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Alduraibi KA, Towhari JA, Alebdi HA, Alfadhel BZ, Alotaibi GS, Ghosh S, Bin Saeedan M. Osteosarcoma Metastasis to the Thorax: A Pictorial Review of Chest Computed Tomography Findings. Diagnostics (Basel) 2024; 14:2085. [PMID: 39335763 PMCID: PMC11431112 DOI: 10.3390/diagnostics14182085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 09/03/2024] [Accepted: 09/16/2024] [Indexed: 09/30/2024] Open
Abstract
Background: Osteosarcoma, a primary bone malignancy in children and adolescents, frequently metastasizes to the lungs, contributing significantly to morbidity and mortality. Lung Metastases: At diagnosis, 15-20% of patients present with detectable lung metastases. Chest computed tomography (CT) is vital for the early detection and monitoring of these metastases. Lung involvement typically presents as multiple nodules of varying sizes and can include atypical features such as cavitation, cystic lesions, ground-glass halos, intravascular tumor thrombi, and endobronchial disease. Additional Findings: Pleural metastasis often occurs alongside pulmonary disease, and complications like spontaneous pneumothorax may arise. Additional findings may include thoracic lymphadenopathy, cardiac tumor thrombus, and chest wall deposits. Conclusion: Familiarity with these imaging patterns is essential for radiologists to ensure timely diagnosis and effective management. This review highlights the critical role of chest CT in detecting and characterizing osteosarcoma metastasis.
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Affiliation(s)
- Khalid Abdulaziz Alduraibi
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh 11533, Saudi Arabia
| | - Jawaher Ali Towhari
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh 11533, Saudi Arabia
| | - Hatim Abdullah Alebdi
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh 11533, Saudi Arabia
| | - Bader Zaid Alfadhel
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh 11533, Saudi Arabia
| | - Ghazi S Alotaibi
- Division of Hematology, Department of Medicine, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
| | - Subha Ghosh
- Department of Radiology, Thoracic Imaging, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Mnahi Bin Saeedan
- Department of Radiology, Thoracic Imaging, Cleveland Clinic, Cleveland, OH 44195, USA
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2
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Melemenidis S, Knight JC, Kersemans V, Perez-Balderas F, Zarghami N, Soto MS, Cornelissen B, Muschel RJ, Sibson NR. In Vivo PET Detection of Lung Micrometastasis in Mice by Targeting Endothelial VCAM-1 Using a Dual-Contrast PET/MRI Probe. Int J Mol Sci 2024; 25:7160. [PMID: 39000268 PMCID: PMC11241628 DOI: 10.3390/ijms25137160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/21/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
Current clinical diagnostic imaging methods for lung metastases are sensitive only to large tumours (1-2 mm cross-sectional diameter), and early detection can dramatically improve treatment. We have previously demonstrated that an antibody-targeted MRI contrast agent based on microparticles of iron oxide (MPIO; 1 μm diameter) enables the imaging of endothelial vascular cell adhesion molecule-1 (VCAM-1). Using a mouse model of lung metastasis, upregulation of endothelial VCAM-1 expression was demonstrated in micrometastasis-associated vessels but not in normal lung tissue, and binding of VCAM-MPIO to these vessels was evident histologically. Owing to the lack of proton MRI signals in the lungs, we modified the VCAM-MPIO to include zirconium-89 (89Zr, t1/2 = 78.4 h) in order to allow the in vivo detection of lung metastases by positron emission tomography (PET). Using this new agent (89Zr-DFO-VCAM-MPIO), it was possible to detect the presence of micrometastases within the lung in vivo from ca. 140 μm in diameter. Histological analysis combined with autoradiography confirmed the specific binding of the agent to the VCAM-1 expressing vasculature at the sites of pulmonary micrometastases. By retaining the original VCAM-MPIO as the basis for this new molecular contrast agent, we have created a dual-modality (PET/MRI) agent for the concurrent detection of lung and brain micrometastases.
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Affiliation(s)
- Stavros Melemenidis
- Department of Radiation Oncology, Stanford School of Medicine, Cancer Institute, Stanford University, Stanford, CA 94305, USA;
| | - James C. Knight
- School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
| | - Veerle Kersemans
- Clinical Nuclear Medicine Imaging, Siemens Healthineers, 2595 BN The Hague, The Netherlands;
| | | | - Niloufar Zarghami
- Department of Oncology, University of Oxford, Oxford OX3 7DQ, UK; (N.Z.); (R.J.M.)
| | - Manuel Sarmiento Soto
- Department of Biochemistry and Molecular Biology, University of Seville, 41004 Seville, Spain;
| | - Bart Cornelissen
- Department of Nuclear Medicine, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Ruth J. Muschel
- Department of Oncology, University of Oxford, Oxford OX3 7DQ, UK; (N.Z.); (R.J.M.)
| | - Nicola R. Sibson
- Department of Oncology, University of Oxford, Oxford OX3 7DQ, UK; (N.Z.); (R.J.M.)
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Yamagata Y, Komiyama M, Iwata S. Clinical characteristics and management of primary retroperitoneal sarcoma: A literature review. Ann Gastroenterol Surg 2024; 8:21-29. [PMID: 38250690 PMCID: PMC10797828 DOI: 10.1002/ags3.12756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/21/2023] [Accepted: 10/29/2023] [Indexed: 01/23/2024] Open
Abstract
Retroperitoneal sarcoma (RPS) is a rare tumor classified into many histological types. It is also often detected only after it has grown to a considerable size and requires extensive resection of the surrounding organs, making it difficult to offer optimal patient-tailored management. Evidence supporting specific treatment modalities for RPS is insufficient, owing to its rarity. The Japanese clinical practice guidelines for RPS were published in December 2021, with the aim of accumulating existing evidence and indicating the optimal practice for RPS. These guidelines provide important clinical questions (CQs) concerning the diagnosis and treatment of RPS. This review, with a particular focus on primary RPS, attempts to introduce clinical problems in the diagnosis and treatment of RPS and to assess those problems along with the CQs in the guidelines. According to these guidelines, although chemotherapy and radiotherapy are expected to have therapeutic effects, the level of evidence to support these treatments is not very high at present. Accordingly, complete resection of the tumor is the first and only option for managing primary RPS. However, as with other tumors, the demand for multidisciplinary treatment for RPS is increasing. These guidelines will undoubtedly represent a milestone in clinical practice in relation to RPS in the future, and further evidence is expected to be accumulated based on the CQs that have been proposed.
