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ABSTRACT: Introduction: Planar bone scan (PBS) is a standard modality for detecting skeletal metastasis. Although PBS is very sensitive, it lacks specificity, especially when a solitary or few atypical osseous lesions depicted. The addition of SPECT/CT can greatly enhance diagnostic accuracy and help reclassify non-conclusive findings on PBS. In this work, we evaluated the added value of SPECT/CT in characterization of equivocal osseous lesions seen on conventional PBS in breast cancer patients. Materials and Methods: This prospective study recruited patients known to have breast cancer referred for conventional planar bone scanning (PBS).Immediately after PBS was acquired, planar images were reviewed. If two nuclear medicine physicians agreed on the non-conclusive nature of the lesion(s), a targeted SPECT/CT was acquired in the same day, to cover the suspected area. Diagnostic performance indices from both modalities (PBS&SPECT/CT) were compared against the reference standard (clinical/imaging follow-up for at least 6-12 months). Results: A total of 83 breast cancer patients were included in this study (81 females, 2 males) with median age 52 years (range: 32-84). The sensitivity, specificity and accuracy for PBS versus SPECT/CT were 89% vs. 100%, 30%vs. 87% &57%vs. 93%; respectively; (P = 0.125, 0.0001, 0.0001); respectively. SPECT/CT changed management in 36% of breast cancer patients by down-staging and upstaging their skeletal disease status. Conclusion: Skeletal SPECT/CT offers an important diagnostic advantage over planar bone scan for characterization of inconclusive osseous lesions in patients with breast cancer and could significantly impact patient management.

ABSTRACT: Introduction: Planar bone scan (PBS) is a standard modality for detecting skeletal metastasis. Although PBS is very sensitive, it lacks specificity, especially when a solitary or few atypical osseous lesions depicted. The addition of SPECT/CT can greatly enhance diagnostic accuracy and help reclassify non-conclusive findings on PBS. In this work, we evaluated the added value of SPECT/CT in characterization of equivocal osseous lesions seen on conventional PBS in breast cancer patients. Materials and Methods: This prospective study recruited patients known to have breast cancer referred for conventional planar bone scanning (PBS).Immediately after PBS was acquired, planar images were reviewed. If two nuclear medicine physicians agreed on the non-conclusive nature of the lesion(s), a targeted SPECT/CT was acquired in the same day, to cover the suspected area. Diagnostic performance indices from both modalities (PBS&SPECT/CT) were compared against the reference standard (clinical/imaging follow-up for at least 6-12 months). Results: A total of 83 breast cancer patients were included in this study (81 females, 2 males) with median age 52 years (range: 32-84). The sensitivity, specificity and accuracy for PBS versus SPECT/CT were 89% vs. 100%, 30%vs. 87% &57%vs. 93%; respectively; (P = 0.125, 0.0001, 0.0001); respectively. SPECT/CT changed management in 36% of breast cancer patients by down-staging and upstaging their skeletal disease status. Conclusion: Skeletal SPECT/CT offers an important diagnostic advantage over planar bone scan for characterization of inconclusive osseous lesions in patients with breast cancer and could significantly impact patient management.

ABSTRACT: Introduction: Planar bone scan (PBS) is a standard modality for detecting skeletal metastasis. Although PBS is very sensitive, it lacks specificity, especially when a solitary or few atypical osseous lesions depicted. The addition of SPECT/CT can greatly enhance diagnostic accuracy and help reclassify non-conclusive findings on PBS. In this work, we evaluated the added value of SPECT/CT in characterization of equivocal osseous lesions seen on conventional PBS in breast cancer patients. Materials and Methods: This prospective study recruited patients known to have breast cancer referred for conventional planar bone scanning (PBS).Immediately after PBS was acquired, planar images were reviewed. If two nuclear medicine physicians agreed on the non-conclusive nature of the lesion(s), a targeted SPECT/CT was acquired in the same day, to cover the suspected area. Diagnostic performance indices from both modalities (PBS&SPECT/CT) were compared against the reference standard (clinical/imaging follow-up for at least 6-12 months). Results: A total of 83 breast cancer patients were included in this study (81 females, 2 males) with median age 52 years (range: 32-84). The sensitivity, specificity and accuracy for PBS versus SPECT/CT were 89% vs. 100%, 30%vs. 87% &57%vs. 93%; respectively; (P = 0.125, 0.0001, 0.0001); respectively. SPECT/CT changed management in 36% of breast cancer patients by down-staging and upstaging their skeletal disease status. Conclusion: Skeletal SPECT/CT offers an important diagnostic advantage over planar bone scan for characterization of inconclusive osseous lesions in patients with breast cancer and could significantly impact patient management.

