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Neurosurgery. 2009 Jan;64(1):107-13; discussion 113-4. doi: 10.1227/01.NEU.0000335176.98788.A1.

The accuracy of [(18)F]fluorodeoxyglucose positron emission tomography as confirmed by biopsy in the diagnosis of spine metastases in a cancer population.

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1
Department of Neurological Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.

Abstract

OBJECTIVE:

To determine the accuracy of [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) in the diagnosis of vertebral metastases in patients with cancer using needle-biopsy results and patient follow-up data.

METHODS:

A retrospective chart review of all patients who underwent a needle biopsy of a spinal lesion and underwent FDG-PET within 6 weeks of the biopsy was performed. Biopsy results and magnetic resonance imaging and computed tomographic appearance of the biopsied lesion, as well as long-term clinical follow-up data, were recorded for each patient. A total of 82 patients with solid tumors and hematological spine metastases were included in this study.

RESULTS:

The mean standardized uptake values of lesions with active cancer were 7.1 and 2.1 in benign lesions (P < 0.02). In patients with metastatic solid tumors, the mean standardized uptake value was 7.3. Stratification of solid tumor lesions according to whether they had a sclerotic appearance on computed tomographic scans showed that FDG-PET was a significantly better predictor of cancer status in lytic or mixed lesions. In patients with a history of solid tumors, there was 100% concordance between the FDG-PET and needle-biopsy diagnoses in nonsclerotic lesions, when the standardized uptake value cutoff of 2 was used.

CONCLUSION:

FDG-PET is an accurate screening test for vertebral metastases in cancer patients. It is especially accurate in patients with nonsclerotic vertebral lesions and a history of solid malignancy.

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