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Qualitative and Semi-Quantitative 18-F FDG PET/CT for Osteosarcoma: A Review

  • Nuclear Medicine (B Franc, Section Editor)
  • Published:
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Abstract

Purpose of review

This work is focused on (i) reviewing different tools of 18F-FDG PET/CT image analysis considering the most recent literature and our experience and (ii) their correlation with clinical outcome in the setting of osteosarcoma.

Recent findings

Although there is a clear role for PET/CT in the staging of osteosarcoma, considerable debate exists concerning the use of PET/CT for prognostication. The potential to use PET/CT to predict clinical outcomes and treatment responses is an attractive concept, particularly prior to obtaining final surgical pathology at resection. SUV is the mainstay semi-quantitative measurement utilized, and multiple variables have been investigated to try to identify the most reproducible and significant predictor of prognosis, including SUVmax, SUVmean, SUVpeak, and tumor background ratio. More recently, other semi-quantitative methods, such as total lesion glycolysis and metabolic tumor volume, have been studied and demonstrated to be valuable both in identifying malignant tissue and assessing response to therapy. New technologies such as dual-phase PET/CT have also shown promise to be able to differentiate malignant from nonmalignant causes of FDG uptake.

Summary

Although there are limitations to the existing studies including small sample sizes, differing cutoff points and the used variables, PET/CT has a clear role in helping to determine osteosarcoma disease prognosis, in conjunction with clinical data. Additional prospective and larger studies are needed to help assess how to best incorporate PET/CT into treatment optimization for osteosarcoma patients in the future.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. O’Reilly R, Link M, Fletcher B, et al. NCCN pediatric osteosarcoma practice guidelines. The National Comprehensive Cancer Network. Oncology (Williston Park). 1996;10(12):1799–806.

    Google Scholar 

  2. Davis AM, Bell RS, Goodwin PJ. Prognostic factors in osteosarcoma: a critical review. J Clin Oncol. 1994;12(2):423–31.

    Article  CAS  PubMed  Google Scholar 

  3. Whelan JS, Jinks RC, McTiernan A, et al. Survival from high-grade localised extremity osteosarcoma: combined results and prognostic factors from three European Osteosarcoma Intergroup randomised controlled trials. Ann Oncol. 2012;23(6):1607–16.

    Article  CAS  PubMed  Google Scholar 

  4. Biermann JS, Chow W, Reed DR, et al. NCCN guidelines insights: bone cancer, version 2.2017. J Natl Compr Cancer Netw. 2017;15(2):155–67.

    Article  Google Scholar 

  5. Byun BH, Kong CB, Park J, et al. Initial metabolic tumor volume measured by 18F-FDG PET/CT can predict the outcome of osteosarcoma of the extremities. J Nucl Med. 2013;54(10):1725–32.

    Article  CAS  PubMed  Google Scholar 

  6. Huvos AG. Bone tumors, diagnosis, treatment, and prognosis. Philadelphia: Saunders; 1979.

    Google Scholar 

  7. Daw NC, Chou AJ, Jaffe N, et al. Recurrent osteosarcoma with a single pulmonary metastasis: a multi-institutional review. Br J Cancer. 2015;112(2):278–82.

    Article  CAS  PubMed  Google Scholar 

  8. Hawkins DS, Conrad EU 3rd, Butrynski JE, Schuetze SM, Eary JF. [F-18]-fluorodeoxy-d-glucose-positron emission tomography response is associated with outcome for extremity osteosarcoma in children and young adults. Cancer. 2009;115(15):3519–25.

    Article  PubMed  PubMed Central  Google Scholar 

  9. • Costelloe CM, Macapinlac HA, Madewell JE, et al. 18F-FDG PET/CT as an indicator of progression-free and overall survival in osteosarcoma. J Nucl Med. 2009;50(3):340–347. This work demonstrated how (18)F-FDG PET/CT can be used as a prognostic indicator for progression-free survival, overall survival, and tumor necrosis in osteosarcoma.

  10. Benz MR, Czernin J, Tap WD, et al. FDG-PET/CT imaging predicts histopathologic treatment responses after neoadjuvant therapy in adult primary bone Sarcomas. Sarcoma. 2010;2010:143540.

    Article  PubMed  PubMed Central  Google Scholar 

  11. London K, Stege C, Cross S, et al. 18F-FDG PET/CT compared to conventional imaging modalities in pediatric primary bone tumors. Pediatr Radiol. 2012;42(4):418–30.

