• Punit Sharma, Harmandeep Singh, Rakesh Kumar, Chandrasekhar Bal, Sanjay Thulkar, Vulatheru Seenu, and Arun Malhotra.
• Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
• Nucl Med Commun. 2012 Feb 1; 33 (2): 139-47.

PurposeTo evaluate the incremental value of single-photon emission computed tomography-computed tomography (SPECT-CT) over planar scintigraphy and SPECT alone for equivocal bone scintigraphy lesions in patients with breast cancer and to assess its impact on patient management.MethodsA total of 102 patients with 115 equivocal lesions on planar scintigraphy underwent SPECT and SPECT-CT of selected volume. Images were evaluated in separate sessions to minimize recall bias. A scoring scale of 1-5 was used, where 1 is definitely metastatic, 2 is probably metastatic, 3 is indeterminate, 4 is probably benign, and 5 is definitely benign. With receiver operating characteristic analysis, area under the curves was constructed for each modality. Clinical/imaging follow-up and/or histopathology were taken as the reference standard.ResultsThere were 52 indeterminate lesions on planar scintigraphy, 15 on SPECT, and three on SPECT-CT. Area under the curve for SPECT-CT was significantly larger compared with planar scintigraphy (P<0.001) and SPECT (P=0.033). This improvement was mostly for lytic lesions (P<0.0001). In patients (n=67) in whom the lesions under evaluation were the only lesions and hence whose management was decided, SPECT-CT was superior to SPECT (P=0.045) and planar scintigraphy (P <0.001).ConclusionSPECT-CT is better than planar scintigraphy and SPECT alone for characterizing equivocal bone scintigraphy lesions in patients with breast cancer and can have a significant impact on patient management.

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