title: Fluorodeoxyglucose positron emission tomography of soft tissue tumours: is a non-invasive determination of biological activity possible?
abstract: Since musculoskeletal tumours comprise a large heterogeneous group of entities with different biological behaviour, clinical diagnosis of such lesions can be very difficult. The aim of this prospective study was to assess the usefulness of 2-[F-18]-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) in the non-invasive evaluation of soft tissue tumours. One hundred and two patients with suspected soft tissue neoplasms were investigated by FDG-PET. The uptake of FDG was evaluated semiquantitatively by determining the tumour to background ratio (TBR). All patients underwent biopsy, resulting in the histological detection of 39 high-grade sarcomas, 16 intermediate-grade sarcomas, 11 low-grade sarcomas, 25 benign tumours, 10 tumour-like lesions such as spontaneous myositis ossificans (n = 6) and one non-Hodgkin lymphoma. All lesions except for two lipomas disclosed an increased FDG uptake. Sarcomas showed significantly higher TBR values than latent or active benign lesions (P<0.001) and aggressive benign lesions (P<0.05). Using a TBR cut-off level of 3.0 for malignancy, sensitivity of FDG-PET was 97.0%, specificity 65.7% and accuracy 86. 3%. From our data there are three main conclusions: (1) Except for patients with pseudotumoral myositis ossificans, lesions with a TBR >3 were sarcomas (91.7%) or aggressive benign tumours (8.3%). (2) Tumours with a TBR <1.5 were latent or active benign lesions, exclusively. (3) The group with intermediate TBR values (<3 and >1. 5) comprised primarily latent or active benign lesions, but also four aggressive benign tumours and two low-grade sarcomas. Our data suggest that FDG-PET represents a useful tool for the evaluation of the biological activity of soft tissue neoplasms.
authors.affiliation: Department of Trauma, Hand- and Reconstructive Surgery, University Hospital Ulm, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schulte
authors.forename: D
authors.initials: D
authors.lastname: Brecht-Krauss
authors.forename: B
authors.initials: B
authors.lastname: Heymer
authors.forename: A
authors.initials: A
authors.lastname: Guhlmann
authors.forename: E
authors.initials: E
authors.lastname: Hartwig
authors.forename: M R
authors.initials: MR
authors.lastname: Sarkar
authors.forename: C G
authors.initials: CG
authors.lastname: Diederichs
authors.forename: M
authors.initials: M
authors.lastname: Schultheiss
authors.forename: J
authors.initials: J
authors.lastname: Kotzerke
authors.forename: S N
authors.initials: SN
authors.lastname: Reske
mesh_terms: D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012983:Soft Tissue Neoplasms / Q000000981:diagnostic imaging*; D014055:Tomography, Emission-Computed
chemical_list: D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18