Role of 18F-FDG PET/CT in bone and soft tissue sarcoma

Document Type : Original Article


1 Assistant Professor, Department of Orthopedic, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran

2 2. Razavi Cancer Research Center, Razavi Hospital, Imam Reza International University, Mashhad, Iran.

3 Razavi Cancer Research Center, Razavi Hospital, Imam Reza International University, Mashhad, Iran.

4 Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, IR Iran


Effective management of patients with sarcoma requires accurate diagnosis and staging. Imaging techniques such as ultrasound, CT, and MRI are commonly used for detecting the location, size, and morphological and structural changes of adjacent tissues. However, these modalities provide little information about tumor biology.
The present study reports the experiences of a private clinical center on the role of 18F-FDG PET/CT in the diagnosis, staging, restaging and monitoring of a treatment response in the management of patients with sarcoma.
Methods: The records of patients with bone and soft tissue sarcoma referred to a private specialized hospital for 18F-FDG PET/CT from 2016 to 2019 were evaluated. Information such as radiotherapy, chemotherapy and pathology of patients was recorded.
Results: 66.7% of males (mean age of 26.37 years) and 33.3% females (mean age of 28.76 years) were included in the study. Among SUVmax reported in observed lesions, either metastasis or recurrence and primary tumor, the highest value was found in the lymph node on the right side of neck due to metastasis of the giant cell tumor of the bone (SUVmax = 18.23) and the lowest in the right lung pulmonary node due to the retroperitoneal sarcoma metastasis (SUVmax = 0.88). Mean SUVmax of hepatic right lobe was not significantly different between diabetic and non-diabetic patients (p=0.761).
Conclusion: 18F-FDG PET/CT appears to be a noninvasive measurement method that can be used to predict events and outcomes, but it is currently considered an optional test, which calls for further studies to corroborate its case-effectiveness.


 1.Coindre JM, Terrier P, Guillou L, Le Doussal V,
Collin F, Ranchère D, et al. Predictive value of grade for
metastasis development in the main histologic types of
adult soft tissue sarcomas: a study of 1240 patients from
the French Federation of Cancer Centers Sarcoma
Group. Cancer 2001;91:1914–1926.
2. Brennan MF, Antonescu CR, Moraco N, Singer S.
Lessons learned from the
study of 10,000 patients with soft tissue sarcoma. Ann
Surg 2014;260:416–421; (discussion 421–412).
3. Jo VY, Fletcher CD. WHO classification of soft tissue
tumours: an update based on the 2013 (4th) edition.
Pathology 2014; 46:95–104.
4.Schulte M, Brecht-Krauss D, Heymer B, et al. Grading
of tumors and tumorlike lesions of bone: evaluation by
FDG PET. J Nucl Med 2000;41:1695–1701.
5. Kole AC, Nieweg OE, van Ginkel RJ, Pruim J,
Hoekstra HJ, Paans AM, et al.
Detection of local recurrence of soft-tissue sarcoma with
positron emission tomography using
[18F]fluorodeoxyglucose. Ann Surg Oncol 1997; 4:57–
6. Miraldi F, Adler LP, Faulhaber P. PET imaging in soft
tissue sarcomas. Cancer Treat Res 1997; 91:51–64.
7.Hicks RJ, Toner GC, Choong PF. Clinical applications
of molecular imaging in sarcoma evaluation. Cancer
Imaging 2005; 5:66–72.
8. Benz MR, Czernin J, Allen-Auerbach MS, Tap WD,
Dry SM, Elashoff D, et al.FDG-PET/CT imaging
predicts histopathologic treatment responses after the
initial cycle of neoadjuvant chemotherapy in high-grade
soft-tissue sarcomas. Clin Cancer Res 2009; 15:2856–
9. Folpe AL, Lyles RH, Sprouse JT, Conrad EU, Eary
JF. (F-18) fluorodeoxyglucose positron emission
tomography as a predictor of pathologic grade and other
prognostic variables in bone and soft tissue sarcoma.
Clin Cancer Res 2000; 6:1279–1287.
10. Li YJ, Dai YL, Cheng YS, Zhang WB, Tu CQ.
Positron emission tomography
(18)F-fluorodeoxyglucose uptake and prognosis in
patients with bone and prognosis in patients with bone
and soft tissue sarcoma: A meta-analysis. Eur J Surg
Oncol 2016; 42:1103–1114.
11. Skamene SR, Rakheja R, Dahlstrom KR, Roberge D,
Nahal A, Charest M,et al. Metabolic activity measured
on PET/CT correlates with clinical outcomes in patients
with limb and girdle sarcomas. J Surg Oncol 2014;
12.Lisle JW, Eary JF, O’Sullivan J, Conrad EU. Risk
assessment based on FDGPET
imaging in patients with synovial sarcoma. Clin Orthop
Relat Res 2009;467:1605–1611.
13. Kubo T, Furuta T, Johan MP, Ochi M. Prognostic
significance of (18)F-FDG
PET at diagnosis in patients with soft tissue sarcoma and
bone sarcoma; systematic review and meta-analysis. Eur
J Cancer 2016; 58:104–111.
14. Eary JF, O’Sullivan F, Powitan Y, Chandhury KR,
Vernon C, Bruckner JD, et al. Sarcoma tumor FDG
uptake measured by PET and patient outcome: a
retrospective analysis. Eur J Nucl Med Mol Imaging
2002; 29:1149–1154.
15. Rakheja R, Makis W, Tulbah R, Skamene S,
Holcroft C, Nahal A, et al. Necrosis on FDG PET/CT
correlates with prognosis and mortality in
sarcomas. Am J Roentgenol 2013; 201:170–177.
16. Hong SP, Lee SE, Choi YL, Seo SW, Sung KS, Koo
HH, et al. Prognostic value of 18F-FDG PET/CT in
patients with soft tissue sarcoma: comparisons
between metabolic parameters. Skeletal Radiol 2014;
17.Lee JW, Kang CM, Choi HJ, et al. Prognostic value
of metabolic tumor volume and total lesion glycolysis on
preoperative (1)(8)F-FDG PET/CT in patients with
pancreatic cancer. J Nucl Med 2014; 55:898–904.
18. Pak K, Cheon GJ, Nam HY, Kim SJ, Kang KW,
Chung JK, et al. Prognostic value of metabolic tumor
volume and total lesion glycolysis in head and neck
cancer: a systematic review and meta-analysis. J Nucl
Med 2014;55:884–890.
19. Lodge MA, Lucas JD, Marsden PK, Cronin BF,
O’Doherty MJ, Smith MA. A
PET study of 18FDG uptake in soft tissue masses. Eur J
Nucl Med 1999;26:22–30.
20. Uslu L, Donig J, Link M, Rosenberg J, Quon A,
Daldrup-Link HE. Value of 18F-FDG PET and PET/CT
for evaluation of pediatric malignancies. J Nucl
Med 2015; 56:274–286.
21. Bastiaannet E, Groen H, Jager PL, Cobben DC, van
der Graaf WT, Vaalburg W, et al. The value of FDGPET in the detection, grading and

