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[¹⁸F]Fluorodeoxyglucose Positron Emission Tomography Is More Sensitive Than Skeletal Scintigraphy for Detecting Bone Metastasis in Endemic Nasopharyngeal Carcinoma at Initial Staging

From the Department of Nuclear Medicine and Molecular Imaging Center; Department of Radiation Oncology, Division of Hematology/Oncology; Department of Internal Medicine, Section of Head and Neck Surgery; Department of Otorhinolaryngology; and Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan

Address reprint requests to and correspondence to Tzu-Chen Yen, MD, PhD, Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, 199 Dunhua N Rd, Taipei 10507, Taiwan; e-mail: yen1110{at}adm.cgmh.org.tw

PURPOSE: Bone metastasis occurs frequently in patients with endemic nasopharyngeal carcinoma (NPC). The main objective of this study is to evaluate positron emission tomography (PET) using fluorine-18–labeled fluorodeoxyglucose ([¹⁸F]FDG) and conventional skeletal scintigraphy (SS) for detecting bone metastasis at initial staging. Auxiliary objectives are to identify risk factors for bone metastasis and features associated with poor survival in patients with bone metastasis.

PATIENTS AND METHODS: Patients with endemic NPC before initiation of treatment were enrolled. PET and SS were performed at initial staging and compared using McNemar's paired-sample test. Bone metastasis was considered to be present if there was any reliable evidence identified within 1 year after primary diagnosis. Multiple logistic regression and Cox's proportional hazards models were used for auxiliary objectives.

RESULTS: Thirty (15%) of 202 eligible patients were found to have bone metastasis. [¹⁸F]FDG PET was found to be more sensitive than SS in the patient-based analysis (P = .006) and in the region-based analysis at the spine (P = .001). Advanced N stage was the only significant risk factor (P < .0001), and the coexistence of hepatic metastasis was a prognosticator of poor survival (P = .017). The survival was not significantly better for patients with bone metastasis undetected at primary staging than for those with initially detectable bone metastasis (P = .620).

CONCLUSION: [¹⁸F]FDG PET is more sensitive than SS for detecting bone metastasis in endemic NPC at initial staging, whereas SS can be considered as supplementary in this setting.

Supported by Grant No. CMRPG32042 from the Chang Gung Memorial Hospital and University, Taipei, Taiwan.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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Related Correspondence

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  JCO 2007 25: 1297 [Full Text]

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