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18F-FDG PET/CT in the evaluation of cartilaginous bone neoplasms: the added value of tumor grading

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Abstract

Objectives

Cartilaginous bone tumors represent a wide variety of neoplasms ranging from benign to extremely aggressive malignant lesions. Unlike other tumors, the biopsy cannot easily predict the histological grade, sometimes not allowing choosing the best therapeutic approach. The aim of the study was to evaluate the ability of 18F-FDG PET/CT to differentiate enchondroma from chondrosarcoma and to predict the histological grade as compared to biopsy.

Methods

18F-FDG PET/CT of 95 patients with chondroid lesions were retrospectively evaluated. The best SUVmax cutoff to predict the post-surgical histological grade were correlated to those of biopsy and to several radiologic aggressiveness features, which were summarized in the parameter “Radiologic Aggressiveness Score” (AgSCORE).

Results

A concordance between the preoperative biopsy and the definitive histological grade was observed overall in 78.3% of patients, the lowest accuracy (58.6%) being in the identification of intermediate/high-grade chondrosarcoma (G2/G3). The best SUVmax cutoff was 2.6 to discriminate enchondroma vs. low-grade chondrosarcoma (sensitivity 0.68, specificity 0.86), 3.7 to differentiate low-grade vs. intermediate/high-grade chondrosarcoma (sensitivity 0.83, specificity 0.84) and 7.7 to differentiate intermediate/high-grade vs. dedifferentiated chondrosarcoma (sensitivity 0.92, specificity 0.9). The AgSCORE also showed a high accuracy to differentiate between G1 and G2/G3 chondrosarcoma (cutoff = 4; sensitivity 0.76; specificity 0.89). An even higher accuracy was observed in those cases in which both SUVmax and AgSCORE cutoff were concordant.

Conclusions

Results in this large series of patients suggest a potential role of 18F-FDG PET/CT for histological grading of cartilaginous tumors, thus helping the orthopedic surgeon towards the most appropriate surgical procedure.

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References

  1. Bertoni F, Bacchini P, Hogendoorn PCW. Chondrosarcoma. In: Fletcher CDM, Unni KK, Mertens F, editors. World Health Organisation Classification of tumours Pathology and genetics of tumours of soft tissue and bone. Lyon: IARC; 2002. p. 247–251.

    Google Scholar 

  2. Damron TA, Ward WG, Stewart A. Osteosarcoma, chondrosarcoma, and Ewing's sarcoma: National Cancer Data Base Report. Clin Orthop Relat Res. 2007;459:40–7.

    Article  PubMed  Google Scholar 

  3. Mankin HJ, Lange TA, Spanier SS. The CLASSIC: the hazards of biopsy in patients with malignant primary bone and soft-tissue tumors. Clin Orthop Relat Res. 2006;450:4–10.

    Article  PubMed  Google Scholar 

  4. Laitinen MK, Stevenson JD, Parry MC, Sumathi V, Grimer RJ, Jeys LM. The role of grade in local recurrence and the disease-specific survival in chondrosarcomas. Bone Joint J. 2018;100-B:662–6.

    Article  CAS  PubMed  Google Scholar 

  5. Fletcher CDM, Bridge JA, Hogendoorn P, Mertens F (eds). WHO classification of tumours of soft tissue and bone. 4th ed. Lyon: IARC Press; 2013.

    Google Scholar 

  6. Nota SP, Braun Y, Schwab JH, van Dijk CN, Bramer JA. The identification of prognostic factors and survival statistics of conventional central chondrosarcoma. Sarcoma. 2015. https://doi.org/10.1155/2015/623746.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Strotman PK, Reif TJ, Kliethermes SA, Sandhu JK, Nystrom LM. Dedifferentiated chondrosarcoma: a survival analysis of 159 cases from the SEER database (2001–2011). J Surg Oncol. 2017;116:252–7.

    Article  PubMed  Google Scholar 

  8. Staals EL, Bacchini P, Mercuri M, Bertoni F. Dedifferentiated chondrosarcomas arising in preexisting osteochondromas. J Bone Joint Surg Am. 2007;89:987–93.

    Article  PubMed  Google Scholar 

  9. Marco RA, Gitelis S, Brebach GT, Healey JH. Cartilage tumors: evaluation and treatment. J Am Acad Orthop Surg. 2000;8:292–304.

    Article  CAS  PubMed  Google Scholar 

  10. Zoccali C, Baldi J, Attala D, Rossi B, Anelli V, Annovazzi A, et al. Intralesional vs. extralesional procedures for low-grade central chondrosarcoma: a systematic review of the literature. Arch Orthop Trauma Surg. 2018;138:929–37.