ABSTRACT: Introduction: Planar bone scan (PBS) is a standard modality for detecting skeletal metastasis. Although PBS is very sensitive, it lacks specificity, especially when a solitary or few atypical osseous lesions depicted. The addition of SPECT/CT can greatly enhance diagnostic accuracy and help reclassify non-conclusive findings on PBS. In this work, we evaluated the added value of SPECT/CT in characterization of equivocal osseous lesions seen on conventional PBS in breast cancer patients. Materials and Methods: This prospective study recruited patients known to have breast cancer referred for conventional planar bone scanning (PBS).Immediately after PBS was acquired, planar images were reviewed. If two nuclear medicine physicians agreed on the non-conclusive nature of the lesion(s), a targeted SPECT/CT was acquired in the same day, to cover the suspected area. Diagnostic performance indices from both modalities (PBS&SPECT/CT) were compared against the reference standard (clinical/imaging follow-up for at least 6-12 months). Results: A total of 83 breast cancer patients were included in this study (81 females, 2 males) with median age 52 years (range: 32-84). The sensitivity, specificity and accuracy for PBS versus SPECT/CT were 89% vs. 100%, 30%vs. 87% &57%vs. 93%; respectively; (P = 0.125, 0.0001, 0.0001); respectively. SPECT/CT changed management in 36% of breast cancer patients by down-staging and upstaging their skeletal disease status. Conclusion: Skeletal SPECT/CT offers an important diagnostic advantage over planar bone scan for characterization of inconclusive osseous lesions in patients with breast cancer and could significantly impact patient management.

Aim To compare inter-reader agreement for planar and SPECT/CT interpretation of equivocal osseous lesions detected on bone scintigraphy in cancer patients. Materials & Methods This prospective study recruited patients known to have primary tumor referred for bone scintigraphy with their planar images showing solitary or few equivocal osseous lesions. Every patient underwent planar whole body scan followed by SPECT/CT for the concerned region(s). The gold standard was based on clinical/ imaging follow-up for at least 6-12 months. Two experienced readers (reader 1 has 8-year experience&reader 2 has 12-year experience) scored each lesion on a subjective 5-point score for the possibility of being malignant (1=benign, 2= probably benign, 3 = equivocal, 4=probably malignant & 5 = malignant). True & false results were identified were identified in relation to the gold standard. Kappa measure of agreement was measured for both modalities. Results A total of 150 patients were included in this study (110 females ,40 males) with median age 54 years (range:7-84). On planar imaging, both readers successfully identified 48 true positive (TP) & 19 true negative (TN) patients. Both readers were false positive (FP) in 31&false negative (FN) in 3 patients. They disagree in 2 patients. Moderate agreement was noted (kappa = 0.55). While on SPECT/CT imaging, both readers successfully identified 58 TP & 62 TN patients. Both readers reported FP results in 11 & FN in 2 patients. They disagree in a total of 9 patients. Perfect agreement was noted (kappa = 0.82). Conclusion SPECT/CT significantly improved inter-observer agreement among readers for equivocal osseous lesions detected on planar bone scintigraphy.

Aim To compare inter-reader agreement for planar and SPECT/CT interpretation of equivocal osseous lesions detected on bone scintigraphy in cancer patients. Materials & Methods This prospective study recruited patients known to have primary tumor referred for bone scintigraphy with their planar images showing solitary or few equivocal osseous lesions. Every patient underwent planar whole body scan followed by SPECT/CT for the concerned region(s). The gold standard was based on clinical/ imaging follow-up for at least 6-12 months. Two experienced readers (reader 1 has 8-year experience&reader 2 has 12-year experience) scored each lesion on a subjective 5-point score for the possibility of being malignant (1=benign, 2= probably benign, 3 = equivocal, 4=probably malignant & 5 = malignant). True & false results were identified were identified in relation to the gold standard. Kappa measure of agreement was measured for both modalities. Results A total of 150 patients were included in this study (110 females ,40 males) with median age 54 years (range:7-84). On planar imaging, both readers successfully identified 48 true positive (TP) & 19 true negative (TN) patients. Both readers were false positive (FP) in 31&false negative (FN) in 3 patients. They disagree in 2 patients. Moderate agreement was noted (kappa = 0.55). While on SPECT/CT imaging, both readers successfully identified 58 TP & 62 TN patients. Both readers reported FP results in 11 & FN in 2 patients. They disagree in a total of 9 patients. Perfect agreement was noted (kappa = 0.82). Conclusion SPECT/CT significantly improved inter-observer agreement among readers for equivocal osseous lesions detected on planar bone scintigraphy.

Aim To compare inter-reader agreement for planar and SPECT/CT interpretation of equivocal osseous lesions detected on bone scintigraphy in cancer patients. Materials & Methods This prospective study recruited patients known to have primary tumor referred for bone scintigraphy with their planar images showing solitary or few equivocal osseous lesions. Every patient underwent planar whole body scan followed by SPECT/CT for the concerned region(s). The gold standard was based on clinical/ imaging follow-up for at least 6-12 months. Two experienced readers (reader 1 has 8-year experience&reader 2 has 12-year experience) scored each lesion on a subjective 5-point score for the possibility of being malignant (1=benign, 2= probably benign, 3 = equivocal, 4=probably malignant & 5 = malignant). True & false results were identified were identified in relation to the gold standard. Kappa measure of agreement was measured for both modalities. Results A total of 150 patients were included in this study (110 females ,40 males) with median age 54 years (range:7-84). On planar imaging, both readers successfully identified 48 true positive (TP) & 19 true negative (TN) patients. Both readers were false positive (FP) in 31&false negative (FN) in 3 patients. They disagree in 2 patients. Moderate agreement was noted (kappa = 0.55). While on SPECT/CT imaging, both readers successfully identified 58 TP & 62 TN patients. Both readers reported FP results in 11 & FN in 2 patients. They disagree in a total of 9 patients. Perfect agreement was noted (kappa = 0.82). Conclusion SPECT/CT significantly improved inter-observer agreement among readers for equivocal osseous lesions detected on planar bone scintigraphy.