Relationship between tumor markers, Ca 15-3 and Ca 125, levels and Sodium-18 Fluoride Positron Emission Tomography Scan in breast cancer bone metastasis

• Published in: The Journal of nuclear medicine (1978) Vol. 60
• Main Authors: Abbaspour, Farzad, Kasraei, Farzad, Maliha, Peter G, Almanier, Nada, Alzahrani, Ahmed, Derbekyan, Vilma, Ciarallo, Anthony, Lisbona, Robert, diaz, Javier Novales, Abikhzar, Gad Salomon, Hickeson, Marc
• Format: Journal Article
• Language: English
• Published: New York Society of Nuclear Medicine 01-05-2019
• Subjects: Biomarkers; Bone cancer; Breast cancer; Fluorides; Fluorine isotopes; Markers; Metastases; Metastasis; Positron emission; Positron emission tomography; Radioisotopes; Serum levels; Sodium; Sodium fluoride; Statistical analysis; Tomography; Tumor markers; Tumors
• ISSN: 0161-5505; 1535-5667

Objectives: F-18 Sodium fluoride Positron Emission Tomography (NaF PET) is replacing conventional Tc99m-MDP bone scan for bone metastasis investigations, proving to be the more accurate test (1, 2). In breast cancer patients, rising Ca 15-3 and Ca 125 levels may represent tumor recurrence or bone metastasis and may be a poor prognosis factor. Understanding the relationship between Ca 15-3 and Ca 125 and NaF PET findings can potentially clarify the ideal time to request the scan. We decided to review NaF PET scan results performed in the last two years for breast cancer and correlate the results with Ca 15-3 and Ca 125 serum levels. Methods: A total of 359 NaF PET scans in 359 patients were retrospectively analyzed from May 2016 to December 2017 at a single academic university center. The population average age was 62 and the median Ca15-3 and Ca125 levels were 18.2 and 18 U/ml, respectively. NaF PET results were categorized as positive (presence of bone metastasis), negative (absence of bone metastasis) and suspicious (inconclusive for bone metastasis). A receiver operating characteristic curve analysis was conducted. Results: There was statistically significant correlation between NaF PET scan results and tumor markers Ca15-3 and Ca125 values (P-value = 0.001). According to scan result, there was significant difference in Ca15-3 and Ca 125 levels (P-value=0.001). The optimal cut-off value of Ca15-3 and Ca125 in a positive scan was calculated at 31.35 and 27.5 U/ml respectively. (Area under curve= 0.976 and 0.964, P-value =0.011 and 0.014). Conclusions: Knowing the appropriate cutoff values of Ca15-5 and Ca125 allows better timing for bone metastasis investigations using NaF PET.