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Affiliation(s)
- Yukinori Yamagata
- Department of Gastric SurgeryNational Cancer Center HospitalCyuo‐kuJapan
| | | | - Shintaro Iwata
- Department of Musculoskeletal Oncology and RehabilitationNational Cancer Center HospitalCyuo‐kuJapan
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4
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The Role of Imaging in Soft Tissue Sarcoma Diagnosis and Management. Surg Clin North Am 2022; 102:539-550. [DOI: 10.1016/j.suc.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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5
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Camacho M, Carvalho M, Munhoz R, Etchebehere M, Etchebehere E. FDG PET/CT in bone sarcomas. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00062-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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6
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Vaarwerk B, Breunis WB, Haveman LM, de Keizer B, Jehanno N, Borgwardt L, van Rijn RR, van den Berg H, Cohen JF, van Dalen EC, Merks JH. Fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) computed tomography (CT) for the detection of bone, lung, and lymph node metastases in rhabdomyosarcoma. Cochrane Database Syst Rev 2021; 11:CD012325. [PMID: 34753195 PMCID: PMC8577863 DOI: 10.1002/14651858.cd012325.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rhabdomyosarcoma (RMS) is the most common paediatric soft-tissue sarcoma and can emerge throughout the whole body. For patients with newly diagnosed RMS, prognosis for survival depends on multiple factors such as histology, tumour site, and extent of the disease. Patients with metastatic disease at diagnosis have impaired prognosis compared to those with localised disease. Appropriate staging at diagnosis therefore plays an important role in choosing the right treatment regimen for an individual patient. Fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) is a functional molecular imaging technique that uses the increased glycolysis of cancer cells to visualise both structural information and metabolic activity. 18F-FDG-PET combined with computed tomography (CT) could help to accurately stage the extent of disease in patients with newly diagnosed RMS. In this review we aimed to evaluate whether 18F-FDG-PET could replace other imaging modalities for the staging of distant metastases in RMS. OBJECTIVES To determine the diagnostic accuracy of 18F-FDG-PET/CT imaging for the detection of bone, lung, and lymph node metastases in RMS patients at first diagnosis. SEARCH METHODS We searched MEDLINE in PubMed (from 1966 to 23 December 2020) and Embase in Ovid (from 1980 to 23 December 2020) for potentially relevant studies. We also checked the reference lists of relevant studies and review articles; scanned conference proceedings; and contacted the authors of included studies and other experts in the field of RMS for information about any ongoing or unpublished studies. We did not impose any language restrictions. SELECTION CRITERIA We included cross-sectional studies involving patients with newly diagnosed proven RMS, either prospective or retrospective, if they reported the diagnostic accuracy of 18F-FDG-PET/CT in diagnosing lymph node involvement or bone metastases or lung metastases or a combination of these metastases. We included studies that compared the results of the 18F-FDG-PET/CT imaging with those of histology or with evaluation by a multidisciplinary tumour board as reference standard. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, data extraction, and methodological quality assessement according to Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). We analysed data for the three outcomes (nodal involvement and lung and bone metastases) separately. We used data from the 2 × 2 tables (consisting of true positives, false positives, true negatives, and false negatives) to calculate sensitivity and specificity in each study and corresponding 95% confidence intervals. We did not consider a formal meta-analysis to be relevant because of the small number of studies and substantial heterogeneity between studies. MAIN RESULTS Two studies met our inclusion criteria. The diagnostic accuracy of 18F-FDG-PET/CT was reported in both studies, which included a total of 36 participants. We considered both studies to be at high risk of bias for the domain reference standard. We considered one study to be at high risk of bias for the domain index test and flow and timing. Sensitivity and specificity of 18F-FDG-PET/CT for the detection of bone metastases was 100% in both studies (95% confidence interval (CI) for sensitivity was 29% to 100% in study one and 40% to 100% in study two; 95% CI for specificity was 83% to 100% in study one and 66% to 100% in study two). The reported sensitivity of 18F-FDG-PET/CT for the detection of lung metastases was not calculated since only two participants in study two showed lung metastases, of which one was detected by 18F-FDG-PET/CT. Reported specificity was 96% in study one (95% CI 78% to 100%) and 100% (95% CI 72% to 100%) in study two. The reported sensitivity for the detection of nodal involvement was 100% (95% CI 63% to 100% in study one and 40% to 100% in study two); the reported specificity was 100% (95% CI 78% to 100%) in study one and 89% (95% CI 52% to 100%) in study two. AUTHORS' CONCLUSIONS The diagnostic accuracy of 18F-FDG-PET/CT for the detection of bone, lung, and lymph node metastases was reported in only two studies including a total of only 36 participants with newly diagnosed RMS. Because of the small number of studies (and participants), there is currently insufficient evidence to reliably determine the diagnostic accuracy of 18F-FDG-PET/CT in the detection of distant metastases. Larger series evaluating the diagnostic accuracy of 18F-FDG-PET/CT for the detection of metastases in patients with RMS are necessary.
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Affiliation(s)
- Bas Vaarwerk
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Willemijn B Breunis
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Oncology and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Lianne M Haveman
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Bart de Keizer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Nina Jehanno
- Department of Nuclear Medicine, Institut Curie, Paris, France
| | - Lise Borgwardt
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen , Denmark
| | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Henk van den Berg
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Jérémie F Cohen
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), UMR1153, Université de Paris, Paris, France
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker - Enfants malades hospital, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France
| | | | - Johannes Hm Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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7
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Husseini JS, Balza R, Evangelista L, Cañamaque LG, Catalano OA. PET/MR for evaluation of musculoskeletal malignancies. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00470-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Dammerer D, VAN Beeck A, Schneeweiss V, Schwabegger A. Follow-up Strategies for Primary Extremity Soft-tissue Sarcoma in Adults: A Systematic Review of the Published Literature. In Vivo 2021; 34:3057-3068. [PMID: 33144410 DOI: 10.21873/invivo.12140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 01/22/2023]
Abstract
AIM Follow-up strategies for primary extremity soft-tissue sarcomas (eSTS) in adults were evaluated in a systematic review of the published literature. MATERIAL AND METHODS The published literature was reviewed using PubMed. Of 136,646 studies published between 1985 and 2019, 78 original articles met the inclusion criteria. Articles were selected on the basis of the PRISMA guidelines. The selected articles were then cross-searched to identify further publications. August 1, 2019 was used as the concluding date of publication. RESULTS A variety of follow-up schedules have been reported in recently published literature. Two official guidelines have been approved by international societies. The guidelines distinguish between high- and low-grade STS, but mention a wide range of follow-up intervals. Established tools of follow-up include computed tomograph, X-rays of the chest, and magnetic resonance imaging of the primary tumor site in addition to clinical observation and physical examination. CONCLUSION Further research will be needed to establish evidence-based guidelines and schedules for follow-up strategies in patients with eSTS.
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Affiliation(s)
- Dietmar Dammerer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Viktoria Schneeweiss
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anton Schwabegger
- Department of Plastic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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9
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Nguyen MT, Jiang YQ, Li XL, Dong J. Risk Factors for Incidence and Prognosis in Chondrosarcoma Patients with Pulmonary Metastasis at Initial Diagnosis. Med Sci Monit 2019; 25:10136-10153. [PMID: 31885034 PMCID: PMC6951109 DOI: 10.12659/msm.919184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background The incidence and prognostic factors of chondrosarcoma patients have been reported in early studies. However, the association between risk factors and the incidence or prognosis of chondrosarcoma patients with pulmonary metastasis remains unclear. Therefore, we assessed these risk factors among chondrosarcoma patients with pulmonary metastasis. Material/Methods From 1365 chondrosarcoma patients in the Surveillance, Epidemiology, and End Results (SEER) database, we collected the information of 69 patients with pulmonary metastasis at the initial diagnosis of chondrosarcoma from 2010 to 2016. We investigated the incidence, risk factors, and prognostic factors for pulmonary metastasis patients by using multivariate logistic regression and multivariate Cox regression analyses. Results Data from a total of 69 (6.8%) chondrosarcoma patients with pulmonary metastasis at initial diagnosis were extracted. Patients with the following characteristics were positively associated with higher risk of pulmonary metastasis: dedifferentiated subtype, high grade of malignancy, extracompartmental tumor (Enneking B), presence of regional lymph nodes, local recurrence, large tumor size (larger than 15 cm), and being married. Older patients (older than 67 years), and patients with clear cell chondrosarcoma or large tumor size (larger than 15 cm) exhibited the worse prognosis and survival (overall and cancer-specific). Resection of the primary tumor tended to be correlated with a better prognosis. Conclusions The incidence of pulmonary metastasis in chondrosarcoma was approximately 6.8%, with poor prognosis. Identifying risk factors and their associations with the incidence and prognosis in chondrosarcoma patients with pulmonary metastasis could provide a reference for clinical surveillance and guide the design of personalized treatment plans.
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Affiliation(s)
- Minh Tien Nguyen
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China (mainland)
| | - Yun-Qi Jiang
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China (mainland)
| | - Xi-Lei Li
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China (mainland)
| | - Jian Dong
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China (mainland)
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10
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Kogan F, Broski SM, Yoon D, Gold GE. Applications of PET-MRI in musculoskeletal disease. J Magn Reson Imaging 2019; 48:27-47. [PMID: 29969193 DOI: 10.1002/jmri.26183] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/19/2018] [Indexed: 12/26/2022] Open
Abstract
New integrated PET-MRI systems potentially provide a complete imaging modality for diagnosis and evaluation of musculoskeletal disease. MRI is able to provide excellent high-resolution morphologic information with multiple contrast mechanisms that has made it the imaging modality of choice in evaluation of many musculoskeletal disorders. PET offers incomparable abilities to provide quantitative information about molecular and physiologic changes that often precede structural and biochemical changes. In combination, hybrid PET-MRI can enhance imaging of musculoskeletal disorders through early detection of disease as well as improved diagnostic sensitivity and specificity. The purpose of this article is to review emerging applications of PET-MRI in musculoskeletal disease. Both clinical applications of malignant musculoskeletal disease as well as new opportunities to incorporate the molecular capabilities of nuclear imaging into studies of nononcologic musculoskeletal disease are discussed. Lastly, we discuss some of the technical considerations and challenges of PET-MRI as they specifically relate to musculoskeletal disease. LEVEL OF EVIDENCE 5 TECHNICAL EFFICACY: Stage 3 J. Magn. Reson. Imaging 2018;48:27-47.