    Article  PubMed  Google Scholar 

  12. Tateishi U, Kawai A, Chuman H, et al. PET/CT allows stratification of responders to neoadjuvant chemotherapy for high-grade sarcoma: a prospective study. Clin Nucl Med. 2011;36(7):526–32.

    Article  PubMed  Google Scholar 

  13. Costelloe CM, Raymond AK, Fitzgerald NE, et al. Tumor necrosis in osteosarcoma: inclusion of the point of greatest metabolic activity from F-18 FDG PET/CT in the histopathologic analysis. Skeletal Radiol. 2010;39(2):131–40.

    Article  PubMed  Google Scholar 

  14. • Byun BH, Kong CB, Lim I, et al. Combination of 18F-FDG PET/CT and diffusion- weighted MR imaging as a predictor of histologic response to neoadjuvant chemotherapy: preliminary results in osteosarcoma. J Nucl Med. 2013;54(7):1053–1059. PET/CT was shown to be an effective method to predict histologic response to neoadjuvant chemotherapy in a well selected cohort of osteosarcoma.

  15. Im HJ, Kim TS, Park SY, et al. Prediction of tumour necrosis fractions using metabolic and volumetric 18F-FDG PET/CT indices, after one course and at the completion of neoadjuvant chemotherapy, in children and young adults with osteosarcoma. Eur J Nucl Med Mol Imaging. 2012;39(1):39–49.

    Article  CAS  PubMed  Google Scholar 

  16. Huang TL, Liu RS, Chen TH, Chen WY, Hsu HC, Hsu YC. Comparison between F-18-FDG positron emission tomography and histology for the assessment of tumor necrosis rates in primary osteosarcoma. J Chin Med Assoc: JCMA. 2006;69(8):372–6.

    Article  PubMed  Google Scholar 

  17. Havaleshko DM, Smith SC, Cho H, et al. Comparison of global versus epidermal growth factor receptor pathway profiling for prediction of lapatinib sensitivity in bladder cancer. Neoplasia. 2009;11(11):1185–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Denecke T, Hundsdorfer P, Misch D, 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(10):1842–53.

    Article  PubMed  Google Scholar 

  19. Kim DH, Kim SY, Lee HJ, et al. Assessment of chemotherapy response using FDG-PET in pediatric bone tumors: a single institution experience. Cancer Res Treat. 2011;43(3):170–5.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gaston LL, Di Bella C, Slavin J, Hicks RJ, Choong PF. 18F-FDG PET response to neoadjuvant chemotherapy for Ewing sarcoma and osteosarcoma are different. Skeletal Radiol. 2011;40(8):1007–15.

    Article  PubMed  Google Scholar 

  21. Benz MR, Evilevitch V, Allen-Auerbach MS, et al. Treatment monitoring by 18F-FDG PET/CT in patients with sarcomas: interobserver variability of quantitative parameters in treatment-induced changes in histopathologically responding and nonresponding tumors. J Nucl Med. 2008;49(7):1038–46.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Andersen KF, Fuglo HM, Rasmussen SH, Petersen MM, Loft A. Semi-quantitative calculations of primary tumor metabolic activity using F-18 FDG PET/CT as a predictor of survival in 92 patients with high-grade Bone or soft tissue Sarcoma. Medicine (Baltimore). 2015;94(28):e1142.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nakamoto Y, Zasadny KR, Minn H, Wahl RL. Reproducibility of common semi-quantitative parameters for evaluating lung cancer glucose metabolism with positron emission tomography using 2-deoxy-2-[18F]fluoro-D-glucose. Mol Imaging Biol. 2002;4(2):171–8.

    Article  PubMed  Google Scholar 

  24. Nahmias C, Wahl LM. Reproducibility of standardized uptake value measurements determined by 18F-FDG PET in malignant tumors. J Nucl Med. 2008;49(11):1804–8.

    Article  PubMed  Google Scholar 

  25. Vanderhoek M, Perlman SB, Jeraj R. Impact of the definition of peak standardized uptake value on quantification of treatment response. J Nucl Med. 2012;53(1):4–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. He JP, Hao Y, Li M, Wang J, Guo FJ. Tumor-to-background ratio to predict response to chemotherapy of osteosarcoma better than standard uptake values. Orthop Surg. 2014;6(2):145–53.

