Fluorocholine (18F) and sodium fluoride (18F) PET/CT in the detection of prostate cancer: prospective comparison of diagnostic performance determined by masked reading

• Published in: The quarterly journal of nuclear medicine and molecular imaging Vol. 55; no. 4; pp. 448 - 457
• Main Authors: Langsteger, W, Balogova, S, Huchet, V, Beheshti, M, Paycha, F, Egrot, C, Janetschek, G, Loidl, W, Nataf, V, Kerrou, K, Pascal, O, Cussenot, O, Talbot, J N
• Format: Journal Article
• Language: English
• Published: Italy Edizioni Minerva Medica 01-08-2011
• Subjects: Aged; Aged, 80 and over; Bone Neoplasms - diagnostic imaging; Bone Neoplasms - secondary; Bones; Choline - analogs & derivatives; Fluorine Radioisotopes; Humans; Male; Medical diagnosis; Medical imaging; Metastasis; Middle Aged; Positron-Emission Tomography - methods; Prospective Studies; Prostate cancer; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Fluoride; Tomography, X-Ray Computed - methods
• EISSN: 1827-1936
• ISSN: 1824-4785

The aim of this paper was to compare the diagnostic performance of positron emission tomography/computed tomography (PET/CT) with fluorocholine (18F) (FCH) or fluoride(18F) (FNa) for the detection of bone metastasis in patients with prostate cancer complaining from osteoarticular pain, taking into account whether they were referred for initial staging or recurrence localization. The initial hypothesis was that FCH site-based specificity would be superior to that of F Na, with no loss in sensitivity.
Forty-two patients were enrolled in this prospective study, underwent both PET/CTs and were then followed-up for at least 6 months. The standard of truth (SOT) about the presence/absence and location of bone metastasis could be determined in 40 patients, by 2 independent medical assessors, blinded to the results of both PET/CTs. The comparison was performed according to the guideline of the European Medicines Agency, i.e. based on the results of blind reading with SOT as reference.
Bone extension was present in 22 patients and absent in 18. Patient-based performance for FCH vs. FNa was 91% vs. 91% for sensitivity, 89% vs. 83% for specificity and 90% vs. 88% for accuracy (no significant difference). Of 360 skeletal sites, 68 were malignant and 292 non-invaded. There was no significant difference in site-based performance in the group of patients referred at initial staging, but in the group of patients referred for suspicion of recurrence, FCH was significantly more specific than FNa (96% vs. 91%, P=0.033 with Obuchowski's correction) while sensitivity was the same, 89%.
Both radiopharmaceuticals, based on a very different metabolic approach, showed good diagnostic performance. If FCH is available, it should be preferred in patients after initial treatment.