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Affiliation(s)
- Feliks Kogan
- Department of Radiology, Stanford University, Stanford, California, USA
| | | | - Daehyun Yoon
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, California, USA.,Department of Bioengineering, Stanford University, Stanford, California, USA.,Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
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11
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Huang T, Li F, Yan Z, Ma Y, Xiong F, Cai X, Zhang Q, Liu F, Dong J. Effectiveness of 18F-FDG PET/CT in the diagnosis, staging and recurrence monitoring of Ewing sarcoma family of tumors: A meta-analysis of 23 studies. Medicine (Baltimore) 2018; 97:e13457. [PMID: 30508968 PMCID: PMC6283220 DOI: 10.1097/md.0000000000013457] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To investigate the value of positron emission tomography (PET) and PET/computed tomography (CT) using fluorine-18-fluorodeoxyglucose (F-FDG) in the diagnosis, staging, restaging and recurrence monitoring of Ewing sarcoma family of tumors (ESFTs), a meta-analysis was performed through systematically searching PubMed, Embase, and Cochrane Central library to retrieve articles. METHODS After screening and diluting out the articles that met inclusion criteria to be used for statistical analysis the pooled evaluation indexes including sensitivity, specificity, and diagnostic odd ratio (DOR) as well as the summary receiver operating characteristic curve (SROC) were calculated involving diagnostic data (true positive, false positive, false negative, and true negative) extracted from original studies. RESULTS Screening determined that out of 2007, 23 studies involving a total of 524 patients were deemed viable for inclusion in the meta-analysis. The results of the analysis showed that the sensitivity and specificity were at 86% and 80%, respectively. Additionally, a satisfactory accuracy of F-FDG PET and PET/CT was observed in detecting ESFT recurrence, lung metastasis, and osseous metastasis. CONCLUSION This meta-analysis suggests that F-FDG PET and PET/CT with an extremely high accuracy could be considered a valuable method for detecting distant metastasis and post-operational recurrence of ESFT, which might have a profound impact on the development of treatment protocols for ESFT.
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Affiliation(s)
- Tao Huang
- Department of Orthopaedics, Yantai Shan Hospital, Yantai
| | - Feng Li
- Department of Orthopaedics, Zhangqiu District People's Hospital of Jinan City, Zhangqiu District, Jinan City, Shandong Province, China
| | - Zexing Yan
- Department of Trauma Surgery, University of Regensburg, Regensburg
| | - Yupeng Ma
- Department of Orthopaedics, Yantai Shan Hospital, Yantai
| | - Fei Xiong
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Großhadern, Munich, Germany
| | - Xia Cai
- Department of Orthopaedics, Zhangqiu District People's Hospital of Jinan City, Zhangqiu District, Jinan City, Shandong Province, China
| | - Qingyu Zhang
- Department of Orthopaedics, Qilu Hospital, Shandong University
| | - Fanxiao Liu
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Großhadern, Munich, Germany
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
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13
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Abstract
The purpose of staging in orthopaedic oncology is to provide a framework for classifying tumors based on their risk of local recurrence and distant metastasis to guide treatment decisions. Two separate systems are commonly used to categorize bone and soft-tissue sarcomas. The Musculoskeletal Tumor Society system for bone sarcomas and the Enneking system for soft-tissue sarcomas are the original staging systems developed by orthopaedic surgeons. The American Joint Committee on Cancer staging systems for bone and soft-tissue sarcomas are periodically updated based on new data, and they are currently on their eighth edition.
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Duranti L, Leo F, Pastorino U. PET Scan Contribution in Chest Tumor Management: A Systematic Review for Thoracic Surgeons. TUMORI JOURNAL 2018; 98:175-84. [DOI: 10.1177/030089161209800201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Aims and background In the 90s, the introduction of positron emission tomography (PET) represented a milestone in the staging of thoracic tumors. In the last 10 years, PET scan has been widely adopted in thoracic oncology, showing high accuracy in diagnosis and staging and with promising issues in defining prognosis. The aim of this systematic review was to focus on the results and pitfalls of PET scan use in the modern management of chest tumors. Methods and study design. The literature search was performed on May 2010 in PubMed, Embase, and Cochrane according to PRISMA protocol. The search was restricted to publications in English, using in the same string the word “PET” with 9 different chest tumors; results were then filtered by eliminating technical articles, focusing only on papers in which surgery was considered as a potential diagnostic or therapeutic tool. From 6600 papers initially selected, 99 manuscripts were fully analyzed. Results Glucose uptake is a metabolic marker useful in the diagnosis and staging of chest tumors. In lung cancer screening, standard uptake value is helpful in defining the risk of malignancy of isolated pulmonary nodules. The addition of PET scan to conventional staging increases detection of nodal and distant metastases in lung cancer, esophageal cancer and malignant mesothelioma. In thymoma, a close relationship between standard uptake value, histology, and Masaoka stage has been advocated. This link between glucose uptake and prognosis suggests that PET translates biological tumor behavior into clinically detectable findings. Conclusions PET scan has a crucial role in thoracic oncology due to its impact on diagnosis, staging and prognosis. PET scan expresses the biological behavior of tumors, opening interesting perspectives in chest tumor management and improving detection and stage grouping in lung cancer. It anticipates the diagnosis in long-incubating diseases such as mesothelioma and increases biological knowledge of rare diseases, such as thymoma and other mediastinal tumors.
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Affiliation(s)
- Leonardo Duranti
- Thoracic Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Leo
- Thoracic Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ugo Pastorino
- Thoracic Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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15
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Yoshihiro T, Tsuchihashi K, Nio K, Arita S, Nakano T, Yasumatsu R, Jiroumaru R, Ariyama H, Kusaba H, Oda Y, Akashi K, Baba E. Lingual alveolar soft part sarcoma responsive to pazopanib: A case report. Medicine (Baltimore) 2017; 96:e8470. [PMID: 29095301 PMCID: PMC5682820 DOI: 10.1097/md.0000000000008470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE The multi-targeted tyrosine kinase inhibitors such as cediranib, sunitinib and pazopanib have been reported to be effective for alveolar soft part sarcoma (ASPS). The efficacy of pazopanib for the patient with lingual ASPS has yet to be reported. PATIENT CONCERNS A 23-year old man presented with articulation disorder and swelling of the tongue. Diagnosis of lingual ASPS was made after incisional biopsy and complete excision of the mass was performed. Three months later, he presented with a protruding mental region. DIAGNOSES Computed tomography revealed mental region mass and lung metastasis. INTERVENTIONS After the failure of combination therapy of doxorubicin and ifosfamide, pazopanib was administered. OUTCOMES Shrinkage of both the mental region and lung mass continued for more than two months, but regrowth was confirmed at the fourth month. LESSONS Lingual ASPS is an exceedingly rare subset of ASPS with distinct molecular and histological characteristics and appropriate therapy remains to be established. Our findings suggest a possible therapeutic strategy for lingual ASPS.