    Article  PubMed  Google Scholar 

  11. Dickey ID, Rose PS, Fuchs B, Wold LE, Okuno SH, Sim FH, et al. Dedifferentiated chondrosarcoma: the role of chemotherapy with updated outcomes. J Bone Joint Surg Am. 2004;86-A:2412–8.

    Article  Google Scholar 

  12. Feldman F, Van Heertum R, Saxena C, Parisien M. 18FDG-PET applications for cartilage neoplasms. Skelet Radiol. 2005;34:367–74.

    Article  Google Scholar 

  13. Brenner W, Conrad EU, Eary JF. FDG PET imaging for grading and prediction of outcome in chondrosarcoma patients. Eur J Nucl Med Mol Imaging. 2004;31:189–95.

    Article  PubMed  Google Scholar 

  14. Jesus-Garcia R, Osawa A, Filippi RZ, Viola DC, Korukian M, de Carvalho Campos Neto G, et al. Is PET-CT an accurate method for the differential diagnosis between chondroma and chondrosarcoma? Springerplus. 2016;5:236.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lee FY, Yu J, Chang SS, Fawwaz R, Parisien MV. Diagnostic value and limitations of fluorine-18 fluorodeoxyglucose positron emission tomography for cartilaginous tumors of bone. J Bone Joint Surg Am. 2004;86-A:2677–85.

    Article  Google Scholar 

  16. Purandare NC, Rangarajan V, Agarwal M, Sharma AR, Shah S, Arora A, et al. Integrated PET/CT in evaluating sarcomatous transformation in osteochondromas. Clin Nucl Med. 2009;34:350–4.

    Article  PubMed  Google Scholar 

  17. Douis H, Saifuddin A. The imaging of cartilaginous bone tumours. I. Benign lesions. Skelet Radiol. 2012;41:1195–212.

    Article  CAS  Google Scholar 

  18. Parlier-Cuau C, Bousson V, Ogilvie CM, Lackman RD, Laredo JD. When should we biopsy a solitary central cartilaginous tumor of long bones? Literature review and management proposal. Eur J Radiol. 2011;77:6–12.

    Article  PubMed  Google Scholar 

  19. Skeletal Lesions Interobserver Correlation among Expert Diagnosticians (SLICED) Study Group. Reliability of histopathologic and radiologic grading of cartilaginous neoplasms in long bones. J Bone Joint Surg Am. 2007;89:2113–23.

    Article  Google Scholar 

  20. Subhawong TK, Winn A, Shemesh SS, Pretell-Mazzini J. F-18 FDG PET differentiation of benign from malignant chondroid neoplasms: a systematic review of the literature. Skelet Radiol. 2017;46:1233–9.

    Article  Google Scholar 

  21. Eefting D, Schrage YM, Geirnaerdt MJ, Le Cessie S, Taminiau AH, Bovée JV, et al. EuroBoNeT consortium. Assessment of interobserver variability and histologic parameters to improve reliability in classification and grading of central cartilaginous tumors. Am J Surg Pathol. 2009;33:50–7.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors wish to thank Miss Elisa Checchucci, Data Manager of the Disease Management Team (DMT) of bone and soft tissue sarcoma at our Institution, for her invaluable collaboration on patient management and data collection.

Funding

This work has not received any funding.

Author information

Author notes

  1. Mariangela Novello

    Present address: Pathology, S. Bortolo Hospital, Vicenza, Italy

Authors and Affiliations

  1. Nuclear Medicine Unit, IRCCS-Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy

    Alessio Annovazzi & Rosa Sciuto

  2. Radiology and Diagnostic Imaging Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy

    Vincenzo Anelli

  3. Oncological Orthopaedics Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy

    Carmine Zoccali, Agnese Persichetti & Roberto Biagini

  4. Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy

    Nicolò Rumi

  5. Pathology Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy

    Mariangela Novello

  6. Department of Pathology, Villa Erbosa Hospital, Bologna, Italy

    Franco Bertoni

  7. First Division of Medical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy

    Virginia Ferraresi

Authors
  1. Alessio Annovazzi
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  2. Vincenzo Anelli
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  3. Carmine Zoccali
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  4. Nicolò Rumi
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  5. Agnese Persichetti
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  6. Mariangela Novello
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  7. Rosa Sciuto
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  8. Franco Bertoni
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  9. Virginia Ferraresi
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Correspondence to Alessio Annovazzi.

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Annovazzi, A., Anelli, V., Zoccali, C. et al. 18F-FDG PET/CT in the evaluation of cartilaginous bone neoplasms: the added value of tumor grading. Ann Nucl Med 33, 813–821 (2019). https://doi.org/10.1007/s12149-019-01392-3

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  • DOI: https://doi.org/10.1007/s12149-019-01392-3

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