Hajialiloo Sami S et al.
8 Razavi Int J Med. 2022; 10(3):e1105.
response to therapy of soft tissue and bone sarcomas; a
systematic review and meta-analysis. Cancer Treat Rev
2004; 30:83–101.
22.Sambri, A., Bianchi, G., Longhi, A., Righi, A.,
Donati, D. M., Nanni, C., ... Errani, C. (2019). The role
of 18F-FDG PET/CT in soft tissue sarcoma.
Medicine Communications, 40(6), 626-
23.La TH, Filion EJ, Turnbull BB, Chu JN, Lee P,
Nguyen K, et al. Metabolic tumor volume predicts for
recurrence and death in head-and-neck cancer. Int J
Radiat Oncol Biol Phys 2009; 74:1335–1341
24.Schwarzbach MH, Hinz U, Dimitrakopoulou-Strauss
A,Willeke F, Cardona S, Mechtersheimer G, et al.
Prognostic significance of preoperative [18-F]
fluorodeoxyglucose (FDG) positron emission
tomography (PET) imaging in patients with resectable
soft tissue sarcomas. Ann Surg 2005;241:286–294.
25.Schwarzbach MH, Dimitrakopoulou-Strauss A,
Willeke F, Hinz U, Strauss LG, Zhang YM, et al.
Clinical value of [18-F] fluorodeoxyglucose positron
emission tomography imaging in soft tissue sarcomas.
Ann Surg 2000; 231:380–386.
26.Schuetze SM, Rubin BP, Vernon C et al (2005) Use
of positron emission tomography in localized
extremity soft-tissue sarcoma treated with neoadjuvant
chemotherapy. Cancer 103:339–348.
27.Evilevitch V, Weber WA, Tap WD et al (2008)
Reduction of glucose metabolic activity is more
accurate than change in size at predicting histopathologic response to neoadjuvant therapy in highgrade soft-tissue sarcomas. Clin Cancer Res 14:715–720
28.Németh, Z., Boér, K. & Borbély, K. Advantages
18F FDG-PET/CT over Conventional Staging
for Sarcoma Patients.
Pathol. Oncol. Res. 25, 131–136