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Affiliation(s)
| | | | - Kenta Nio
- Department of Hematology, Oncology and Cardiovascular medicine
| | - Shuji Arita
- Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences
| | | | | | - Rina Jiroumaru
- Department of Anatomical Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Ariyama
- Department of Hematology, Oncology and Cardiovascular medicine
| | - Hitoshi Kusaba
- Department of Hematology, Oncology and Cardiovascular medicine
| | - Yoshinao Oda
- Department of Anatomical Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Akashi
- Department of Hematology, Oncology and Cardiovascular medicine
| | - Eishi Baba
- Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences
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Royce TJ, Punglia RS, Chen AB, Patel SA, Thornton KA, Raut CP, Baldini EH. Cost-Effectiveness of Surveillance for Distant Recurrence in Extremity Soft Tissue Sarcoma. Ann Surg Oncol 2017; 24:3264-3270. [PMID: 28718037 DOI: 10.1245/s10434-017-5996-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Optimal distant recurrence (DR) surveillance strategies for extremity soft tissue sarcoma (STS) are unknown. We performed a cost-effectiveness analysis of different imaging modalities performed at guideline-specified intervals. METHODS We developed a Markov model simulating lifetime outcomes for 54-year-old patients after definitive treatment for American Joint Committee on Cancer stage II-III extremity STS using four surveillance strategies: watchful waiting (WW), chest X-ray (CXR), chest computed tomography (CCT), and positron emission tomography-computed tomography (PET/CT). Probabilities, utilities, and costs were extracted from the literature and Medicare claims to determine incremental cost-effectiveness ratios (ICER). RESULTS CCT was the most effective and most costly strategy with CXR the most cost-effective strategy at a societal willing-to-pay (WTP) of $100,000/quality-adjusted life year (QALY). The ICER was $12,113/QALY for CXR versus $104,366/QALY for CCT while PET/CT was never cost-effective. Sensitivity analyses demonstrated CCT becomes the preferred imaging modality as the lifetime risk of DR increases beyond 33% or as the WTP increases beyond $120,000/QALY. CONCLUSIONS Optimal DR surveillance imaging for stage II-III extremity STS should be individualized based on patients' risks for DR. These results suggest CXR, or CCT performed at more protracted intervals, may be preferred for lower-risk patients (i.e., DR risk <33%), whereas CCT may be preferred for higher-risk patients (i.e., DR risk >33%). Further study of optimal strategies is needed. In the interim, these findings may help to refine guidelines to reduce resource overutilization during routine surveillance of lower-risk sarcoma patients.
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Affiliation(s)
- Trevor J Royce
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, USA. .,Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.
| | - Rinaa S Punglia
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | - Aileen B Chen
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | - Sagar A Patel
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, USA.,Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | - Katherine A Thornton
- Center for Bone and Soft Tissue Sarcoma, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | - Chandrajit P Raut
- Center for Bone and Soft Tissue Sarcoma, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.,Division of Surgical Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | - Elizabeth H Baldini
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.,Center for Bone and Soft Tissue Sarcoma, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
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17
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Nakamura T, Matsumine A, Matsusaka M, Mizumoto K, Mori M, Yoshizaki T, Matsubara T, Asanuma K, Sudo A. Analysis of pulmonary nodules in patients with high-grade soft tissue sarcomas. PLoS One 2017; 12:e0172148. [PMID: 28182790 PMCID: PMC5300188 DOI: 10.1371/journal.pone.0172148] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 01/31/2017] [Indexed: 11/18/2022] Open
Abstract
Nowadays, small pulmonary nodules are easily detectable in patients with soft tissue sarcomas (STSs) because of highly improved computed tomography (CT) technologies. The purpose of this study was to determine the frequency and significance of the pulmonary nodules detected by CT in high-grade STS patients. 124 patients with high-grade STS were retrospectively reviewed. There were 72 males (57%) and 52 females (43%). Patients’ average age was 61 years (median (quartiles) 66 years (48–75), range 8–94 years). Pulmonary nodules were detected in 49 (39.5%) of 124 patients by CT scanning at first presentation. Of 49 patients with nodules at first presentation, 34 (69.4%) had benign lesions, and 13 (26.5%) had metastatic nodules. One patient (2%) had primary lung cancer and the remaining one with one nodule could not be definitively diagnosed due to a short follow-up time. 30 patients (24.1%) of 124 patients developed pulmonary nodules during their clinical progression. Seven (23.3%) had benign lesions, whereas 21 (70%) had metastatic lesions. Primary lung cancer was detected in two patients (6.7%). The size and timing of detection of a pulmonary nodule significantly affected the final clinical diagnosisby multivariate analysis. We conclude that pulmonary nodules can be detected highly frequently in patients with high-grade STSs because of improved CT technologies. Careful follow-up is needed if nodules are detected after initial treatment or during the clinical course of the disease.
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Affiliation(s)
- Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu-city, Mie, Japan
- * E-mail:
| | - Akihiko Matsumine
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu-city, Mie, Japan
| | - Miki Matsusaka
- Medical student, Mie University School of Medicine, Tsu-city, Mie, Japan
| | - Keitaro Mizumoto
- Medical student, Mie University School of Medicine, Tsu-city, Mie, Japan
| | - Mayuko Mori
- Medical student, Mie University School of Medicine, Tsu-city, Mie, Japan
| | - Tomoya Yoshizaki
- Medical student, Mie University School of Medicine, Tsu-city, Mie, Japan
| | - Takao Matsubara
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu-city, Mie, Japan
| | - Kunihiro Asanuma
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu-city, Mie, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu-city, Mie, Japan
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18
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Current utilities of imaging in grading musculoskeletal soft tissue sarcomas. Eur J Radiol 2016; 85:1336-44. [DOI: 10.1016/j.ejrad.2016.05.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/02/2016] [Accepted: 05/09/2016] [Indexed: 12/21/2022]
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19
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Tabacchi E, Fanti S, Nanni C. The Possible Role of PET Imaging Toward Individualized Management of Bone and Soft Tissue Malignancies. PET Clin 2016; 11:285-96. [PMID: 27321032 DOI: 10.1016/j.cpet.2016.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This article presents fluorodeoxyglucose PET/computed tomography for the evaluation of soft tissue sarcomas. Its clinical impact is discussed analyzing all the clinical information provided when applied in different phases of the disease. A special paragraph is dedicated to the use of functional imaging for driving the biopsy.
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Affiliation(s)
- Elena Tabacchi
- Nuclear Medicine, AOU di Bologna Policlinico S. Orsola-Malpighi, Via Massarenti 9, Bologna 40138, Italy
| | - Stefano Fanti
- Nuclear Medicine, AOU di Bologna Policlinico S. Orsola-Malpighi, Via Massarenti 9, Bologna 40138, Italy
| | - Cristina Nanni
- Nuclear Medicine, AOU di Bologna Policlinico S. Orsola-Malpighi, Via Massarenti 9, Bologna 40138, Italy.
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20
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Roberts CC, Kransdorf MJ, Beaman FD, Adler RS, Amini B, Appel M, Bernard SA, Fries IB, Germano IM, Greenspan BS, Holly LT, Kubicky CD, Lo SSM, Mosher TJ, Sloan AE, Tuite MJ, Walker EA, Ward RJ, Wessell DE, Weissman BN. ACR Appropriateness Criteria Follow-Up of Malignant or Aggressive Musculoskeletal Tumors. J Am Coll Radiol 2016; 13:389-400. [PMID: 26922595 DOI: 10.1016/j.jacr.2015.12.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 12/16/2015] [Indexed: 02/07/2023]
Abstract
Appropriate imaging modalities for the follow-up of malignant or aggressive musculoskeletal tumors include radiography, MRI, CT, (18)F-2-fluoro-2-deoxy-D-glucose PET/CT, (99m)Tc bone scan, and ultrasound. Clinical scenarios reviewed include evaluation for metastatic disease to the lung in low- and high-risk patients, for osseous metastatic disease in asymptomatic and symptomatic patients, for local recurrence of osseous tumors with and without significant hardware present, and for local recurrence of soft tissue tumors. The timing for follow-up of pulmonary metastasis surveillance is also reviewed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - Ronald S Adler
- New York University Center for Musculoskeletal Care, New York, New York
| | - Behrang Amini
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marc Appel
- Warwick Valley Orthopedic Surgery, Warwick, New York, American Academy of Orthopaedic Surgeons
| | - Stephanie A Bernard
- Penn State University Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Ian Blair Fries
- Bone, Spine and Hand Surgery, Chartered, Brick, New Jersey, American Academy of Orthopaedic Surgeons
| | | | | | - Langston T Holly
- University of California Los Angeles Medical Center, Los Angeles, California
| | | | - Simon Shek-Man Lo
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Timothy J Mosher
- Penn State University Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Andrew E Sloan
- University Hospital Case Medical Center, Cleveland, Ohio
| | | | - Eric A Walker
- Penn State University Milton S. Hershey Medical Center, Hershey, Pennsylvania
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21
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Garner HW, Kransdorf MJ. Musculoskeletal Sarcoma: Update on Imaging of the Post-treatment Patient. Can Assoc Radiol J 2016; 67:12-20. [DOI: 10.1016/j.carj.2014.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/18/2014] [Indexed: 12/30/2022] Open
Abstract
Post-treatment imaging of musculoskeletal sarcoma remains challenging, but newer imaging techniques are improving our ability to recognize both local and distant recurrence and accurately distinguish local recurrence from post-treatment change. We review recent advances in dynamic contrast-enhanced magnetic resonance imaging, diffusion-weighted magnetic resonance imaging with apparent diffusion coefficient mapping and positron emission tomography/computed tomography in the post-treatment follow-up of musculoskeletal sarcoma. We also describe our multidisciplinary sarcoma team approach to patient care and the essential role of the radiologist in the clinical follow-up scheme.
