Skip to main content

Advertisement

SpringerLink
Log in

The role of 18F-FDG PET/CT in the detection of osteosarcoma recurrence

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Aim

The aim of this study was to investigate the diagnostic accuracy of 18F-FDG-PET/CT in osteosarcoma patients suspicious for disease recurrence after adequate surgical therapy.

Methods

Inclusion criteria were: a) adequate surgical treatment for proven osteosarcoma and documented complete remission after therapy; b) 18F-FDG-PET/CT performed during follow-up for clinical/diagnostic suspicion of relapse; c) new surgical treatment with excision of the suspected lesions; d) histological validation of 18F-FDG-PET/CT findings. Thirty-seven patients matching all inclusion criteria were retrospectively enrolled (20 men and 17 female). Primary surgical treatment consists of resection (31 cases) or amputation (six cases). 18F-FDG-PET/CT performance was assessed with a per-patient and per-site evaluation of sensitivity, specificity, accuracy, positive predicting value (PPV), and negative predicting value (NPV). The sites of relapse were classified as local, lung, lymphnodes (LNs), and distant (other skeletal segments and/or distant soft tissue). The disease-free survival (DFS) and the overall survival (OS) after 18F-FDG PET/CT were evaluated.

Results

18F-FDG-PET/CT was positive in 89.2% (33/37) of patients. Local uptake only was observed in 35.1% patients (13/37); lung uptake only in 18.9% (7/37); distant uptake only in 2.7% (1/37) case; multiple sites of uptake in 32.4% (12/37). Histology resulted positive in 92% (34/37) of patients. A total of 51 pathologic lesions were evaluated (22 local relapse, 11 lung metastasis, 10 metastatic LNs, eight distant metastatic lesions). On a per-patient analysis 18F-FDG-PET/CT showed a sensitivity, specificity, accuracy, PPV, and NPV of 91%, 75%, 89%, 97%, 50%. On a per-site analysis the performance for local relapse was 96%, 100%, 97%, 100%, 93%, while for lung relapse detection was 80%, 100%, 92%, 100%, 88%. The mean follow-up after 18F-FDG-PET/CT was 21.5 months. At the last follow-up, 19% (7/37) of patients were death with disease, 38% (14/37) were alive with disease, and 43% (16/37) had no evidence of disease. Overall survival was 90% and 75% at 24 and 60 months, respectively.

Conclusion

18F-FDG-PET/CT showed valuable results for detecting recurrence(s) in osteosarcoma patients with suspicious of relapse after treatment, particularly in the detection of local relapse and lung metastasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. ESMO/European Sarcoma Network Working Group. Bone sarcomas. ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25(Suppl 3):iii113–23.

    Article  Google Scholar 

  2. Mirabello L, Troisi RJ, Savage SA. Osteosarcoma incidence and survival rates from 1973 to 2004: data from the Surveillance, Epidemiology, and End Results Program. Cancer. 2009;115:1531–43.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ritter J, Bielack SS. Osteosarcoma. Ann Oncol. 2010;21:320–5.

    Article  Google Scholar 

  4. Bielack SS, Kempf-Bielack B, Delling G, Exner GU, Flege S, Helmke K, et al. Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol. 2002;20:776–90.

    Article  PubMed  Google Scholar 

  5. Bielack SS, Jürgens H, Jundt G, Kevric M, Kühne T, Reichardt P, et al. Osteosarcoma: the COSS experience. Cancer Treat Res. 2009;152:289–308.

    Article  PubMed  Google Scholar 

  6. Arndt CA, Crist WM. Common musculoskeletal tumors of childhood and adolescence. N Engl J Med. 1999;341:342–52.

    Article  CAS  PubMed  Google Scholar 

  7. Bacci G, Rocca M, Salone M, Balladelli A, Ferrari S, Palmerini E, et al. High grade osteosarcoma of the extremities with lung metastases at presentation: treatment with neoadjuvant chemotherapy and simultaneous resection of primary and metastatic lesions. J Surg Oncol. 2008;98:415–20.

    Article  PubMed  Google Scholar 

  8. Bielack SS, Carrle D, Hardes J, Schuck A, Paulussen M. Bone tumors in adolescents and young adults. Curr Treat Options Oncol. 2008;9:67–80.

    Article  PubMed  Google Scholar 

  9. Kager L, Zoubek A, Pötschger U, Kastner U, Flege S, Kempf-Bielack B, et al. Cooperative German-Austrian-Swiss Osteosarcoma Study Group. Primary metastatic osteosarcoma: presentation and outcome of patients treated on neoadjuvant Cooperative Osteosarcoma Study Group protocols. J Clin Oncol. 2003;21:2011–8.

    Article  PubMed  Google Scholar 

  10. Posthuma De Boer J, Witlox MA, Kaspers GJ, van Royen BJ. Molecular alterations as target for therapy in metastatic osteosarcoma: a review of literature. Clin Exp Metastasis. 2011;28:493–503.

    Article  CAS  Google Scholar 

  11. Kim DH, Kim SY, Lee HJ, Song BS, Kim DH, Cho JB, et al. Assessment of Chemotherapy Response Using FDG-PET in Pediatric Bone Tumors: A Single Institution Experience. Cancer Res Treat. 2011;43:170–5.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Wuisman P, Enneking WF. Prognosis for patients who have osteosarcoma with skip metastasis. J Bone Joint Surg Am. 1990;72:60–8.

    Article  CAS  PubMed  Google Scholar 

  13. Messerschmitt PJ, Garcia RM, Abdul-Karim FW, Greenfield EM, Getty PJ. Osteosarcoma. J Am Acad Orthop Surg. 2009;17(8):515–27.

