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Expert System for Bone Scan Interpretation Improves Progression Assessment in Bone Metastatic Prostate Cancer

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Abstract

Introduction

The bone scan index (BSI) was introduced as a quantitative tool for tumor involvement in bone of patients with metastatic prostate cancer (mPCa). The computer-aided diagnosis device for BSI analysis EXINIboneBSI seems to represent technical progress for the quantitative assessment of bone involvement. But it is not yet clear if the automated BSI (aBSI) could contribute to improved evaluation of progression in patients under antiandrogens or chemotherapy in contrast to the visual interpretation and/or conventional biomarkers such as the prostate-specific antigen (PSA).

Methods

In 49 mPCa patients, bone scans were performed initially and during different therapy courses. Scans were evaluated visually and by the artificial-neural-network-based expert system EXINIboneBSI. Progression of metastatic bone involvement was defined according to the Prostate Cancer Clinical Trials Working Group 2 (PCWG2) criteria in the visual interpretation. The computer-assisted interpretation was based on different cutoff values in relative changes of the aBSI. Additionally, assessments according to bone scanning were compared to changes in the PSA value as a potential surrogate for treatment response.

Results

Using a sensitive cutoff value (5% or 10%) for the relative aBSI increase led to significantly increased progression determination compared to the visual interpretation of bone scans (49% and 43% vs. 27%, p < 0.001). In 63% of the cases PSA and BSI changes matched, whereas in 18% progression was only indicated by the aBSI. A relative cutoff of 5% for the aBSI decrease could reclassify 47 serial scan pairs which were visually interpreted as stable into 22 progressive and 25 remissive scans.

Conclusion

Distinct thresholds of the relative aBSI could help to better assess disease progression in mPCa patients. Manual corrections of the BSI values are not required in most cases. The aBSI could serve as a useful additional parameter for therapy monitoring in mPCa patients in the future.

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Acknowledgements

All patients had been participating in studies at the Department of Urology at Hannover Medical School and whole body bone scintigraphy (WBS) was part of their study assessments. EXINI Diagnostics (Lund, Sweden) distributed the license for EXINIboneBSI to the Department of Nuclear Medicine at Hannover Medical School. No funding or sponsorship was received for this study or publication of this article.

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Fabian Haupt performed the analysis of bone scans based on the results from EXINIboneBSI, authored the statistics, and drafted out the manuscript. Georg Berding made substantial contributions to conception and design of the study, created additional statistics, and contributed in drafting the manuscript. Ali Narmazian performed the analysis specific to the reduction of artifacts between V1.6 and V1.8 and the correlation of the BSI to the PSA after chemotherapy. Florian Wilke performed automated analysis of the BSI with all used versions of EXINIboneBSI. Alena Böker, Lilli Geworski, Markus Antonius Kuczyk, and Frank Michael Bengel have been involved in revising the manuscript. Inga Peters and Axel Merseburger integrated the clinical aspects as a specialist in urology. Inga Peters and Fabian Haupt drafted and revised the manuscript.

Disclosures

Fabian Haupt, Georg Berding, Ali Namazian, Florian Wilke, Alena Böker, Axel Merseburger, Lilli Geworski, Markus Antonius Kuczyk, Frank Michael Bengel, and Inga Peters report no conflicts of interest in this work.

Compliance with Ethics Guidelines

All procedures followed were in accordance with the ethical standards of the clinical ethics commission of Hannover Medical School and with the Helsinki Declaration of 1964, as revised in 2013. Informed consent was obtained from all patients for being included in the study.

Data Availability

The datasets during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany

    Fabian Haupt, Georg Berding, Ali Namazian & Frank Michael Bengel

  2. Department of Medical Physics and Radiation Protection, Hannover Medical School, Hannover, Germany

    Florian Wilke & Lilli Geworski

  3. Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany

    Alena Böker, Markus Antonius Kuczyk & Inga Peters

  4. Department of Urology, University Lübeck, Lübeck, Germany

    Axel Merseburger

  5. Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

    Fabian Haupt

Authors
  1. Fabian Haupt
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  2. Georg Berding
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  3. Ali Namazian
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  4. Florian Wilke
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  7. Lilli Geworski
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  8. Markus Antonius Kuczyk
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  9. Frank Michael Bengel
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  10. Inga Peters
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Corresponding author

Correspondence to Fabian Haupt.

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Haupt, F., Berding, G., Namazian, A. et al. Expert System for Bone Scan Interpretation Improves Progression Assessment in Bone Metastatic Prostate Cancer. Adv Ther 34, 986–994 (2017). https://doi.org/10.1007/s12325-017-0505-z

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  • DOI: https://doi.org/10.1007/s12325-017-0505-z

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