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Liu F, Zhang Q, Zhu D, Liu F, Li Z, Li J, Wang B, Zhou D, Dong J. Performance of Positron Emission Tomography and Positron Emission Tomography/Computed Tomography Using Fluorine-18-Fluorodeoxyglucose for the Diagnosis, Staging, and Recurrence Assessment of Bone Sarcoma: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2015; 94:e1462. [PMID: 26356700 PMCID: PMC4616630 DOI: 10.1097/md.0000000000001462] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To investigate the performance of fluorine-18-fluorodeoxyglucose (F-FDG) positron emission tomography (PET) and PET/computed tomography (CT) in the diagnosis, staging, restaging, and recurrence surveillance of bone sarcoma by systematically reviewing and meta-analyzing the published literature.To retrieve eligible studies, we searched the MEDLINE, Embase, and the Cochrane Central library databases using combinations of following Keywords: "positron emission tomography" or "PET," and "bone tumor" or "bone sarcoma" or "sarcoma." Bibliographies from relevant articles were also screened manually. Data were extracted and the pooled sensitivity, specificity, and diagnostic odds ratio (DOR), on an examination-based or lesion-based level, were calculated to appraise the diagnostic accuracy of F-FDG PET and PET/CT. All statistical analyses were performed using Meta-Disc 1.4.Forty-two trials were eligible. The pooled sensitivity and specificity of PET/CT to differentiate primary bone sarcomas from benign lesions were 96% (95% confidence interval [CI], 93-98) and 79% (95% CI, 63-90), respectively. For detecting recurrence, the pooled results on an examination-based level were sensitivity 92% (95% CI, 85-97), specificity 93% (95% CI, 88-96), positive likelihood ratio (PLR) 10.26 (95% CI, 5.99-17.60), and negative likelihood ratio (NLR) 0.11 (95% CI, 0.05-0.22). For detecting distant metastasis, the pooled results on a lesion-based level were sensitivity 90% (95% CI, 86-93), specificity 85% (95% CI, 81-87), PLR 5.16 (95% CI, 2.37-11.25), and NLR 0.15 (95% CI, 0.11-0.20). The accuracies of PET/CT for detecting local recurrence, lung metastasis, and bone metastasis were satisfactory. Pooled outcome estimates of F-FDG PET were less complete compared with those of PET/CT.F-FDG PET and PET/CT showed a high sensitivity for diagnosing primary bone sarcoma. Moreover, PET/CT demonstrated excellent accuracy for the staging, restaging, and recurrence surveillance of bone sarcoma. However, to avoid misdiagnosis, pathological examination or long-term follow-up should be carried out for F-FDG-avid lesions in patients with suspected bone sarcoma.
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Affiliation(s)
- Fanxiao Liu
- From the Department of Orthopedics, Shandong Hospital Affiliated to Shandong University, Jinan, Shandong, China (FL, BW, DZ); Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (QZ, ZL, JL); and Department of Orthopedics, Heze Peony People's Hospital, Heze, Shandong, China (DZ, FL)
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Raciborska A, Bilska K, Drabko K, Michalak E, Chaber R, Pogorzała M, Połczyńska K, Sobol G, Wieczorek M, Muszyńska-Rosłan K, Rychlowska-Pruszyńska M, Rodriguez-Galindo C, Dziuk M. Response to chemotherapy estimates by FDG PET is an important prognostic factor in patients with Ewing sarcoma. Clin Transl Oncol 2015; 18:189-95. [DOI: 10.1007/s12094-015-1351-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
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24
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The role of 18F-FDG PET/CT in diagnosis and staging of musculoskeletal soft tissue sarcomas. Clin Transl Imaging 2015. [DOI: 10.1007/s40336-015-0108-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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25
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Bluemel C, Fendler WP, Lopci E, Rubello D, Herrmann K. Positron emission tomography in pediatric and adult sarcoma. Clin Transl Imaging 2015. [DOI: 10.1007/s40336-015-0109-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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26
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Quartuccio N, Fox J, Kuk D, Wexler LH, Baldari S, Cistaro A, Schöder H. Pediatric bone sarcoma: diagnostic performance of ¹⁸F-FDG PET/CT versus conventional imaging for initial staging and follow-up. AJR Am J Roentgenol 2015; 204:153-60. [PMID: 25539251 DOI: 10.2214/ajr.14.12932] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the diagnostic performance of (18)F-FDG PET/CT and conventional imaging for staging and follow-up of pediatric osteosarcoma and skeletal Ewing sarcoma. MATERIALS AND METHODS We calculated sensitivity, specificity, and accuracy of PET/CT and conventional imaging (CT, MRI, bone scanning) for sites of disease and number of lesions. Diagnostic benefit, defined as better characterization of lesions, was evaluated on a per-scan basis, comparing PET/CT and conventional imaging. RESULTS A total of 412 lesions were characterized by imaging in 64 patients (20, osteosarcoma; 44, Ewing sarcoma). For osteosarcoma patients PET/CT was available only at follow-up, where it proved more accurate than conventional imaging for the detection of bone lesions (accuracy, 95% vs 67% for CT and 86% for MRI) and complementary to CT in evaluating lung nodules (sensitivity, 84% vs 94%; specificity, 79% vs 71%) with diagnostic benefit in 18% of examinations. In patients with Ewing sarcoma, PET/CT tended to perform better during follow-up than at initial staging (accuracy, 85% vs 69%). For lung findings, PET/CT was more specific than CT but was less sensitive. The diagnostic benefit of PET/CT was greater at staging (28%) than during followup (9%). On a per-patient basis, PET/CT provided diagnostic benefit in 21 of 44 patients with Ewing sarcoma and nine of 20 patients with osteosarcoma at least once during clinical management. CONCLUSION FDG PET/CT provides diagnostic benefit in Ewing sarcoma and osteosarcoma, with the exception of small lung nodules. Prospective studies are needed to define the best imaging algorithm and combination of tests in the staging and follow-up of patients with pediatric bone sarcoma.
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Affiliation(s)
- Natale Quartuccio
- 1 Nuclear Medicine Unit, Department of Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Messina, Italy
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27
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Freebody J, Wegner EA, Rossleigh MA. 2-deoxy-2-( 18F)fluoro-D-glucose positron emission tomography/computed tomography imaging in paediatric oncology. World J Radiol 2014; 6:741-755. [PMID: 25349660 PMCID: PMC4209422 DOI: 10.4329/wjr.v6.i10.741] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 03/05/2014] [Accepted: 09/17/2014] [Indexed: 02/06/2023] Open
Abstract
Positron emission tomography (PET) is a minimally invasive technique which has been well validated for the diagnosis, staging, monitoring of response to therapy, and disease surveillance of adult oncology patients. Traditionally the value of PET and PET/computed tomography (CT) hybrid imaging has been less clearly defined for paediatric oncology. However recent evidence has emerged regarding the diagnostic utility of these modalities, and they are becoming increasingly important tools in the evaluation and monitoring of children with known or suspected malignant disease. Important indications for 2-deoxy-2-(18F)fluoro-D-glucose (FDG) PET in paediatric oncology include lymphoma, brain tumours, sarcoma, neuroblastoma, Langerhans cell histiocytosis, urogenital tumours and neurofibromatosis type I. This article aims to review current evidence for the use of FDG PET and PET/CT in these indications. Attention will also be given to technical and logistical issues, the description of common imaging pitfalls, and dosimetric concerns as they relate to paediatric oncology.
