Prospective Evaluation of Computer-assisted Analysis of Skeletal Lesions for the Staging of Prostate Cancer

Overview

Journal BMC Med Imaging

Publisher Biomed Central

Specialty Radiology

Date 2017 Jul 12

PMID 28693433

Citations 3

Authors

Lars J Petersen

Jesper C Mortensen

Henrik Bertelsen

Helle D Zacho

Affiliations

Soon will be listed here.

Abstract

Background: The purpose of this study was to compare the agreement of the bone scan index (BSI) using EXINI Bone versus experts' readings in the initial staging for bone metastasis in prostate cancer. In addition, the diagnostic outcome was assessed in a large subset of patients where a true reference for metastases could be determined based on clinical and biochemical follow-up and/or supplementary imaging.

Methods: A total of 342 patients had a bone scintigraphy as part of routine staging for prostate cancer. Supplementary imaging was obtained at the discretion of the referring urologist. After full recruitment, the BSI and the number of malignant lesions were calculated using EXINI Bone, and three imaging experts independently classified bone status by a dichotomous outcome (M1 for bone metastasis, M0 for no bone metastasis). A true reference was available in a subset of the patients based on post-operative prostate-specific antigen responses after radical prostatectomy and/or supplementary imaging.

Results: Software analysis with a BSI > 0 as the cut-off for metastasis showed excellent agreement with expert classification for M1 disease (96% of the patients) but modest agreement for M0 disease (38%). With a BSI > 1, the agreement was 58% for M1 and 98% for M0. Software analyses based on individual European Association of Urology risk classification did not improve the diagnostic performance. Among patients with a true reference, the software showed metastasis in 64% of the M0 patients but correctly classified metastases in all M1 patients. The sensitivity was 100%, the specificity was 36%, the positive predictive value was 12.6% and the negative predictive value was 100% with a BSI >0 compared with 66.7%, 97.8%, 72.7%, and 97.0% with a BSI > 1.

Conclusion: The diagnostic value of using EXINI Bone for the BSI in the staging of newly diagnosed prostate cancer is limited.

Citing Articles

Application of SPECT and PET / CT with computer-aided diagnosis in bone metastasis of prostate cancer: a review.

Chen Z, Chen X, Wang R Cancer Imaging. 2022; 22(1):18.

PMID: 35428360 PMC: 9013072. DOI: 10.1186/s40644-022-00456-4.

Progress in diagnosis of bone metastasis of prostate cancer.

Liu J, Dong Y, Xu D, Zhang C, Lan T, Chang D Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2021; 46(10):1147-1152.

PMID: 34911846 PMC: 10930230. DOI: 10.11817/j.issn.1672-7347.2021.200999.

Analysis of Bone Scans in Various Tumor Entities Using a Deep-Learning-Based Artificial Neural Network Algorithm-Evaluation of Diagnostic Performance.

Wuestemann J, Hupfeld S, Kupitz D, Genseke P, Schenke S, Pech M Cancers (Basel). 2020; 12(9).

PMID: 32957650 PMC: 7565494. DOI: 10.3390/cancers12092654.

References

Kalderstam J, Sadik M, Edenbrandt L, Ohlsson M . Analysis of regional bone scan index measurements for the survival of patients with prostate cancer. BMC Med Imaging. 2014; 14:24. PMC: 4105506. DOI: 10.1186/1471-2342-14-24. View

Sonpavde G, Pond G, Armstrong A, Galsky M, Leopold L, Wood B . Radiographic progression by Prostate Cancer Working Group (PCWG)-2 criteria as an intermediate endpoint for drug development in metastatic castration-resistant prostate cancer. BJU Int. 2013; 114(6b):E25-E31. DOI: 10.1111/bju.12589. View

Armstrong A, Kaboteh R, Carducci M, Damber J, Stadler W, Hansen M . Assessment of the bone scan index in a randomized placebo-controlled trial of tasquinimod in men with metastatic castration-resistant prostate cancer (mCRPC). Urol Oncol. 2014; 32(8):1308-16. PMC: 6341998. DOI: 10.1016/j.urolonc.2014.08.006. View

Anand A, Morris M, Kaboteh R, Bath L, Sadik M, Gjertsson P . Analytic Validation of the Automated Bone Scan Index as an Imaging Biomarker to Standardize Quantitative Changes in Bone Scans of Patients with Metastatic Prostate Cancer. J Nucl Med. 2015; 57(1):41-5. PMC: 4975929. DOI: 10.2967/jnumed.115.160085. View

Reza M, Bjartell A, Ohlsson M, Kaboteh R, Wollmer P, Edenbrandt L . Bone Scan Index as a prognostic imaging biomarker during androgen deprivation therapy. EJNMMI Res. 2014; 4:58. PMC: 4205473. DOI: 10.1186/s13550-014-0058-y. View

