{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T09:25:23Z","timestamp":1787217923203,"version":"build-2736575974"},"reference-count":28,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Bone is the third most common site of solid-tumor metastasis, and surgical management spans a wide spectrum from observation to curative en bloc resection in selected patients. 18F-FDG PET\/CT has been reported to alter oncologic management in 20% to 45% of patients across diverse settings, yet its specific impact on surgical decision-making within a multidisciplinary orthopedic oncology board (MOOB) reassessment and the predictors of decision change remain undefined. Methods: We retrospectively analyzed consecutive patients with histopathologically confirmed bone metastases evaluated at a tertiary-care MOOB between February 2023 and February 2026. For each patient, the surgical plan was recorded twice: first by the orthopedic team based on available conventional imaging (radiography, computed tomography, magnetic resonance imaging) and then as the final PET\/CT-informed MOOB review. This design evaluates changes in decision-making intent after PET\/CT-informed multidisciplinary reassessment, rather than the isolated causal effect of PET\/CT or actual surgical implementation. Surgical plans were categorized as no surgery, palliative stabilization, palliative resection, or curative-intent resection, and changes were classified as no change, escalation, de-escalation, or cancellation. Results: Among 73 patients (mean age 64.7 \u00b1 12.1 years; 53.4% male), the most frequent primaries were lung (37.0%), breast (21.9%), and renal cell carcinoma (13.7%). Following PET\/CT-informed MOOB reassessment, the intended surgical plan changed in 53.4% of cases (p &lt; 0.001), comprising surgery cancellation (27.4%), escalation (17.8%), and de-escalation (8.2%). Patients directed to no surgery increased fourfold (6.8% to 28.8%), and curative resection emerged as a post-reassessment recommendation (0% to 10.9%). SUVmax did not predict overall decision change, but higher SUVmax was associated with cancellation\/de-escalation in the directional analysis. In exploratory multivariable analysis, polymetastatic disease (OR 0.051; 95% CI 0.005 to 0.547; p = 0.014), long-bone diaphyseal location (OR 0.133; p = 0.006), and higher Eastern Cooperative Oncology Group (ECOG) performance score (OR 2.109 per point; p = 0.018) independently predicted decision change. Conclusions: PET\/CT-informed MOOB reassessment was associated with substantial changes in intended surgical strategy for metastatic bone disease. The findings support careful multidisciplinary integration of metabolic imaging, metastatic burden, anatomic location, and performance status, but should be regarded as hypothesis-generating until validated prospectively with data on treatment delivery and downstream outcomes.<\/jats:p>","DOI":"10.3390\/jcm15166436","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T08:10:20Z","timestamp":1787213420000},"page":"6436","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["18F-FDG PET\/CT-Informed Multidisciplinary Reassessment Modifies Surgical Strategy in Patients with Metastatic Bone Disease: Exploratory Predictors of Decision Change in an Orthopedic Oncology Board"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7461-3526","authenticated-orcid":false,"given":"Erkan","family":"Akgun","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Traumatology, Ankara Etlik City Hospital, Halil Sezai Korkmaz St., Varl\u0131k, Ankara 06170, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3946-8554","authenticated-orcid":false,"given":"H. Emre","family":"Tepedelenlio\u011flu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Ankara Etlik City Hospital, Halil Sezai Korkmaz St., Varl\u0131k, Ankara 06170, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3620-7041","authenticated-orcid":false,"given":"Serkan","family":"Aydin","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Ankara Etlik City Hospital, Halil Sezai Korkmaz St., Varl\u0131k, Ankara 06170, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Turgut","family":"Yurdakul","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Ankara Etlik City Hospital, Halil Sezai Korkmaz St., Varl\u0131k, Ankara 06170, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2458-3530","authenticated-orcid":false,"given":"S. Sinan","family":"G\u00fcltekin","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Ankara