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Amini B, Jessop AC, Ganeshan DM, Tseng WW, Madewell JE. Contemporary imaging of soft tissue sarcomas. J Surg Oncol 2014; 111:496-503. [DOI: 10.1002/jso.23801] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 08/14/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Behrang Amini
- Department of Diagnostic Radiology; The University of Texas M.D. Anderson Cancer Center; Houston Texas
| | - Aaron C. Jessop
- Department of Diagnostic Radiology; The University of Texas M.D. Anderson Cancer Center; Houston Texas
| | - Dhakshina M. Ganeshan
- Department of Diagnostic Radiology; The University of Texas M.D. Anderson Cancer Center; Houston Texas
| | - William W. Tseng
- Division of Upper GI/General Surgery; Section of Surgical Oncology; University of Southern California; Los Angeles California
- Hoag Family Cancer Institute, Hoag Memorial Hospital Presbyterian, Newport Beach; California
| | - John E. Madewell
- Department of Diagnostic Radiology; The University of Texas M.D. Anderson Cancer Center; Houston Texas
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Hoshi M, Oebisu N, Takada J, Ieguchi M, Wakasa K, Nakamura H. Role of FDG-PET/CT for monitoring soft tissue tumors. Oncol Lett 2014; 7:1243-1248. [PMID: 24660036 PMCID: PMC3961202 DOI: 10.3892/ol.2014.1876] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 01/23/2014] [Indexed: 12/16/2022] Open
Abstract
The aim of the current study was to evaluate the limitations of 2-deoxy-2-F18-fluoro-D-glucose positron emission tomography combined with computed tomography (FDG-PET/CT) when monitoring soft tissue tumors. The diagnostic criteria of malignancy was defined as the tumor having a maximum standardized uptake value (SUVmax) ≥2.0 and a maximum diameter ≥5 cm as measured using FDG-PET/CT. One-hundred-and-thirteen patients, that were either included in the criteria or not, were compared. In addition, the values of SUVmax of the primary tumor and relapse in 12 patients were evaluated. The Kaplan-Meier analysis demonstrated that patients with tumors measuring ≥5 cm size and ≥2.0 SUVmax were associated with a worse survival rate. Among the 12 patients with relapse, statistical significances were detected in the tumor diameters, however, not in the SUVmax values. Thus, the criteria identified patients that were associated with a poor prognosis, and the SUVmax of distant metastases and local recurrences were identified to be significantly affected by tumor size.
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Affiliation(s)
- Manabu Hoshi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Naoto Oebisu
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Jun Takada
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Makoto Ieguchi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Kenichi Wakasa
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
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Peller PJ. Role of positron emission tomography/computed tomography in bone malignancies. Radiol Clin North Am 2013; 51:845-64. [PMID: 24010909 DOI: 10.1016/j.rcl.2013.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This article presents an overview of positron emission tomography combined with computed tomography (PET/CT) imaging of bone tumors for the practicing radiologist. The clinical roles and utility of (18)F-labeled fluorodeoxyglucose PET/CT in patients with primary bone tumors, osseous metastases, and multiple myeloma are reviewed. The clinical and research data supporting the utility of PET/CT in the evaluation of skeletal malignancies continues to grow.
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Affiliation(s)
- Patrick J Peller
- Nuclear Radiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Radiology, College of Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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Necrosis on FDG PET/CT Correlates With Prognosis and Mortality in Sarcomas. AJR Am J Roentgenol 2013; 201:170-7. [DOI: 10.2214/ajr.12.9795] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Quartuccio N, Treglia G, Salsano M, Mattoli MV, Muoio B, Piccardo A, Lopci E, Cistaro A. The role of Fluorine-18-Fluorodeoxyglucose positron emission tomography in staging and restaging of patients with osteosarcoma. Radiol Oncol 2013; 47:97-102. [PMID: 23801904 PMCID: PMC3691088 DOI: 10.2478/raon-2013-0017] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 11/14/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The objective of this study is to systematically review the role of positron emission tomography (PET) and PET/computed tomography (PET/CT) with Fluorine-18-Fluorodeoxyglucose (FDG) in patients with osteosarcoma (OS). METHODS A comprehensive literature search of published studies through October 10(th), 2012 in PubMed/MEDLINE, Embase and Scopus databases regarding whole-body FDG-PET and FDG-PET/CT in patients with OS was performed. RESULTS We identified 13 studies including 289 patients with OS. With regard to the staging and restaging of OS, the diagnostic performance of FDG-PET and PET/CT seem to be high; FDG-PET and PET/CT seem to be superior to bone scintigraphy and conventional imaging methods in detecting bone metastases; conversely, spiral CT seems to be superior to FDG-PET in detecting pulmonary metastases from OS. CONCLUSIONS Metabolic imaging may provide additional information in the evaluation of OS patients. The combination of FDG-PET or FDG-PET/CT with conventional imaging methods seems to be a valuable tool in the staging and restaging of OS and may have a relevant impact on the treatment planning.
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Affiliation(s)
- Natale Quartuccio
- Department of Radiological Sciences, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Giorgio Treglia
- Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Marco Salsano
- Institute of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Barbara Muoio
- School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Egesta Lopci
- Nuclear Medicine Unit, Humanitas Hospital, Milan, Italy
| | - Angelina Cistaro
- Positron Emission Tomography Center IRMET, Euromedic inc., Turin, Italy. Coordinator of the AIMN PET-Pediatric Study Group
- Correspondence to: Angelina Cistaro, MD, Coordinator of the AIMN PET-Pediatric Study Group, Positron Emission Tomography Centre IRMET S.p.A., Via O. Vigliani 89, Turin 10136, Italy. Phone: +39 0113160158; Fax: +39 0113160828; E-mail:
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Al-Ibraheem A, Buck AK, Benz MR, Rudert M, Beer AJ, Mansour A, Pomykala KL, Haller B, Juenger H, Scheidhauer K, Schwaiger M, Herrmann K. (18) F-fluorodeoxyglucose positron emission tomography/computed tomography for the detection of recurrent bone and soft tissue sarcoma. Cancer 2012; 119:1227-34. [PMID: 23233156 DOI: 10.1002/cncr.27866] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 09/18/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND The clinical utility of modern hybrid imaging modalities for detecting recurrent bone or soft tissue sarcoma remains to be determined. In this report, the authors present a clinical study on the diagnostic accuracy and incremental value of integrated (18) F-fluorodeoxyglucose positron emission tomography/computed tomography ((18) F-FDG PET/CT) in patients with a history of sarcoma who have clinically suspected disease recurrence. METHODS Forty-three patients who had a history of bone or soft tissue sarcoma and had documented complete remission underwent (18) F-FDG PET/CT. Image analysis was performed independently for (18) F-FDG PET (n = 43) and for contrast-enhanced spiral CT (CE-CT) (n = 30) by 2 separate readers, whereas combined (18) F-FDG PET/CT (n = 43) images were analyzed in consensus by both readers. Imaging findings were rated on a 5-point scale and finally were reported as malignant, benign, or equivocal. Imaging findings were validated either by histopathology (n = 24) or by clinical follow-up (n = 19). RESULTS (18) F-FDG PET/CT had greater sensitivity and specificity compared with CE-CT alone (94% and 92% vs 78% and 67%, respectively), resulting in significantly greater accuracy (93% vs 73%; P = .03). (18) F-FDG PET/CT was particularly superior regarding detection of local recurrence or soft tissue lesions (sensitivity and specificity: 83% and 100% vs 50% and 100%, respectively) or bone metastases (100% and 100% vs 85% and 88%, respectively). CONCLUSIONS (18) F-FDG PET/CT had greater diagnostic accuracy in the detection of recurrent bone or soft tissue sarcoma compared with CE-CT alone. The detection of local recurrence was the most evident advantage of (18) F-FDG PET/CT over CE-CT. Cancer 2013. © 2012 American Cancer Society.
