title: Diagnostic accuracy of 18F-FDG PET/CT for detecting recurrence in patients with primary skeletal Ewing sarcoma.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of (18)F-FDG PET/CT for detecting recurrence in patients with primary skeletal Ewing sarcoma.
  
  
  METHODS
  We retrospectively analysed data from 53 patients (age 20.1 ± 10.5 years, 39 male) who had undergone 71 (18)F-FDG PET/CT studies for suspected recurrence (52 studies) or for routine follow-up (19 studies) after primary therapy of skeletal Ewing sarcoma. (18)F-FDG PET/CT studies were evaluated qualitatively and quantitatively (maximum standardized uptake value, SUVmax) by two nuclear medicine physicians in consensus. Sensitivity, specificity, predictive values and accuracy were calculated on per study basis. Clinical/imaging follow-up (minimum 6 months) and/or histopathology (when available) were taken as the reference standard.
  
  
  RESULTS
  Of the total of 71 (18)F-FDG PET/CT studies, 42 (59.1%) were positive for recurrence and 29 (40.9%) were negative for recurrence. Local recurrence was most common (38 studies) followed by bone metastasis (9 studies), and node and lung metastasis (2 studies each). Of the 71 studies, 38 were true-positive, 27 were true-negative, 4 were false-positive and 2 were false-negative. Overall per study based sensitivity was 95%, specificity was 87%, PPV was 90%, NPV was 93% and accuracy was 91.5%. No significant difference was found in the accuracy of PET/CT between the suspected recurrence group and the routine follow-up group (94% vs. 84%; P = 0.390). Overall mean lesion SUVmax was 7.8 ± 4.1 (range 1.9-17.2). No site-based difference was found in SUVmax.
  
  
  CONCLUSIONS
  (18)F-FDG PET/CT demonstrates high diagnostic accuracy for detecting recurrence in patients with primary skeletal Ewing sarcoma, when it is suspected (clinically or on imaging) or during routine follow-up.
authors.affiliation: Department of Nuclear Medicine, All India Institute of Medical Sciences, E-81, Ansari Nagar (East), AIIMS Campus, New Delhi 110029, India.
authors.forename: Punit
authors.initials: P
authors.lastname: Sharma
authors.forename: Bangkim Chandra
authors.initials: BC
authors.lastname: Khangembam
authors.forename: K C Sudhir
authors.initials: KC
authors.lastname: Suman
authors.forename: Harmandeep
authors.initials: H
authors.lastname: Singh
authors.forename: Sishir
authors.initials: S
authors.lastname: Rastogi
authors.forename: Shah Alam
authors.initials: SA
authors.lastname: Khan
authors.forename: Sameer
authors.initials: S
authors.lastname: Bakhshi
authors.forename: Sanjay
authors.initials: S
authors.lastname: Thulkar
authors.forename: Chandrasekhar
authors.initials: C
authors.lastname: Bal
authors.forename: Arun
authors.initials: A
authors.lastname: Malhotra
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000000981:diagnostic imaging*; D002648:Child; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012008:Recurrence; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18
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