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18F-FDG PET SUVmax as an indicator of histopathologic response after neoadjuvant chemotherapy in extremity osteosarcoma

  • Chang-Bae Kong
  • Byung Hyun Byun
  • Ilhan Lim
  • Chang Woon Choi
  • Sang Moo LimEmail author
  • Won Seok Song
  • Wan Hyeong Cho
  • Dae-Geun Jeon
  • Jae-Soo Koh
  • Ji Young Yoo
  • Soo-Yong Lee
Original Article

Abstract

Purpose

This study evaluated the usefulness of the maximum standardized uptake value (SUVmax) as a measure of histologic response to neoadjuvant chemotherapy in patients with extremity osteosarcoma. The correlation between [18 F]FDG PET SUVmax values and histologic response to preoperative chemotherapy was also assessed prospectively using PET/MRI.

Methods

A total of 26 consecutive patients with high-grade osteosarcoma were prospectively enrolled. All patients underwent parallel PET and MRI scans before and after neoadjuvant chemotherapy. Using the PET and MRI images and pathologic mapping, we assessed the percentage necrosis by histology at the highest metabolic activity point in the tumors. This was defined as the minimum histologic response. The predictive values of SUVmax before (SUV1) and after (SUV2) chemotherapy and the SUV change ratio were determined. Correlations were also investigated among SUV2, minimum histologic response and histologic response.

Results

Histologically, 13 patients were classified as good responders and 13 as poor responders. Patients with an SUV2 of >5 showed a poor histologic response. A significant correlation was found between SUV2 and histologic response (Spearman’s rho −0.642; P < 0.001), and SUV2 and histologic response were both found to be significantly correlated with minimum histologic response (Spearman’s rho −0.515 and 0.911; P = 0.007 and P < 0.001, respectively).

Conclusion

A SUVmax of more than 5 after neoadjuvant chemotherapy identified the majority of histologic nonresponders (sensitivity 61.3 %, PPV 88.9 %). Tumor necrosis at the point of maximum metabolic activity was found to be significantly correlated with the histologic response of entire resected specimen.

Keywords

Osteosarcoma FDG PET SUVmax Histologic response 

Notes

Acknowledgment

This study was supported by a grant of the RTR (Radiological Translational Research program), Korea Institute of Radiological & Medical Sciences (50453–2011).

Conflicts of interest

None.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Chang-Bae Kong
    • 1
  • Byung Hyun Byun
    • 2
  • Ilhan Lim
    • 2
  • Chang Woon Choi
    • 2
  • Sang Moo Lim
    • 2
    Email author
  • Won Seok Song
    • 1
  • Wan Hyeong Cho
    • 1
  • Dae-Geun Jeon
    • 1
  • Jae-Soo Koh
    • 3
  • Ji Young Yoo
    • 4
  • Soo-Yong Lee
    • 1
  1. 1.Department of Orthopedic SurgeryKorea Cancer Center HospitalSeoulSouth Korea
  2. 2.Department of Nuclear MedicineKorea Cancer Center HospitalSeoulSouth Korea
  3. 3.Department of PathologyKorea Cancer Center HospitalSeoulSouth Korea
  4. 4.Department of RadiologyKorea Cancer Center HospitalSeoulSouth Korea

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