Etlik City Hospital, Halil Sezai Korkmaz St., Varl\u0131k, Ankara 06170, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1945-3715","authenticated-orcid":false,"given":"H. Bilgehan","family":"\u00c7evik","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Ankara Etlik City Hospital, Halil Sezai Korkmaz St., Varl\u0131k, Ankara 06170, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Zhang, J., Cai, D., and Hong, S. (2023). Prevalence and prognosis of bone metastases in common solid cancers at initial diagnosis: A population-based study. BMJ Open, 13.","DOI":"10.1136\/bmjopen-2022-069908"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"875","DOI":"10.3892\/mco.2014.326","article-title":"Metastatic bone tumors: Analysis of factors affecting prognosis and efficacy of CT and (18)F-FDG PET-CT in identifying primary lesions","volume":"2","author":"Shimada","year":"2014","journal-title":"Mol. Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3347","DOI":"10.3390\/curroncol28050290","article-title":"Current Overview of Treatment for Metastatic Bone Disease","volume":"28","author":"Tsukamoto","year":"2021","journal-title":"Curr. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Goker, B., Shea, M., Zhang, R., Wang, J., Ferrena, A., Chae, S.-S., Borjihan, H., Yang, R., Hoang, B.H., and Geller, D.S. (2024). The evolution of the multidisciplinary tumor board in orthopedic oncology: From its historical roots to its future potential. Holist. Integr. Oncol., 3.","DOI":"10.1007\/s44178-024-00107-7"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Hofman, M.S., and Hicks, R.J. (2016). How We Read Oncologic FDG PET\/CT. Cancer Imaging, 16.","DOI":"10.1186\/s40644-016-0091-3"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/S1095-0397(01)00055-3","article-title":"Combined PET\/CT Imaging in Oncology. Impact on Patient Management","volume":"3","author":"Kluetz","year":"2000","journal-title":"Clin. Positron Imaging"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1007\/s00330-019-06518-9","article-title":"Impact of PET\/CT on clinical management in patients with cancer of unknown primary-a PET\/CT registry study","volume":"30","author":"Reinert","year":"2020","journal-title":"Eur. Radiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1053\/j.semnuclmed.2024.10.008","article-title":"Diagnosing Bone Metastases in Breast Cancer: A Systematic Review and Network Meta-Analysis on Diagnostic Test Accuracy Studies of 2-[18F]FDG-PET\/CT, 18F-NaF-PET\/CT, MRI, Contrast-Enhanced CT, and Bone Scintigraphy","volume":"55","author":"Gerke","year":"2025","journal-title":"Semin Nucl. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1016\/j.ejrad.2011.01.126","article-title":"A meta-analysis of 18FDG-PET-CT, 18FDG-PET, MRI and bone scintigraphy for diagnosis of bone metastases in patients with lung cancer","volume":"81","author":"Qu","year":"2012","journal-title":"Eur. J. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3647","DOI":"10.7314\/APJCP.2013.14.6.3647","article-title":"Diagnostic value of 18 F-FDG PET\/CT in comparison to bone scintigraphy, CT and 18 F-FDG PET for the detection of bone metastasis","volume":"14","author":"Liu","year":"2013","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Huang, R., Hu, Y., and Zhang, Y. (2024). Utility of (18)F-FDG PET\/CT in Treatment Strategies for Patients with Cancer of Unknown Primary: A Single-Center, Retrospective Change-in-Management Study. Clin. Med. Insights Oncol., 18.","DOI":"10.1177\/11795549241245691"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.2967\/jnumed.123.267274","article-title":"Evaluating the utility of 18F-FDG PET\/CT in cancer of unknown primary","volume":"65","author":"Sivakumaran","year":"2024","journal-title":"J. Nucl. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jos.2023.11.007","article-title":"Japanese orthopaedic association (JOA) clinical practice guideline on the management of primary malignant bone tumors\u2014Secondary publication","volume":"30","author":"Tsuchiya","year":"2025","journal-title":"J. Orthop. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1159\/000503095","article-title":"Performance Status Assessment by Using ECOG (Eastern Cooperative Oncology Group) Score for Cancer Patients by Oncology Healthcare Professionals","volume":"12","author":"Azam","year":"2019","journal-title":"Case Rep. