Roles of Positron Emission Tomography With Fluorine-18-Deoxyglucose in the Detection of Local Recurrent and Distant Metastatic Sarcoma

Abstract

Sarcomas are a heterogeneous group of tumors comprising approximately 1% of all malignancies. Definitive treatment of sarcoma is surgical resection. However, after surgical removal, 40% to 60% of the patients will develop local or distant recurrence. Therefore, the early detection and treatment of recurrence is an important part of modern sarcoma therapy. Positron emission tomography with fluorine-18-deoxyglucose (FDG-PET) has been highly successful in detecting and staging a variety of malignancies. However, its use in the management of patients with sarcoma is less defined. The purpose of our study was to assess the potential roles of FDG-PET in the detection of local recurrence and distant metastases. In this retrospective study, the images of 33 FDG-PET scans, reports of 29 computed tomography (CT) scans, and 8 magnetic resonance imaging (MRI) scans from 28 patients were compared with surgical pathology or clinical follow up for at least 6 months. FDG-PET detected all 25 cases of local and distant recurrences with 100% sensitivity. CT was able to detect 18 of the 22 possible cases of recurrent disease, whereas MRI was able to detect 5 of 7 cases of recurrent disease. PET was particularly useful in patients with extensive histories of surgery and radiation therapy, precisely the setting in which CT and MRI have the lowest specificity and sensitivity. In conclusion, FDG-PET was a sensitive test to detect local and distant recurrences of sarcoma and this warrants further investigation.

Bone and Soft-Tissue Sarcoma: Preoperative Staging with Fluorine 18 Fluorodeoxyglucose PET/CT and Conventional Imaging

“…Fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) has been shown to be useful for detection of nodal and distant metastases in patients with soft-tissue sarcomas compared with that at conventional imaging (5)(6)(7).…”

18F-FDG PET Scanning Correlates with Tissue Markers of Poor Prognosis and Predicts Mortality for Patients After Liver Resection for Colorectal Metastases

“…PETusi ng 18 F-FDG has become an indispensable staging modality for many types of cancer, including colorectal cancer (1,2), esophageal cancer (3), melanoma (4), sarcoma (5), and lung cancer (6). This imaging technique detects glucose-avid cancer deposits and can enhance the detection of metastatic deposits, resulting in more complete tumor resections and preventing nontherapeutic laparotomies for patients with unresectable disease (7).…”

Utility of positron emission tomography in sarcomas

“…As previously reviewed, investigators have explored the use of FDG PET to detect disease recurrence because of the potential advantages of functional over anatomic imaging of anatomy disrupted by surgery and radiation, and of imaging the whole body in one session [2]. A recently reported retrospective analysis suggests that FDG PET is more sensitive and specific than MRI and CT in detecting local recurrence of STSs, but pulmonary metastasis are detected equally well using CT or PET [26]. The authors did not report whether contrast-enhanced MRI was performed or the criteria used to score a PET scan as positive for disease recurrence.…”