Intra-individual comparability of 18F-sodium fluoride PET–CT and 99mTc bone scintigraphy with SPECT in sufferers with prostate most cancers or breast most cancers at excessive threat for skeletal metastases (MITNEC-A1): a multicentre, segment 3 trial

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Background

Detection of skeletal metastases in sufferers with prostate most cancers or breast most cancers
stays a significant scientific problem. We aimed to check the diagnostic efficiency
of 99mTc-methylene diphosphonate (99mTc-MDP) single-photon emission CT (SPECT) and 18F-sodium fluoride (18F-NaF) PET–CT for the detection of osseous metastases in sufferers with high-risk prostate
or breast most cancers.

Strategies

MITNEC-A1 used to be a potential, multicentre, single-cohort, segment 3 trial carried out in
ten hospitals throughout Canada. Sufferers elderly 18 years or older with breast or prostate
most cancers with a WHO efficiency standing of 0–2 and with excessive threat or scientific suspicion
for bone metastasis, however with out in the past documented bone involvement, had been eligible.
18F-NaF PET–CT and 99mTc-MDP SPECT had been achieved inside 14 days of one another for each and every player. Two unbiased
reviewers interpreted each and every modality with out wisdom of different imaging findings. The
number one endpoint used to be the total accuracy of 99mTc-MDP SPECT and 18F-NaF PET–CT scans for the detection of bone metastases within the per-protocol inhabitants.
A mixture of histopathological, scientific, and imaging follow-up for as much as 24 months
used to be used because the reference usual to evaluate the imaging effects. Protection used to be assessed
in all enrolled contributors. This learn about is registered with ClinicalTrials.gov, NCT01930812, and is whole.

Findings

Between July 11, 2014, and March 3, 2017, 290 sufferers had been screened, 288 of whom
had been enrolled (64 contributors with breast most cancers and 224 with prostate most cancers). 261
contributors underwent each 18F-NaF PET–CT and 99mTc-MDP SPECT and finished the desired follow-up for statistical research. Median
follow-up used to be 735 days (IQR 727–750). According to the reference strategies used, 109 (42%)
of 261 sufferers had bone metastases. Within the patient-based research, 18F-NaF PET–CT used to be extra correct than 99mTc-MDP SPECT (84·3% [95% CI 79·9–88·7] vs 77·4% [72·3–82·5], distinction 6·9% [95% CI 1·3–12·5]; p=0·016). No opposed occasions
had been reported for the 288 sufferers recruited.

Interpretation

18F-NaF has the prospective to displace 99mTc-MDP because the bone imaging radiopharmaceutical of selection in sufferers with high-risk
prostate or breast most cancers.

Investment

Canadian Institutes of Well being Analysis.



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