Role of 18F-FDG PET/CT in Bone and Soft Tissue Sarcoma

Document Type : Original Article

Authors

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

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

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

Abstract

Background: Precise diagnosis and staging was required for effective management pationts. Imaging techniques, such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), are commonly used for the detection of the location, size, as well as morphological and structural changes of adjacent tissues. Nonetheless, these modalities provide little information about tumor biology.
 
Objective: This study presents the experiences of a private clinical center regarding the role of F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the diagnosis, staging, restaging, and monitoring of 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 in this study. Information, such as radiotherapy, chemotherapy, and pathology of patients, was recorded.
 
Results: Regarding gender, 66.7% of cases were male (mean age of 26.37 years) and 33.3% of subjects were females (mean age of 28.76 years). Among SUVmax reported in observed lesions, either metastasis or recurrence, and primary tumor, the highest value was observed in the lymph node on the right side of the 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). Furthermore, the mean SUVmax of the hepatic right lobe was not significantly different between diabetic and non-diabetic patients (P=0.761).
 
Conclusion: As evidenced by the obtained results, 18F-FDG PET/CT appears to be a noninvasive measurement method for the prediction of events and outcomes; nonetheless, it is currently considered an optional test, which calls for further studies to corroborate its case-effectiveness.
 

Keywords


Copyright © 2024, Razavi International Journal of Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.
https://doi.org/10.1002/1097-0142(20010515)91:10<1914::AID-CNCR1214>3.0.CO;2-3
PMid:11346874
 
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).
https://doi.org/10.1097/SLA.0000000000000869
PMid:25115417 PMCid:PMC4170654
 
3. Jo VY, Fletcher CD. WHO classification of soft tissue tumours: an update based on the 2013 (4th) edition. Pathology 2014; 46:95-104.
https://doi.org/10.1097/PAT.0000000000000050
PMid:24378391
 
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; 4:57-63.
https://doi.org/10.1007/BF02316811
PMid:8985518
 
6. Miraldi F, Adler LP, Faulhaber P. PET imaging in soft tissue sarcomas. Cancer Treat Res 1997; 91:51-64.
https://doi.org/10.1007/978-1-4615-6121-7_4
PMid:9286488
 
7.Hicks RJ, Toner GC, Choong PF. Clinical applications of molecular imaging in sarcoma evaluation. Cancer Imaging 2005; 5:66-72.
https://doi.org/10.1102/1470-7330.2005.0008
https://doi.org/10.1102/1470-7330.2005.0007
 
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; 15:2856-2863.
https://doi.org/10.1158/1078-0432.CCR-08-2537
PMid:19351756 PMCid:PMC4068269
 
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.
https://doi.org/10.1016/j.ejso.2016.04.056
PMid:27189833
 
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; 109:410-414.
https://doi.org/10.1002/jso.23523
PMid:24310279
 
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.
https://doi.org/10.1007/s11999-008-0647-z
PMid:19048352 PMCid:PMC2674162
 
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.
https://doi.org/10.1016/j.ejca.2016.02.007
PMid:26990930
 
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.
https://doi.org/10.1007/s00259-002-0859-5
PMid:12192559
 
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.
https://doi.org/10.2214/AJR.12.9795
PMid:23789672
 
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; 43:641-648.
https://doi.org/10.1007/s00256-014-1832-7
PMid:24531303
 
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.
https://doi.org/10.2967/jnumed.113.131847
PMid:24711649
 
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.
https://doi.org/10.2967/jnumed.113.133801
PMid:24752671
 
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.
https://doi.org/10.1007/s002590050355
PMid:9933658
 
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 FDG-PET in the detection, grading and
 
response to therapy of soft tissue and bone sarcomas; a systematic review and meta-analysis. Cancer Treat Rev 2004; 30:83-101.
https://doi.org/10.1016/j.ctrv.2003.07.004
PMid:14766127
 
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. Nuclear Medicine Communications, 40(6), 626-631. https://doi.org/10.1097/MNM.0000000000001002
https://doi.org/10.1097/MNM.0000000000001002
PMid:30908341
 
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
https://doi.org/10.1016/j.ijrobp.2008.10.060
PMid:19289263 PMCid:PMC2752334
 
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.
https://doi.org/10.1097/01.sla.0000152663.61348.6f
PMid:15650639 PMCid:PMC1356914
 
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.
https://doi.org/10.1097/00000658-200003000-00011
PMid:10714631 PMCid:PMC1421009
 
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.
https://doi.org/10.1002/cncr.20769
PMid:15578712
 
27.Evilevitch V, Weber WA, Tap WD et al (2008) Reduction of glucose metabolic activity is more
 
accurate than change in size at predicting histo-pathologic response to neoadjuvant therapy in high-grade soft-tissue sarcomas. Clin Cancer Res 14:715-720
https://doi.org/10.1158/1078-0432.CCR-07-1762
PMid:18245531
 
28.Németh, Z., Boér, K. & Borbély, K. Advantages of 18F FDG-PET/CT over Conventional Staging
 
for Sarcoma Patients. Pathol. Oncol. Res. 25, 131-136 (2019). https://doi.org/10.1007/s12253-017-0325-0
https://doi.org/10.1007/s12253-017-0325-0
PMid:28994004