    Article  PubMed  Google Scholar 

  27. Im H-J, Wu H, Yi Z, Wu J, Shulkin B, Cho S. Baseline metabolic tumor volume measured by FDG PET/CT before neoadjuvant chemotherapy predicts survival in pediatric Osteosarcoma. j nucl Med. 2016;57(supplement 2):429.

    Google Scholar 

  28. Schulte M, Brecht-Krauss D, Werner M, et al. Evaluation of neoadjuvant therapy response of osteogenic sarcoma using FDG PET. J Nucl Med. 1999;40(10):1637–43.

    CAS  PubMed  Google Scholar 

  29. Ye Z, Zhu J, Tian M, et al. Response of osteogenic sarcoma to neoadjuvant therapy: evaluated by 18F-FDG-PET. Ann Nucl Med. 2008;22(6):475–80.

    Article  PubMed  Google Scholar 

  30. Jones DN, McCowage GB, Sostman HD, et al. Monitoring of neoadjuvant therapy response of soft-tissue and musculoskeletal sarcoma using fluorine-18-FDG PET. J Nucl Med. 1996;37(9):1438–44.

    CAS  PubMed  Google Scholar 

  31. Byun BH, Kong CB, Lim I, et al. Early response monitoring to neoadjuvant chemotherapy in osteosarcoma using sequential (1)(8)F-FDG PET/CT and MRI. Eur J Nucl Med Mol Imaging. 2014;41(8):1553–62.

    Article  CAS  PubMed  Google Scholar 

  32. Bajpai J, Kumar R, Sreenivas V, et al. Prediction of chemotherapy response by PET-CT in osteosarcoma: correlation with histologic necrosis. J Pediatr Hematol Oncol. 2011;33(7):e271–8.

    CAS  PubMed  Google Scholar 

  33. Imbriaco M, Caprio MG, Limite G, et al. Dual-time-point 18F-FDG PET/CT versus dynamic breast MRI of suspicious breast lesions. AJR Am J Roentgenol. 2008;191(5):1323–30.

    Article  PubMed  Google Scholar 

  34. Caprio MG, Cangiano A, Imbriaco M, et al. Dual-time-point [18F]-FDG PET/CT in the diagnostic evaluation of suspicious breast lesions. Radiol Med (Torino). 2010;115(2):215–24.

    Article  CAS  Google Scholar 

  35. Byun BH, Kim SH, Lim SM, et al. Prediction of response to neoadjuvant chemotherapy in osteosarcoma using dual-phase (18)F-FDG PET/CT. Eur Radiol. 2015;25(7):2015–24.

    Article  PubMed  Google Scholar 

  36. Ottaviani G, Jaffe N. The epidemiology of osteosarcoma. Cancer Treat Res. 2009;152:3–13.

    Article  PubMed  Google Scholar 

  37. • Palmerini E, Colangeli M, Nanni C, et al. The role of FDG PET/CT in patients treated with neoadjuvant chemotherapy for localized bone sarcomas. Eur J Nucl Med Mol Imaging. 2017;44(2):215–223. This study showed an association between SUV1 and histological/radiological response in patients with osteosarcoma.

  38. Hamada K, Tomita Y, Inoue A, et al. Evaluation of chemotherapy response in osteosarcoma with FDG-PET. Ann Nucl Med. 2009;23(1):89–95.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA

    Lorenzo Nardo & Michelle Zhang

  2. University of Brescia, Spedali Civili 1, 25123, Brescia, Italy

    Luca Facchetti

  3. University of California, San Francisco, 185 Berry Street, San Francisco, CA, 94107, USA

    Benjamin L. Franc

Authors
  1. Lorenzo Nardo
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  2. Michelle Zhang
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  3. Luca Facchetti
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  4. Benjamin L. Franc
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Correspondence to Benjamin L. Franc.

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Conflict of interest

Lorenzo Nardo, Michelle Zhang, Benjamin Franc, and Luca Facchetti have no potential conflicts of interest to declare.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical collection on Nuclear Medicine.

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Nardo, L., Zhang, M., Facchetti, L. et al. Qualitative and Semi-Quantitative 18-F FDG PET/CT for Osteosarcoma: A Review. Curr Radiol Rep 5, 56 (2017). https://doi.org/10.1007/s40134-017-0253-5

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  • DOI: https://doi.org/10.1007/s40134-017-0253-5

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