Positron emission tomography for staging of pediatric sarcoma patients: results of a prospective multicenter trial.
OBJECTIVE
The objective of this study was to evaluate the impact of positron emission tomography (PET) using fluorine-18-fluorodeoxyglucose (FDG) for initial staging and therapy planning in pediatric sarcoma patients.


METHODS
In this prospective multicenter study, 46 pediatric patients (females, n = 22; males, n = 24; age range, 1 to 18 years) with histologically proven sarcoma (Ewing sarcoma family tumors, n = 23; osteosarcoma, n = 11; rhabdomyosarcoma, n = 12) were examined with conventional imaging modalities (CIMs), including ultrasound, computed tomography (CT), magnetic resonance imaging, and bone scintigraphy according to the standardized algorithms of the international therapy optimization trials, and whole-body FDG-PET. A lesion- and patient-based analysis of PET alone and CIMs alone and a side-by-side (SBS) analysis of FDG-PET and CIMs were performed. The standard of reference consisted of all imaging material, follow-up data (mean follow-up time, 24 +/- 12 months), and histopathology and was determined by an interdisciplinary tumor board.


RESULTS
FDG-PET and CIMs were equally effective in the detection of primary tumors (accuracy, 100%). PET was superior to CIMs concerning the correct detection of lymph node involvement (sensitivity, 95% v 25%, respectively) and bone manifestations (sensitivity, 90% v 57%, respectively), whereas CT was more reliable than FDG-PET in depicting lung metastases (sensitivity, 100% v 25%, respectively). The patient-based analysis revealed the best results for SBS, with 91% correct therapy decisions. This was significantly superior to CIMs (59%; P < .001).


CONCLUSIONS
In staging pediatric sarcoma, subsidiary FDG-PET scanning depicts important additional information and has a relevant impact on therapy planning when analyzed side-by-side with CIMs.
Klinik für Pädiatrie m.S. Onkologie und Hämatologie, Charité-Universitätsmedizin Berlin, Berlin.
Thomas
T
Völker
Timm
T
Denecke
Ingo
I
Steffen
Daniel
D
Misch
Stefan
S
Schönberger
Michail
M
Plotkin
Juri
J
Ruf
Christian
C
Furth
Brigitte
B
Stöver
Hubertus
H
Hautzel
Günter
G
Henze
Holger
H
Amthauer
D000293:Adolescent; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007223:Infant; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D012516:Osteosarcoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D049268:Positron-Emission Tomography / Q000379:methods; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012208:Rhabdomyosarcoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D012509:Sarcoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary / Q000628:therapy; D012512:Sarcoma, Ewing / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18