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Affiliation(s)
- Akram Al-Ibraheem
- Department of Nuclear Medicine, Technische Universität München, Munich, Germany
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Van Gaal JC, De Bont ES, Kaal SE, Versleijen-Jonkers Y, van der Graaf WT. Building the bridge between rhabdomyosarcoma in children, adolescents and young adults: The road ahead. Crit Rev Oncol Hematol 2012; 82:259-79. [DOI: 10.1016/j.critrevonc.2011.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 06/29/2011] [Accepted: 06/30/2011] [Indexed: 01/02/2023] Open
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Value of PET scan in patients with retroperitoneal sarcoma treated with preoperative radiotherapy. Eur J Surg Oncol 2011; 38:176-80. [PMID: 22154883 DOI: 10.1016/j.ejso.2011.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 09/16/2011] [Accepted: 11/07/2011] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Preoperative radiotherapy provides advantages in the management of retroperitoneal sarcoma (RPS). We describe our experience treating a cohort who underwent pre- and post-radiotherapy functional imaging with FDG-PET scan. METHODS AND MATERIALS Consecutive patients presenting between January 1999 and December 2009 with a diagnosis of either primary or recurrent RPS were identified from the hospital patient record database using ICD codes, and cross-referenced with the completed radiotherapy course database. Those patients suitable for preoperative radiotherapy and surgery who underwent both pre- and post-radiotherapy FDG-PET were included. Exclusions included presence of metastatic disease, age under 18 years and/or paediatric histology, and treatment with palliative intent. RESULTS Eleven patients were included, of whom six were male. Median age was 63 years (range, 38-78 years). The majority of patients had Stage T2b, high-grade disease. Ten patients were treated at initial presentation and one at first local recurrence. A malignant diagnosis was confirmed in all patients who underwent CT-guided core biopsy; a diagnosis of sarcoma was reached in 91%. Sensitivity of FDG-PET imaging was 100%. Metabolic partial or complete response did not correlate with change in tumour size, nor pathological response assessment. Pulmonary and hepatic metastatic disease was detected in one patient on post-treatment imaging. All patients in the cohort completed preoperative radiotherapy. There was no grade 3 or 4 toxicity. Sixty-four percent proceeded to radical resection. Complete macroscopic excision was achieved in all cases. There was no perioperative mortality. CONCLUSION Combined therapy with preoperative radiotherapy and surgery has acceptable levels of toxicity. CT-guided core biopsy is an accurate means of confirming a diagnosis of RPS prior to definitive treatment. Utility of PET scan in the management of RPS is evolving and further investigation is warranted.
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Aryal S, Chu C, Morehead RS. An 83-year-old man with bilateral spontaneous pneumothoraces and multiple cysts. Chest 2011; 139:1536-1539. [PMID: 21652566 DOI: 10.1378/chest.10-2923] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Shambhu Aryal
- Division of Pulmonary and Critical Care Medicine, University of Kentucky Medical Center, Lexington, KY.
| | - Chau Chu
- Division of Pulmonary and Critical Care Medicine, University of Kentucky Medical Center, Lexington, KY
| | - R Scott Morehead
- Division of Pulmonary and Critical Care Medicine, University of Kentucky Medical Center, Lexington, KY
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Quak E, van de Luijtgaarden ACM, de Geus-Oei LF, van der Graaf WTA, Oyen WJG. Clinical applications of positron emission tomography in sarcoma management. Expert Rev Anticancer Ther 2011; 11:195-204. [PMID: 21342039 DOI: 10.1586/era.10.133] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Positron emission tomography (PET) with the fluorine-18-labeled glucose analog FDG is a technique that noninvasively visualizes glucose metabolism in the human body. In oncology, the addition of FDG-PET to the conventional anatomical imaging techniques provides very useful clinical information in diagnosis, staging, treatment response monitoring and follow-up. In the heterogeneous group of patients with sarcoma, FDG-PET has been shown to be of great value in improving patient care. In this article we will discuss the current role of FDG-PET in the management of patients with sarcoma and its value in assessing tumor grade, guiding biopsy, staging, monitoring treatment response, restaging and prognostication. Our future expectation is that the value of PET will only augment owing to the implementation of FDG-PET in clinical guidelines, the increasing availability worldwide, and the development of new tracers and new hybrid imaging techniques.
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Affiliation(s)
- Elske Quak
- Department of Nuclear Medicine, Internal Postal Code 444, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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Charest M, Hickeson M, Lisbona R, Novales-Diaz JA, Derbekyan V, Turcotte RE. FDG PET/CT imaging in primary osseous and soft tissue sarcomas: a retrospective review of 212 cases. Eur J Nucl Med Mol Imaging 2011; 36:1944-51. [PMID: 19593561 DOI: 10.1007/s00259-009-1203-0] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 06/13/2009] [Indexed: 12/21/2022]
Abstract
PURPOSE The aims of this study are to evaluate the sensitivity of FDG PET/CT for detection of soft tissue and osseous sarcomas on the basis of FDG avidity. METHODS We retrospectively evaluated 212 consecutive patients with known soft tissue or osseous sarcoma who had undergone a FDG PET/CT study for the initial staging or assessment of recurrence of disease. The maximum standardized uptake value (SUVmax) of each primary and/or most intense metastatic lesion was measured and compared with the histological data provided in the final pathological reports. An SUVmax of 2.5 or greater was considered positive for our analysis. RESULTS Sufficient histopathological data were available for 160 soft tissue sarcomas and 52 osseous sarcomas. FDG PET/CT detected 93.9% of all sarcomas with a sensitivity of 93.7% for soft tissue sarcomas and 94.6% for osseous sarcomas. The sensitivities of the most common sarcoma histologies were 100% for leiomyosarcomas, 94.7% for osteosarcomas, 100% for Ewing's sarcomas, 88.9% for liposarcomas, 80.0% for synovial sarcomas, 100% for gastrointestinal stromal tumors, 87.5% for malignant peripheral nerve sheath tumors, 100% for fibroblastic and myoblastic sarcomas, and 100% for malignant fibrohistiocytic tumors. The receiver-operating characteristic curve revealed an area under the curve of 94% for the discrimination of low-grade and high-grade sarcomas imaged for initial staging by FDG PET/CT. CONCLUSION The combined metabolic and morphological information of FDG PET/CT imaging allows high sensitivity for the detection of various sarcomas and accurate discrimination between newly diagnosed low-grade and high-grade sarcomas.
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Affiliation(s)
- Mathieu Charest
- Service of Nuclear Medicine, Lakeshore General Hospital, 160 Stillview Street, Pointe-Claire, Canada.
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Abstract
Alveolar soft part sarcoma (ASPS) is a very rare, but distinctive type of soft tissue sarcoma, whose name is derived from the pseudoalveolar appearance of its histology. In this report, the FDG PET/CT findings of ASPS are described in a 17-year-old asthmatic female who presented with worsening respiratory symptoms and a pelvic mass. The staging PET showed heterogeneous intense incorporation of FDG within the mass and variable FDG incorporation within the multiple lung nodules. In concordance with other soft tissue sarcomas, PET/CT helped to confirm the anatomic origin of the ASPS, to direct its biopsy, and to assess the distribution of disease.
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Schramm N, Schlemmer M, Rist C, Issels R, Reiser MF, Berger F. [Combined functional and morphological imaging of sarcomas: significance for diagnostics and therapy monitoring]. Radiologe 2010; 50:339-48. [PMID: 20221579 DOI: 10.1007/s00117-009-1973-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
(18)F-fluorodeoxyglucose positron-emission tomography (FDG-PET) and especially hybrid FDG-PET/CT is becoming more and more accepted for the clinical management of adult and pediatric patients with sarcomas. By integrating the CT component the specificity in particular but also the sensitivity of the modality are improved further. With PET/CT a complete staging including the detection of lung metastases is feasible in a single examination. For patients with primary bone and soft tissue sarcomas FDG-PET/CT is utilized for diagnosis, staging and restaging, metabolic tumor grading, guidance of biopsies, detection of tumor recurrence and therapy monitoring. Furthermore, it has been demonstrated that FDG uptake of the tumor prior to treatment and changes of FDG uptake after therapy significantly correlate with histopathologic response and survival of patients. Therefore, PET and PET/CT have a prognostic value. In the future new perspectives of hybrid PET/CT imaging will arise by introducing novel radiotracers and combined functional imaging of tumor metabolism and perfusion. High resolution MRI is essential for local evaluation of the primary tumor and preoperative planning with assessment of possible infiltration of vascular or neural structures. Contrast-enhanced MRI remains a key tool in the diagnosis of recurrent disease, especially in tumors which are not hypermetabolic. Dynamic contrast-enhanced MR sequences can significantly contribute to therapy monitoring. More research is necessary to prospectively compare dynamic contrast-enhanced MRI and FDG-PET/CT for evaluation of local and recurrent diseases.
