title: Correlating metabolic activity on 18F-FDG PET/CT with histopathologic characteristics of osseous and soft-tissue sarcomas: a retrospective review of 136 patients.
abstract: OBJECTIVE
  The objective of our study was to determine whether there is a statistically significant correlation between metabolic activity of osseous and soft-tissue sarcomas as measured by the maximum standardized uptake value (SUV(max)) on (18)F-FDG PET/CT and histopathologic characteristics such as mitotic counts, the presence of necrosis, and the presence of a myxoid component.
  
  
  METHODS
  We retrospectively evaluated 238 consecutive patients with known soft-tissue or osseous sarcoma who underwent (18)F-FDG PET/CT for initial staging or assessment for recurrence of disease. The SUV(max) of each primary or of the most intense metastatic lesion was measured and was compared with the histologic data provided in the final pathology reports.
  
  
  RESULTS
  Histopathologic data were available for 136 sarcomas. The median SUV(max) values of sarcomas with mitotic counts of less than 2.00 (per 10 high-power fields [HPF]), 2.00-6.99, 7.00-16.24, and 16.25 or greater were 5.0, 6.6, 10.3, and 13.0, respectively (p = 0.0003). The median SUV(max) for the sarcomas with necrosis (90 patients) was 8.6 and for those without necrosis (43 patients), 6.0 (p = 0.026). The median SUV(max) for the sarcomas without a myxoid component (118 patients) was 7.7 and with a myxoid component (16 patients) was 6.2 (p = 0.28).
  
  
  CONCLUSIONS
  There was a statistically significant correlation between the mitotic count and the SUV(max) as well as between the presence of tumor necrosis and the SUV(max). Although a correlation between the presence of a myxoid component and SUV(max) was shown, it was not found to be statistically significant. These findings improve on the current information in the literature regarding the use of PET/CT for guidance in sarcoma biopsy. Correlating the SUV(max) with histologic markers that also feature prominently in major sarcoma grading systems may help improve the accuracy of grading and of prognostication by allowing the SUV(max) to potentially serve as a surrogate marker in these grading systems, particularly in cases in which there is interobserver disagreement in the pathologic diagnosis or in cases in which the sarcoma cannot be properly classified on the basis of histopathologic evaluation alone.
authors.affiliation: Department of Nuclear Medicine, Royal Victoria Hospital, Montreal, QC, Canada. rajan.rakheja@gmail.com
authors.forename: Rajan
authors.initials: R
authors.lastname: Rakheja
authors.forename: William
authors.initials: W
authors.lastname: Makis
authors.forename: Sonia
authors.initials: S
authors.lastname: Skamene
authors.forename: Ayoub
authors.initials: A
authors.lastname: Nahal
authors.forename: Fadi
authors.initials: F
authors.lastname: Brimo
authors.forename: Laurent
authors.initials: L
authors.lastname: Azoulay
authors.forename: Jonathan
authors.initials: J
authors.lastname: Assayag
authors.forename: Robert
authors.initials: R
authors.lastname: Turcotte
authors.forename: Marc
authors.initials: M
authors.lastname: Hickeson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009336:Necrosis; D009367:Neoplasm Staging; D012516:Osteosarcoma / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000473:pathology; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012189:Retrospective Studies; D012509:Sarcoma / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000473:pathology; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18