Abstract PO4-07-11: FDG-PET is superior to bone scintigraphy for the detection of bone metastases in breast cancer patients

Abstract Background: Bone is the commonest site for metastases in breast cancer patients, with up to 44% of patients having bone as their sole site of metastatic disease. Patients are at increased risk of morbidity from skeletal related events (SRE) from bone metastases due to pathological fractures and spinal cord compression. Early diagnosis is crucial so that bone modifying agents can be used to prevent SREs and other agents such as CDK4/6 inhibitors can be considered. Bone scintigraphy is the most widely performed first investigation for patients at high risk or symptomatic from bone metastases. Methods: We performed a meta-analysis comparing FDG-PET and bone scintigraphy using PubMed, Science Direct, and Embase for the literature search. 1009 patients were included in the study. Data for 2 × 2 contigency tables was selected and QUADAS-2 was used for quality assessment. Diagnostic accuracy was performed using Graph pad Prism 9.5.1 and R studio 2022. Pooled sensitivity and specificity of FDG-PET/CT was 96.6% (95% CI=91.5%-98.7%) and 96.8% (95% CI=82.1%-99.5%) respectively. Respective results for BS were 88.3% (95% CI=79.8%-93.5%) and 81.3% (95% CI=63.1%-91.7%). Sensitivity and specificity of FDG-PET/CT was significantly higher than BS (P=0.0063, P= 0.0068, respectively). The diagnostic odds ratio and area under ROC curve were significantly higher for FDG-PET/CT than BS (654.36 vs 35.24, and 0.980 vs 0.877, respectively). Conclusion: FDG-PET is superior to bone scinitigaphy for the detection of bone metastases in breast cancer.The benefits of replacing BS with FDG-PET/CT are evident. However othere technologies such as DW-MRI should be considered. Large multicentre prospective trials with strict FDG-PET/CT imaging protocols compared to DW-MRI both for disease detection and monitoring of response are required to strengthen the evidence in this field, to help inform imaging guidelines and best practices in the future. Newer technologies such as 18Festradiol (FES)-PET and 18FGE-226 for HER2 expression also warrant further investigation in ER positive and HER2 positive breast cancer. Citation Format: Laura Kenny, Maisher Tin-U. FDG-PET is superior to bone scintigraphy for the detection of bone metastases in breast cancer patients abstract. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-07-11.