Volume-based parameters on FDG PET may predict the proliferative potential of soft-tissue sarcomas
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Soft-tissue sarcomas (STS) are rare types of tumors that have variable levels of tumor differentiation. F-18 fluorodeoxyglucose positron emission tomography (FDG PET) has been established as an useful tool for STS patients, and the metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are reported to be useful in various cancers. We compared the diagnostic value of four PET parameters (maximum standardized uptake value [SUVmax], SUVmean, MTV, and TLG) from two acquisition timings for predicting the expression of the pathological marker of cell proliferation Ki-67, based on pathological investigation.
Materials and methods
In this retrospective study, we investigated 20 patients (59 ± 19 years old, 18–87 years old) with pathologically confirmed STS who underwent FDG PET before surgical intervention. The patients fasted ≥ 6 h before the intravenous injection of FDG. The whole body was scanned twice; at an early phase (61.5 ± 2.6 min) and at a delayed phase (118.0 ± 2.1 min) post-injection. The SUVmax, SUVmean, MTV, and TLG of the primary lesion were measured with a tumor boundary determined by SUV ≥ 2.0. Ki-67 was measured using MIB-1 immunohistochemistry. We used Pearson’s correlation coefficient to analyze the relationships between the PET parameters and Ki-67 expressions. The Kaplan–Meier analysis with the log-rank test was performed to compare overall survival between high-group and low-group at each of the four PET parameters and Ki-67 expression.
All four PET parameters at each phase showed significant correlations with Ki-67. Among them, the Pearson’s correlation coefficient (r) was largest for TLG (r = 0.76 and 0.77 at the early and delayed phases, respectively), followed by MTV (0.70 and 0.72), SUVmax (r = 0.65 and 0.66), and SUVmean (r = 0.62 and r = 0.64). From early to delayed phases, the SUVmax and SUVmean both increased in all 20 patients, whereas the MTV and TLG increased in 13/20 (65%) and 16/20 (80%) patients, respectively. None of the %increases of the PET parameters were significantly correlated with Ki-67. The overall survival was shorter for high-SUVmax, high-SUVmean, high-TLG, and high-Ki-67 groups than the other groups, although the difference did not reach statistical significance.
The SUVmax, SUVmean, MTV, and TLG acquired at both 1 and 2 h after injection showed significant correlations with Ki-67. Among them, correlation coefficient with Ki-67 expression was highest for TLG, although the best parameter should be determined in a larger population. The delayed-phase FDG PET was equally useful as that of early-phase to predict tumor aggressiveness in STS.
KeywordsSoft tissue sarcoma MTV TLG FDG Ki-67 PET
Dynamic row-action maximum likelihood algorithm
Federation National des Centres de Lutte Contre le Cancer
Field of view
Hematoxylin and eosin
Metabolic tumor volume
Positron emission tomography
Row-action maximum likelihood algorithm
Standardized uptake value
Maximum of SUV
Mean of SUV
Total lesion glycolysis
We would like to thank Eriko Suzuki for her great support in the preparation of this manuscript. We would also like to thank the members of the department of Nuclear Medicine, Hokkaido University for their hospitality during the research.
Design of the study: TK, KH. Investigation: TK, TS, KH, NT. Formal analysis: TK, KY. Software: KH. Supervision: TS, MS, TT, KY, NT. Writing—original draft: TK, KH. Writing—review & editing: TK, TS, KH, MS, TT, KY, NT.
Funding information is not applicable.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interests.
Ethics approval and informed consent
This retrospective study was approved by the institutional ethics committee of Hokkaido Cancer Center. The informed consent was waived from individual participants in the retrospective study according to the institutional ethics committee of Hokkaido Cancer Center (#27-43). Patient records/information was anonymized and de-identified prior to analysis.
Research involving human participants
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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