title: The role of18F-FDG PET/CT in the detection of osteosarcoma recurrence.
abstract: OBJECTIVE
  The aim of this study was to investigate the diagnostic accuracy of18F-FDG-PET/CT in osteosarcoma patients suspicious for disease recurrence after adequate surgical therapy.
  
  
  METHODS
  Inclusion criteria were: a) adequate surgical treatment for proven osteosarcoma and documented complete remission after therapy; b)18F-FDG-PET/CT performed during follow-up for clinical/diagnostic suspicion of relapse; c) new surgical treatment with excision of the suspected lesions; d) histological validation of18F-FDG-PET/CT findings. Thirty-seven patients matching all inclusion criteria were retrospectively enrolled (20 men and 17 female). Primary surgical treatment consists of resection (31 cases) or amputation (six cases).18F-FDG-PET/CT performance was assessed with a per-patient and per-site evaluation of sensitivity, specificity, accuracy, positive predicting value (PPV), and negative predicting value (NPV). The sites of relapse were classified as local, lung, lymphnodes (LNs), and distant (other skeletal segments and/or distant soft tissue). The disease-free survival (DFS) and the overall survival (OS) after 18F-FDG PET/CT were evaluated.
  
  
  RESULTS
  18F-FDG-PET/CT was positive in 89.2% (33/37) of patients. Local uptake only was observed in 35.1% patients (13/37); lung uptake only in 18.9% (7/37); distant uptake only in 2.7% (1/37) case; multiple sites of uptake in 32.4% (12/37). Histology resulted positive in 92% (34/37) of patients. A total of 51 pathologic lesions were evaluated (22 local relapse, 11 lung metastasis, 10 metastatic LNs, eight distant metastatic lesions). On a per-patient analysis18F-FDG-PET/CT showed a sensitivity, specificity, accuracy, PPV, and NPV of 91%, 75%, 89%, 97%, 50%. On a per-site analysis the performance for local relapse was 96%, 100%, 97%, 100%, 93%, while for lung relapse detection was 80%, 100%, 92%, 100%, 88%. The mean follow-up after18F-FDG-PET/CT was 21.5 months. At the last follow-up, 19% (7/37) of patients were death with disease, 38% (14/37) were alive with disease, and 43% (16/37) had no evidence of disease. Overall survival was 90% and 75% at 24 and 60 months, respectively.
  
  
  CONCLUSIONS
  18F-FDG-PET/CT showed valuable results for detecting recurrence(s) in osteosarcoma patients with suspicious of relapse after treatment, particularly in the detection of local relapse and lung metastasis.
authors.affiliation: Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Angelini
authors.affiliation: Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy. francesco.ceci3@unibo.it.
authors.forename: Francesco
authors.identifier: http://orcid.org/0000-0001-9785-5248
authors.initials: F
authors.lastname: Ceci
authors.affiliation: Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Castellucci
authors.affiliation: Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Graziani
authors.affiliation: Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Polverari
authors.affiliation: Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Trovarelli
authors.affiliation: Department of Chemotherapy, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Palmerini
authors.affiliation: Department of Chemotherapy, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferrari
authors.affiliation: Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Fanti
authors.affiliation: Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ruggieri
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000000981:diagnostic imaging* / Q000601:surgery; D000072078:Positron Emission Tomography Computed Tomography; D012008:Recurrence; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG-PET/CT; Osteosarcoma; Osteosarcoma re-surgery; Osteosarcoma relapse