Detection and Grading of Soft Tissue Sarcomas of the Extremities with 18F-3′-Fluoro-3′-Deoxy-l-Thymidine

Abstract

Purpose: The aim of the study was to investigate the feasibility of 18 F-3-fluoro-3-deoxy-L-thymidine positron emission tomography (FLT-PET) for the detection and grading of soft tissue sarcoma (STS).Experimental Design: Nineteen patients with 20 STSs of the extremities were scanned, using attenuation corrected whole-body FLT-PET. Standardized uptake values (SUVs) and tumor:nontumor ratios (TNTs) were compared with histopathological parameters using French and Japanese grading systems.Results: Mean SUV, maximal SUV, and TNT could differentiate between low-grade (grade 1; n ‫؍‬ 6) STS and high-grade (grade 2 and 3; n ‫؍‬ 14) STS according to the French grading system (P ‫؍‬ 0.001). Mean SUV, max SUV, and TNT correlated with mitotic score, MIB-1 score, the French and Japanese grading system (• ‫؍‬ 0.550 -0.747).Conclusions: FLT-PET is able to visualize STS and differentiate between low-grade and high-grade STS. The uptake of FLT correlates with the proliferation of STS.

PET Imaging of Proliferation with Pyrimidines

“…In 2 studies of patients with bone or soft-tissue sarcomas, all tumors were visualized in 36 patients (25,26). Both studies showed that 18 F-FLT uptake correlated with grade whereas 18 F-FDG uptake did not.…”

Innovations in Radiotherapy Planning of Head and Neck Cancers: Role of PET

“…However, as these immune response cells are terminally differentiated, the DNA synthesis rate and therefore the 18 F-FLT uptake are not increased. 18 F-FLT PET was validated against histopathology in a variety of solid tumors including breast, lung, and sarcoma (62)(63)(64). In soft-tissue sarcoma, Cobben et al found a significant correlation between the SUVs and labeling index of the proliferation marker Ki-67.…”

“…In soft-tissue sarcoma, Cobben et al found a significant correlation between the SUVs and labeling index of the proliferation marker Ki-67. In addition, 18 F-FLT PET was able to distinguish low-grade from high-grade soft-tissue sarcomas (62). In breast tumors, Kenny et al reported a strong correlation between SUVs and the fully quantitative net irreversible plasma to tumor transfer constant (K i ) parameter of dynamic 18 F-FLT PET and staining of Ki-67 (63).…”

Multidisciplinary Management of Soft-Tissue Sarcoma

“…PET results may allow distinction between low-and high-grade tumors (19) and direct the choice of a biopsy site to the more aggressive region of the mass (5). PET has not been proved in the distinction between low-grade tumors and benign lesions (18,20).…”