    Article  PubMed  Google Scholar 

  14. Johnson GR, Zhuang H, Khan J, Chiang SB, Alavi A. Roles of positron emission tomography with fluorine-18-deoxyglucose in the detection of local recurrent and distant metastatic sarcoma. Clin Nuclear Med. 2003;28:815–20.

    Article  Google Scholar 

  15. Völker T, Denecke T, Steffen I, Misch D, Schönberger S, Plotkin M, et al. Positron emission tomography for staging of pediatric sarcoma patients: results of a prospective multicenter trial. J Clin Oncol. 2007;25:5435–41.

    Article  PubMed  Google Scholar 

  16. Kempf-Bielack B, Bielack SS, Jürgens H, Branscheid D, Berdel WE, Exner GU, et al. Osteosarcoma relapse after combined modality therapy: an analysis of unselected patients in the Cooperative Osteosarcoma Study Group (COSS). J Clin Oncol. 2005;23:559–68.

    Article  PubMed  Google Scholar 

  17. Bastiaannet E, Groen H, Jager PL, Cobben DC, van der Graaf WT, Vaalburg W, et al. The value of FDG-PET in the detection, grading and response to therapy of soft tissue and bone sarcomas; a systematic review and meta-analysis. Cancer Treat Rev. 2004;30:83–101.

    Article  CAS  PubMed  Google Scholar 

  18. Palmerini E, Colangeli M, Nanni C, Fanti S, Marchesi E, Paioli A, Picci P, Cambioli S, Donati D, Cevolani L, De Paolis M, Gambarotti M, Ferrari S. The role of FDG PET/CT in patients treated with neoadjuvant chemotherapy for localized bone sarcomas. Eur J Nucl Med Mol Imaging. 2016.

  19. Tateishi U, Yamaguchi U, Seki K, Terauchi T, Arai Y, Hasegawa T. Glut-1 expression and enhanced glucose metabolism are associated with tumour grade in bone and soft tissue sarcomas: a prospective evaluation by [18F]fluorodeoxyglucose positron emission tomography. Eur J Nucl Med Mol Imaging. 2006;33:683–91.

    Article  CAS  PubMed  Google Scholar 

  20. Denecke T, Hundsdörfer P, Misch D, Steffen IG, Schönberger S, Furth C, et al. Assessment of histological response of paediatric bone sarcomas using FDG PET in comparison to morphological volume measurement and standardized MRI parameters. Eur J Nucl Med Mol Imaging. 2010;37:1842–53.

    Article  PubMed  Google Scholar 

  21. Franzius C, Daldrup-Link HE, Wagner-Bohn A, Sciuk J, Heindel WL, Jürgens H, et al. FDG-PET for detection of recurrences from malignant primary bone tumors: comparison with conventional imaging. Ann Oncol. 2002;13:157–60.

    Article  CAS  PubMed  Google Scholar 

  22. London K, Stege C, Cross S, Onikul E, Graf N, Kaspers G, et al. 18F-FDG PET/CT compared to conventional imaging modalities in pediatric primary bone tumors. Pediatr Radiol. 2012;42:418–30.

    Article  PubMed  Google Scholar 

  23. Franzius C, Daldrup-Link HE, Sciuk J, Rummeny EJ, Bielack S, Jürgens H, et al. FDG-PET for detection of pulmonary metastases from malignant primary bone tumors: comparison with spiral CT. Ann Oncol. 2001;12:479–86.

    Article  CAS  PubMed  Google Scholar 

  24. McCarville MB, Lederman HM, Santana VM, Daw NC, Shochat SJ, Li CS, et al. Distinguishing benign from malignant pulmonary nodules with helical chest CT in children with malignant solid tumors. Radiology. 2006;239:514–20.

    Article  PubMed  Google Scholar 

  25. Abdoli M, Dierckx RA, Zaidi H. Metal artifact reduction strategies for improved attenuation correction in hybrid PET/CT imaging. Med Phys. 2012;39:3343–60.

    Article  PubMed  Google Scholar 

  26. Blodgett TM, Mehta AS, Mehta AS, Laymon CM, Carney J, Townsend DW. PET/CT artifacts. Clin Imaging. 2011;35:49–63.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Author notes

  1. Andrea Angelini and Francesco Ceci contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy

    Andrea Angelini, Giulia Trovarelli & Pietro Ruggieri

  2. Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy

    Francesco Ceci, Paolo Castellucci, Tiziano Graziani, Giulia Polverari & Stefano Fanti

  3. Department of Chemotherapy, Istituto Ortopedico Rizzoli, Bologna, Italy

    Emanuela Palmerini & Stefano Ferrari

Authors
  1. Andrea Angelini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesco Ceci
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paolo Castellucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tiziano Graziani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giulia Polverari
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giulia Trovarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Emanuela Palmerini
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stefano Ferrari
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Stefano Fanti
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Pietro Ruggieri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesco Ceci.

Ethics declarations

Conflict of interest

Authors declare no conflict of interest

Ethical approval

All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and/or nation research committee and with the principles of the 1064 Declaration of Helsinki and its later amendments or comparable ethical standards.

Considering the retrospective design of the study, formal consent was not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Angelini, A., Ceci, F., Castellucci, P. et al. The role of 18F-FDG PET/CT in the detection of osteosarcoma recurrence. Eur J Nucl Med Mol Imaging 44, 1712–1720 (2017). https://doi.org/10.1007/s00259-017-3698-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-017-3698-0

Keywords

Search

Navigation