thresholds for 95% specificity of change versus no-change were then applied to a second cohort of breast cancer patients with bone-dominant metastases. Methods For this study, nine patients with 38 bone lesions were imaged with 18F-FDG in the same calibrated scanner twice within 14 days. Tumor uptake was quantified by the most commonly used PET parameter, the maximum tumor voxel normalized by dose and body weight (SUVmax) and also by the mean of a 1-cc maximal uptake volume normalized by dose and lean-body-mass (SULpeak). The asymmetric repeatability coefficients with confidence intervals for SUVmax and SULpeak were used to determine the limits of 18F-FDG uptake variability. A second cohort of 28 breast cancer patients with bone-dominant metastases that had 146 metastatic bone lesions was imaged with 18F-FDG before and after standard-of-care therapy for response assessment. Results The mean relative difference of SUVmax and SULpeak in 38 bone tumors of the first cohort were 4.3% and 6.7%. The upper and lower asymmetric limits of the repeatability coefficient were 19.4% and − 16.3% for SUVmax, and 21.2% and − 17.5% for SULpeak. 18F-FDG repeatability coefficient confidence intervals resulted in the following patient stratification using SULpeak for the second patient cohort: 11-progressive disease, 5-stable disease, 7-partial response, and 1-complete response with three inevaluable patients. The asymmetric repeatability coefficients response criteria for SULpeak changed the status of 3 patients compared to the standard Positron Emission Tomography Response Criteria in Solid Tumors of ± 30% SULpeak. Conclusion In evaluating bone tumor response for breast cancer patients with bone-dominant metastases using 18F-FDG SUVmax, the repeatability coefficients from test-retest studies show that reductions of more than 17% and increases of more than 20% are unlikely to be due to measurement variability. Serial 18F-FDG imaging in clinical trials investigating bone lesions in these patients, such as the ECOG-ACRIN EA1183 trial, benefit from confidence limits that allow interpretation of response. |
| first_indexed | 2024-04-24T16:13:11Z |
| format | Article |
| id | doaj.art-5598b38be5f54592b546790753a7cb80 |
| institution | Directory Open Access Journal |
| issn | 2191-219X |
| language | English |
| last_indexed | 2024-04-24T16:13:11Z |
| publishDate | 2024-03-01 |
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| spelling | doaj.art-5598b38be5f54592b546790753a7cb802024-03-31T11:35:20ZengSpringerOpenEJNMMI Research2191-219X2024-03-0114111110.1186/s13550-024-01093-7Repeatability of 18F-FDG uptake in metastatic bone lesions of breast cancer patients and implications for accrual to clinical trialsMark Muzi0Lanell M. Peterson1Jennifer M. Specht2Daniel S. Hippe3Alena Novakova-Jiresova4Jean H. Lee5Brenda F. Kurland6David A. Mankoff7Nancy Obuchowski8Hannah M. Linden9Paul E. Kinahan10Department of Radiology, University of Washington Medical CenterDepartment of Radiology, University of Washington Medical CenterDepartment of Radiology, University of Washington Medical CenterDepartment of Radiology, University of Washington Medical CenterThomayer University HospitalDepartment of Radiology, University of Washington Medical CenterDepartment of Radiology, University of Washington Medical CenterUniversity of PennsylvaniaCleveland ClinicDepartment of Radiology, University of Washington Medical CenterDepartment of Radiology, University of Washington Medical CenterAbstract Background Standard measures of response such as Response Evaluation Criteria in Solid Tumors are ineffective for bone lesions, often making breast cancer patients that have bone-dominant metastases ineligible for clinical trials with potentially helpful therapies. In this study we prospectively evaluated the test-retest uptake variability of 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) in a cohort of breast cancer patients with bone-dominant metastases to determine response criteria. The thresholds for 95% specificity of change versus no-change were then applied to a second cohort of breast cancer patients with bone-dominant metastases. Methods For this study, nine patients with 38 bone lesions were imaged with 18F-FDG in the same calibrated scanner twice within 14 days. Tumor uptake was quantified by the most commonly used PET parameter, the maximum tumor voxel normalized by dose and body weight (SUVmax) and also by the mean of a 1-cc maximal uptake volume normalized by dose and lean-body-mass (SULpeak). The asymmetric repeatability coefficients with confidence intervals for SUVmax and SULpeak were used to determine the limits of 18F-FDG uptake variability. A second cohort of 28 breast cancer patients with bone-dominant metastases that had 146 metastatic bone lesions was imaged with 18F-FDG before and after standard-of-care therapy for response assessment. Results The mean relative difference of SUVmax and SULpeak in 38 bone tumors of the first cohort were 4.3% and 6.7%. The upper and lower asymmetric limits of the repeatability coefficient were 19.4% and − 16.3% for SUVmax, and 21.2% and − 17.5% for SULpeak. 18F-FDG repeatability coefficient confidence intervals resulted in the following patient stratification using SULpeak for the second patient cohort: 11-progressive disease, 5-stable disease, 7-partial response, and 1-complete response with three inevaluable patients. The asymmetric repeatability coefficients response criteria for SULpeak changed the status of 3 patients compared to the standard Positron Emission Tomography Response Criteria in Solid Tumors of ± 30% SULpeak. Conclusion In evaluating bone tumor response for breast cancer patients with bone-dominant metastases using 18F-FDG SUVmax, the repeatability coefficients from test-retest studies show that reductions of more than 17% and increases of more than 20% are unlikely to be due to measurement variability. Serial 18F-FDG imaging in clinical trials investigating bone lesions in these patients, such as the ECOG-ACRIN EA1183 trial, benefit from confidence limits that allow interpretation of response.https://doi.org/10.1186/s13550-024-01093-7Breast cancerBone metastases18F-FDG PETTest-retestRepeatability |
| spellingShingle | Mark Muzi Lanell M. Peterson Jennifer M. Specht Daniel S. Hippe Alena Novakova-Jiresova Jean H. Lee Brenda F. Kurland David A. Mankoff Nancy Obuchowski Hannah M. Linden Paul E. Kinahan Repeatability of 18F-FDG uptake in metastatic bone lesions of breast cancer patients and implications for accrual to clinical trials EJNMMI Research Breast cancer Bone metastases 18F-FDG PET Test-retest Repeatability |
| title | Repeatability of 18F-FDG uptake in metastatic bone lesions of breast cancer patients and implications for accrual to clinical trials |
| title_full | Repeatability of 18F-FDG uptake in metastatic bone lesions of breast cancer patients and implications for accrual to clinical trials |
| title_fullStr | Repeatability of 18F-FDG uptake in metastatic bone lesions of breast cancer patients and implications for accrual to clinical trials |
| title_full_unstemmed | Repeatability of 18F-FDG uptake in metastatic bone lesions of breast cancer patients and implications for accrual to clinical trials |
| title_short | Repeatability of 18F-FDG uptake in metastatic bone lesions of breast cancer patients and implications for accrual to clinical trials |
| title_sort | repeatability of 18f fdg uptake in metastatic bone lesions of breast cancer patients and implications for accrual to clinical trials |
| topic | Breast cancer Bone metastases 18F-FDG PET Test-retest Repeatability |
| url | https://doi.org/10.1186/s13550-024-01093-7 |
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