Kaboteh R, Damber J, Gjertsson P, Hoglund P, Lomsky M, Ohlsson M . Bone Scan Index: a prognostic imaging biomarker for high-risk prostate cancer patients receiving primary hormonal therapy. EJNMMI Res. 2013; 3(1):9. PMC: 3570487. DOI: 10.1186/2191-219X-3-9. View

Tokuda O, Harada Y, Ohishi Y, Matsunaga N, Edenbrandt L . Investigation of computer-aided diagnosis system for bone scans: a retrospective analysis in 406 patients. Ann Nucl Med. 2014; 28(4):329-39. DOI: 10.1007/s12149-014-0819-8. View

Mohler J, Kantoff P, Armstrong A, Bahnson R, Cohen M, DAmico A . Prostate cancer, version 2.2014. J Natl Compr Canc Netw. 2014; 12(5):686-718. DOI: 10.6004/jnccn.2014.0072. View

Mitsui Y, Shiina H, Yamamoto Y, Haramoto M, Arichi N, Yasumoto H . Prediction of survival benefit using an automated bone scan index in patients with castration-resistant prostate cancer. BJU Int. 2012; 110(11 Pt B):E628-34. DOI: 10.1111/j.1464-410X.2012.11355.x. View

10.

Imbriaco M, Larson S, Yeung H, Mawlawi O, Erdi Y, Venkatraman E . A new parameter for measuring metastatic bone involvement by prostate cancer: the Bone Scan Index. Clin Cancer Res. 1998; 4(7):1765-72. View

11.

Sadik M, Jakobsson D, Olofsson F, Ohlsson M, Suurkula M, Edenbrandt L . A new computer-based decision-support system for the interpretation of bone scans. Nucl Med Commun. 2006; 27(5):417-23. DOI: 10.1097/00006231-200605000-00002. View

12.

Armstrong A, Eisenberger M, Halabi S, Oudard S, Nanus D, Petrylak D . Biomarkers in the management and treatment of men with metastatic castration-resistant prostate cancer. Eur Urol. 2011; 61(3):549-59. PMC: 3445625. DOI: 10.1016/j.eururo.2011.11.009. View

13.

Poulsen M, Rasmussen J, Edenbrandt L, Hoilund-Carlsen P, Gerke O, Johansen A . Bone Scan Index predicts outcome in patients with metastatic hormone-sensitive prostate cancer. BJU Int. 2015; 117(5):748-53. DOI: 10.1111/bju.13160. View

14.

Anand A, Morris M, Larson S, Minarik D, Josefsson A, Helgstrand J . Automated Bone Scan Index as a quantitative imaging biomarker in metastatic castration-resistant prostate cancer patients being treated with enzalutamide. EJNMMI Res. 2016; 6(1):23. PMC: 4785173. DOI: 10.1186/s13550-016-0173-z. View

15.

Sadik M, Suurkula M, Hoglund P, Jarund A, Edenbrandt L . Improved classifications of planar whole-body bone scans using a computer-assisted diagnosis system: a multicenter, multiple-reader, multiple-case study. J Nucl Med. 2009; 50(3):368-75. DOI: 10.2967/jnumed.108.058883. View

16.

Robinson P . Radiology's Achilles' heel: error and variation in the interpretation of the Röntgen image. Br J Radiol. 1998; 70(839):1085-98. DOI: 10.1259/bjr.70.839.9536897. View

17.

Ulmert D, Kaboteh R, Fox J, Savage C, Evans M, Lilja H . A novel automated platform for quantifying the extent of skeletal tumour involvement in prostate cancer patients using the Bone Scan Index. Eur Urol. 2012; 62(1):78-84. PMC: 3402084. DOI: 10.1016/j.eururo.2012.01.037. View

18.

Doherty M, van de Putte L . Committee on Publication Ethics (COPE) guidelines on good publication practice. Ann Rheum Dis. 2000; 59(6):403-4. PMC: 1753164. DOI: 10.1136/ard.59.6.403. View

19.

Kaboteh R, Gjertsson P, Leek H, Lomsky M, Ohlsson M, Sjostrand K . Progression of bone metastases in patients with prostate cancer - automated detection of new lesions and calculation of bone scan index. EJNMMI Res. 2013; 3(1):64. PMC: 3751570. DOI: 10.1186/2191-219X-3-64. View

20.

Zacho H, Barsi T, Mortensen J, Bertelsen H, Petersen L . Validation of contemporary guidelines for bone scintigraphy in prostate cancer staging: A prospective study in patients undergoing radical prostatectomy. Scand J Urol. 2015; 50(1):29-32. DOI: 10.3109/21681805.2015.1076031. View