Predictive value of bone scintigraphy in the diagnosis of prostate cancer bone metastases and comparison of verification methods

Objective: There is no definitive consensus on the methods to verify suspicious lesions in bone scintigraphy (BS) for bone metastases in patients diagnosed with prostate cancer (PCa). in this study, we aimed to compare the accuracy rates of imaging modalities used for patients with suspected lesions in BS. Design: Retrospective cross-sectional study Setting: Tertiary university hospital Subjects: One hundred and twenty-six PCa patients with bone metastases Intervention: BS was applied to all patients for bone metastases screening. Patients underwent computerized tomography, X-ray, magnetic resonance imaging (MRI) and positron emission tomography for bone metastasis verification for suspicious lesions in BS. Main outcome measures: Comparison of metastasis detection rates of the imaging modalities and the evaluation of sensitivity of BS according to the location and the number of lesions. Results: MRI provided the highest rate of metastasis confirmation (81.3%). We found that the rate of detection of metastases in thoracal vertebrae, pubic bones, femur, L3-5 vertebrae and multiply involved cases was statistically significant (P<.05). Metastasis verification rate in non-vertebral lesions was significantly higher than vertebral lesions (58.2% vs 25.9%, P=.018). Conclusion: MRI is the most accurate method providing metastasis verification for suspect foci in BS. As the number of lesions increases and in the involvement of the non-vertebral locations, the ability of BS to distinguish true metastases from false-positive metastases increases. Prospective, randomized trials are needed to routinely recommend MRI as a first-line procedure for the diagnosis of bone metastases