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Bone and Soft-Tissue Sarcoma: Preoperative Staging with Fluorine 18 Fluorodeoxyglucose PET/CT and Conventional Imaging¹

¹ From the Division of Diagnostic Radiology (U.T., Y.A.), Division of Orthopedic Oncology (U.Y.), and Clinical Laboratory (K.S.), National Cancer Center Hospital, Tokyo, Japan; Division of Cancer Screening, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan (T.T.); and Division of Diagnostic Imaging, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1264, Houston, TX 77030 (U.T., E.E.K.). Received September 5, 2006; revision requested November 10; revision received November 20; accepted January 8, 2007; final version accepted April 2. Supported in part by grants from Scientific Research Expenses for Health and Welfare Programs, No. 17-12, the Promotion and Standardization of Diagnostic Accuracy in PET/CT Imaging, the Grant-in-Aid for Cancer Research from the Ministry of Health, Labor and Welfare, and a Travel Grant from the Princess Takamatsu Cancer Research Fund. Address correspondence to U.T. (e-mail: utateish{at}ncc.go.jp).

Purpose: To retrospectively compare the diagnostic accuracy of positron emission tomography (PET)/computed tomography (CT), PET, conventional imaging, and combined PET/CT and conventional imaging for tumor staging of bone and soft-tissue sarcomas, by using histologic or follow-up imaging findings as the reference standard.

Materials and Methods: Institutional review board approval was received for this HIPAA-compliant study; informed consent was obtained. Integrated PET/CT was performed in 117 patients (69 male patients, 48 female patients; mean age, 42 years ± 21 [standard deviation]; range, 9–86 years). Conventional imaging consisted of magnetic resonance imaging of the primary site, chest radiography, whole-body contrast material–enhanced CT, and bone scintigraphy. A total of four reviewers assessed all images. Overall and T staging were evaluated in 69 (59%) patients who underwent surgical removal of the primary tumors and had pathologically proved results. N and M staging were evaluated in all patients, and their reference methods were based on histologic findings (n = 101) and follow-up CT findings (n = 16).

Results: Interpretations based on combined PET/CT and conventional imaging findings correctly staged tumors in 60 (87%) of 69 patients, overstaged tumors in eight (12%) patients, and understaged tumors in one (1%) patient. Overall staging accuracy of combined PET/CT and conventional imaging was significantly higher than that at PET (P < .0001). Combined PET/CT and conventional imaging resulted in correct N staging in 114 (97%) of 117 patients and M staging in 109 (93%) of 117 patients. Combined PET/CT and conventional imaging helped reduce overstaging in three (4%) patients and helped change tumor diagnosis from unresectable to resectable in two (2%) patients compared with PET/CT.

Conclusion: The combination of PET/CT and conventional imaging is accurate in preoperative staging of bone and soft-tissue sarcoma.

© RSNA, 2007

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