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European Radiology
Published in: European Radiology 8/2015

01-08-2015 | Nuclear Medicine

Evaluation of several FDG PET parameters for prediction of soft tissue tumour grade at primary diagnosis and recurrence

Authors: Wolfgang P. Fendler, Rebecca P. Chalkidis, Harun Ilhan, Thomas Knösel, Ken Herrmann, Rolf D. Issels, Peter Bartenstein, Clemens C. Cyran, Lars H. Lindner, Marcus Hacker

Published in: European Radiology | Issue 8/2015

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ABSTRACT

Objectives

This study evaluates the diagnostic accuracy of SUV-based parameters derived from [18 F]-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in order to optimize non-invasive prediction of soft tissue tumour (STT) grade.

Methods

One hundred and twenty-nine lesions from 123 patients who underwent FDG-PET for primary staging (n = 79) or assessment of recurrence (n = 44) of STT were analyzed retrospectively. Histopathology was the reference standard for tumour grading. Absolute values and tumour-to-liver ratios of several standardized uptake value (SUV) parameters were correlated with tumour grading.

Results

At primary diagnosis SUVmax, SUVpeak, SUVmax/SUVliver and SUVpeak/SUVliver showed good correlation with tumour grade. SUVpeak (area under the receiver-operating-characteristic, AUC-ROC: 0.82) and SUVpeak/SUVliver (AUC-ROC: 0.82) separated best between low grade (WHO intermediate, grade 1 sarcoma, and low risk gastrointestinal stromal tumours, GISTs) and high grade (grade 2/3 sarcoma and intermediate/high risk GISTs) lesions: optimal threshold for SUVpeak/SUVliver was 2.4, which resulted in a sensitivity of 79 % and a specificity of 81 %. At disease recurrence, the AUC-ROC was <0.75 for each parameter.

Conclusions

A tumour SUVpeak of at least 2.4 fold mean liver uptake predicts high grade histopathology with good diagnostic accuracy at primary staging. At disease recurrence, FDG-PET does not reliably separate high and low grade lesions.

Key Points

• Several SUV parameters accurately predict soft tissue sarcoma grade at primary diagnosis.
• Tumour-to-liver ratios are of comparable value to absolute SUV parameters.
• SUV peak /SUV liver >2.4 had 79 % sensitivity and 81 % specificity for high grade lesions.
• At recurrence, FDG PET does not reliably indicate high grade sarcomas.
Appendix
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Metadata
Title
Evaluation of several FDG PET parameters for prediction of soft tissue tumour grade at primary diagnosis and recurrence
Authors
Wolfgang P. Fendler
Rebecca P. Chalkidis
Harun Ilhan
Thomas Knösel
Ken Herrmann
Rolf D. Issels
Peter Bartenstein
Clemens C. Cyran
Lars H. Lindner
Marcus Hacker
Publication date
01-08-2015
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 8/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-3654-y

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