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Affiliation(s)
- N Schramm
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland
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Abstract
Imaging is critical for the proper evaluation of patients with primary tumors of bone. There is a growing role for (18)F-fluorodeoxyglucose PET and PET/computed tomography (CT) in the grading, staging, prognostication, evaluation of therapeutic response, and detection of recurrent disease in bone. These modalities can also be used to help differentiate benign from malignant disorders of bone.
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Affiliation(s)
- Erik Mittra
- Division of Nuclear Medicine, Department of Radiology, Stanford Hospital and Clinics, 300 Pasteur Drive, Room H0101, Stanford, CA 94305-8521, USA.
| | - Andrei Iagaru
- Division of Nuclear Medicine, Department of Radiology, Stanford Hospital and Clinics, 300 Pasteur Drive, Room H0101, Stanford, CA 94305-8521, USA
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Mody RJ, Bui C, Hutchinson RJ, Yanik GA, Castle VP, Frey KA, Shulkin BL. FDG PET imaging of childhood sarcomas. Pediatr Blood Cancer 2010; 54:222-7. [PMID: 19890901 PMCID: PMC2794959 DOI: 10.1002/pbc.22307] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Positron-emission tomography (PET) imaging using [(18)F]fluorodeoxyglucose (FDG) is useful for detection, staging, and monitoring a variety of malignancies, including lymphoma, in adults, but its utility in sarcomas, especially soft tissue sarcomas (STS), in children and young adults is not clear. PROCEDURE To evaluate the potential utility of FDG PET in the care of STS in children and young adults, we analyzed 46 PET scans in 25 patients acquired over 12 years. Scans were interpreted by two imaging physicians blinded to findings from other imaging studies and clinical information. Results were compared with computed tomography and magnetic resonance imaging, biopsy results, where available, and clinical follow-up of at least 12 months. RESULTS For a total of 46 scans in 25 patients, there were 25 true-positive scans, 3 false-positive scans, 12 true-negative scans, and 6 false-negative scans. The sensitivity of the PET scan was 86%, specificity was 80%, positive predictive value was 89%, and negative predictive value was 67%. CONCLUSION FDG PET may be a useful imaging modality in the management of children and young adults with STS, although prospective studies are needed to establish its true utility.
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Affiliation(s)
- Rajen J. Mody
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Chuong Bui
- Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Raymond J. Hutchinson
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Greg A. Yanik
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Valerie P. Castle
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Kirk A Frey
- Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Barry L. Shulkin
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee,Correspondence to: Barry L. Shulkin, Department of Radiological Sciences, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN 38105, , Phone: (901) 595-3347, Fax: (901) 595-3981
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Abstract
PURPOSE OF REVIEW 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) is being used with increased frequency in the care of patients with sarcoma. In this review, the recent literature covering all aspects of PET imaging in the management of patients with soft tissue and bone sarcomas will be discussed. RECENT FINDINGS In a prospective multicenter study, PET imaging accurately detected primary tumors as well as lymph node and bone metastases in patients with sarcoma. Limitations in detecting lung metastasis can be overcome by using a hybrid PET/CT scanner. In patients with neurofibromatosis, 18F-FDG-PET demonstrated its application to detect and monitor for the malignant transformation of neurofibromas. Changes in tumor 18F-FDG uptake correlate significantly with histopathologic response and survival in patients with sarcoma. SUMMARY PET imaging is emerging as an important imaging modality in the management of patients with sarcoma. Its applications include tumor grading, staging, therapeutic monitoring, and prognostication in adult and pediatric populations.
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Management of small pulmonary nodules in patients with sarcoma. Clin Exp Metastasis 2009; 26:713-8. [DOI: 10.1007/s10585-009-9270-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Accepted: 05/08/2009] [Indexed: 01/04/2023]
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Karam I, Devic S, Hickeson M, Roberge D, Turcotte RE, Freeman CR. PET/CT for radiotherapy treatment planning in patients with soft tissue sarcomas. Int J Radiat Oncol Biol Phys 2009; 75:817-21. [PMID: 19386424 DOI: 10.1016/j.ijrobp.2008.11.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 10/13/2008] [Accepted: 11/21/2008] [Indexed: 01/04/2023]
Abstract
PURPOSE To study the possibility of incorporating positron emission tomography/computed tomography (PET/CT) information into radiotherapy treatment planning in patients with high-grade soft tissue sarcomas (STS). METHODS AND MATERIALS We studied 17 patients treated with preoperative radiotherapy at our institution from 2005 to 2007. All patients had a high-grade STS and had had a staging PET/CT scan. For each patient, an MRI-based gross tumor volume (GTV), considered to be the contemporary standard for radiotherapy treatment planning, was outlined on a T1-gadolinium enhanced axial MRI (GTV(MRI)), and a second set of GTVs were outlined using different threshold values on PET images (GTV(PET)). PET-based target volumes were compared with the MRI-based GTV. Threshold values for target contouring were determined as a multiple (from 2 to 10 times) of the background soft tissue uptake values (B) sampled over healthy tissue. RESULTS PET-based GTVs contoured using a threshold value of 2 or 2.5 most closely resembled the GTV(MRI) volumes. Higher threshold values lead to PET volumes much smaller than the GTV(MRI). The standard deviations between the average volumes of GTV(PET) and GTV(MRI) ratios for all thresholds were large, ranging from 36% for 2 xB up to 93% for 10 xB. Maximum uptake-to-background ratio correlated poorly with the maximum standardized uptake values. CONCLUSIONS It is unlikely that PET/CT will make a significant contribution in GTV definition for radiotherapy treatment planning in patients with STS using threshold methods on PET images. Future studies will focus on molecular imaging and tumor physiology.
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Affiliation(s)
- Irene Karam
- Department of Radiation Oncology, McGill University Health Centre, 1650 Cedar Avenue, Montreal, Quebec, Canada
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Impact of PET and CT in PET/CT Studies for Staging and Evaluating Treatment Response in Bone and Soft Tissue Sarcomas. Clin Nucl Med 2009; 34:146-50. [DOI: 10.1097/rlu.0b013e3181966f9d] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
Pulmonary metastases are common in patients following resection for soft tissue sarcoma. Pulmonary resection of metastatic soft tissue sarcomas is widely practiced in surgical oncology. No randomized phase III trials are available, and data for this review were retrieved only from retrospective studies. This article addresses the issues of patient selection, surgical technique, and adjuvant chemotherapy, and provides the surgical oncologist with a current review of pulmonary metastasectomy in metastatic soft tissue sarcoma. In summary, there is a substantial body of evidence demonstrating that resection of soft tissue pulmonary metastases can be performed safely and with a low mortality rate. For a subset of highly selected patients, the overall results of a 5-year actuarial survival rate ranged between 25% and 37.6%. These outcomes exceed those normally associated with metastatic soft tissue sarcoma and are well comparable with surgical resection for other malignancies.
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Carrle D, Bielack S. Osteosarcoma lung metastases detection and principles of multimodal therapy. Cancer Treat Res 2009; 152:165-184. [PMID: 20213390 DOI: 10.1007/978-1-4419-0284-9_8] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The management of pulmonary metastases poses a challenge to the multidisciplinary team involved in the treatment of osteosarcoma. A postal survey on the management of pulmonary metastases in osteosarcoma involving 17 representatives from international study groups and selected institutions was performed in which a response rate of 94% was achieved. The results showed uniform approaches in areas like the imaging methods used for initial staging and the use of manual exploration with thoracotomy. However, it demonstrated diverse practices regarding exploration of the unaffected site in unilateral pulmonary disease, and the approach to lesions disappearing under chemotherapy. Furthermore, agreement on the size of a lesion considered to distinguish between benign and of metastatic origin, varied. Based on the survey and a review of the current literature, detection methods and principles of multimodal therapy will be discussed. Prognostic factors in synchronous and metachronous pulmonary metastases and their implications for a multimodal therapy is also presented.
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Affiliation(s)
- Dorothe Carrle
- Pediatrics 5 (Oncology, Haematology, Immunology), Klinikum Stuttgart, Olgahospital, Bismarckstr. 8, D-70176, Stuttgart, Germany.
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