What is the clinical impact of staging and surveillance PET‐CT scan findings in patients with bone and soft tissue sarcoma?

Abstract

Background and Objectives Positron emission tomography‐computerized tomography (PET‐CTs) are becoming increasingly utilized in sarcoma care, workup, and surveillance. This study aimed to describe additional PET‐CT findings as well as subsequent workups and changes in the clinical course due to those results. Methods Patient records were retrospectively reviewed, and the additional workups and evaluations triggered by PET‐CT findings were qualitatively analyzed to document their results. Additional changes in the clinical course were documented. Results A total of 183 bone and soft tissue sarcoma patients underwent PET‐CT as part of staging or surveillance. Additional workup was performed in 31.5% (n = 41 of 130) patients who had positive PET‐CT findings. Among these, 36.6% (n = 15 of 41) patients had clinically significant findings that altered the clinical course. Overall, 14.8% (n = 27 of 183) experienced a change in the clinical course due to PET‐CT. Conclusion PET‐CT often highlights lesions of potential clinical importance. Additional workup, as well as changes in the clinical course, were not infrequent. Future, multi‐institutional studies should address the value of PET‐CT in sarcoma care.

Primary renal myxoid liposarcoma with pancreatic invasion on 18F-FDG PET/CT: first case report and literature review

“…We have summarized the previously reported manifestations of MLS using 18 F-FDG PET/CT in Table 1 ( 19–29 ), which revealed low 18 F-FDG activity ranging from (0.79 to 5.5, median, 2.535). The utility of FDG PET/CT in tumor follow-up has been questioned in some reports ( 16 , 18 ). However, our case demonstrates a notable 18 F-FDG uptake associated with a high-grade pathology (with at least a 10% round cell component), showing increased 18 F-FDG uptake by round cells.…”

“…Specifically, the uptake of fluorine-18 deoxyglucose ( 18 F-FDG) is utilized to identify the heightened metabolic activity of tumorous cells through glucose metabolism ( 16 ). 18 F-FDG PET/CT plays a significant role in the staging, restaging, detection of local recurrence and metastatic disease, as well as the prediction of prognosis and assessment of therapeutic response in STS ( 17 , 18 ).…”

Imaging Recommendations for Diagnosis, Staging, and Management of Soft Tissue Sarcomas

“…Several studies have assessed its utility in the workup of STS specifically in terms of the ability to predict tumor behavior and prognosis. [26][27][28][29][30] Generally, higher maximum standardized uptake value values have tended to correlate with higher grade disease/malignant disease. [26][27][28] Caution is, however, advised as there are several limitations, including the low uptake of fluorodeoxyglucose (FDG) in certain tumor subtypes including myxoid liposarcoma and synovial sarcoma that inherently limit the application of PET in these specific subtypes.…”

“…27 28 Irrespective of these limitations, FDG-PET-CT has been shown to lead to a change in management in a not insignificant number of patients as demonstrated by Lee et al, although this was not necessarily in direct relation to the known diagnosis of STS. 29…”

“…27,28 Irrespective of these limitations, FDG-PET-CT has been shown to lead to a change in management in a not insignificant number of patients as demonstrated by Lee et al, although this was not necessarily in direct relation to the known diagnosis of STS. 29 Percutaneous biopsy is the standard/preferred method by which to obtain a definitive diagnosis. Although this is now a well-established technique, there are pitfalls that the clinician must be aware of including the potential for under grading the lesion.…”