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1007\/s00259-014-2961-x","article-title":"FDG PET\/CT: EANM procedure guidelines for tumour imaging: Version 2.0","volume":"42","author":"Boellaard","year":"2015","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"318","DOI":"10.9738\/INTSURG-D-16-00006.1","article-title":"Preoperative use of PET\/CT in patients with colorectal and gastric cancer and its impact on treatment decision making","volume":"101","author":"Atici","year":"2016","journal-title":"Int. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1007\/s00259-019-04553-8","article-title":"Good clinical practice recommendations for the use of PET\/CT in oncology","volume":"47","author":"Abgral","year":"2020","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Vijayakumar, S., Yang, J., Nittala, M.R., E Velazquez, A., Huddleston, B.L., A Rugnath, N., Adari, N., Yajurvedi, A.K., Komanduri, A., and Yang, C.C. (2022). Changing Role of PET\/CT in Cancer Care with a Focus on Radiotherapy. Cureus, 14.","DOI":"10.7759\/cureus.32840"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.ejca.2018.08.028","article-title":"Clinical management of spinal metastases-The Dutch national guideline","volume":"104","author":"Bollen","year":"2018","journal-title":"Eur. J. Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.lungcan.2020.04.027","article-title":"ECOG performance status \u22652 as a prognostic factor in patients with advanced non small cell lung cancer treated with immune checkpoint inhibitors-A systematic review and meta-analysis of real world data","volume":"145","author":"Maggio","year":"2020","journal-title":"Lung Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Meares, C., Badran, A., and Dewar, D. (2019). Prediction of survival after surgical management of femoral metastatic bone disease\u2014A comparison of prognostic models. J. Bone Oncol., 15.","DOI":"10.1016\/j.jbo.2019.100225"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/j.spinee.2015.09.043","article-title":"Assessing the utility of a clinical prediction score regarding 30-day morbidity and mortality following metastatic spinal surgery: The New England Spinal Metastasis Score (NESMS)","volume":"16","author":"Schoenfeld","year":"2016","journal-title":"Spine J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1016\/j.ijrobp.2003.12.039","article-title":"Prediction of outcome in head-and-neck cancer patients using the standardized uptake value of 2-[18F] fluoro-2-deoxy-D-glucose","volume":"59","author":"Allal","year":"2004","journal-title":"Int. J. Radiat. Oncol.* Biol.* Phys."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1097\/RLU.0000000000002291","article-title":"Prognostic Value of Volumetric Parameters of Pretreatment 18F-FDG PET\/CT in Esophageal Cancer: A Systematic Review and Meta-analysis","volume":"43","author":"Han","year":"2018","journal-title":"Clin. Nucl. Med."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Huang, M., Zou, Y., Wang, W., Li, Q., and Tian, R. (2024). The role of baseline (18)F-FDG PET\/CT for survival prognosis in NSCLC patients undergoing immunotherapy: A systematic review and meta-analysis. Ther. Adv. Med. Oncol., 16.","DOI":"10.1177\/17588359241293364"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"4661","DOI":"10.1007\/s00259-022-05918-2","article-title":"The value of FDG PET\/CT imaging in outcome prediction and response assessment of lymphoma patients treated with immunotherapy: A meta-analysis and systematic review","volume":"49","author":"Kiamanesh","year":"2022","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1007\/s00259-017-3870-6","article-title":"Absolute number of new lesions on (18)F-FDG PET\/CT is more predictive of clinical response than SUV changes in metastatic melanoma patients receiving ipilimumab","volume":"45","author":"Anwar","year":"2018","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"122s","DOI":"10.2967\/jnumed.108.057307","article-title":"From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors","volume":"50","author":"Wahl","year":"2009","journal-title":"J. Nucl. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6436\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T08:44:28Z","timestamp":1787215468000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6436"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,20]]},"references-count":28,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166436"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166436","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,20]]}}}