Skip to main content


Log in

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

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



This study was conducted to investigate whether 18F-fluorodeoxyglucose (FDG) uptake, quantified by positron emission tomography (PET), correlates with histological variables including tumour grade, cell proliferation, cell cycle control integrity and glucose metabolism in patients with bone and soft tissue sarcomas.


Eighty-two patients clinically suspected of having a bone or soft tissue sarcoma underwent FDG PET within 1 week prior to operation and 63 patients (mean age 48 years, range 18–74 years) were enrolled in the complete analysis. We excluded 17 patients with pathologically confirmed benign tumours and two patients with uncontrolled diabetes or concomitant malignancy from data analysis. Maximum and average standardised uptake values (SUVs) of the primary lesion were compared with histological variables including tumour differentiation, the presence of necrosis, MIB-1 score, mitotic score, p53 overexpression, MIB-1 grade, mitotic grade and GLUT-1 expression.


Significant correlations were found between maximal and mean SUVs and MIB-1 grade, mitotic grade, MIB-1 score, tumour differentiation and mitotic score. The mean and maximal SUVs were significantly higher in tumours with p53 overexpression than in those without p53 overexpression (p<0.0001). GLUT-1-positive tumours had significantly higher mean (6.5±4.2 vs 1.1±0.2, p=0.006) and maximal SUVs (8.8±5.4 vs 1.7±0.5, p=0.005) than the GLUT-1-negative tumours. GLUT-1 intensity correlated positively with both mean (r=0.500, p<0.0001) and maximal SUVs (r=0.509, p<0.0001). Mu ltiple linear regression analysis showed a significant correlation between maximal SUV and MIB-1 grade (p<0.0001).


The enhanced glucose metabolism, as determined by SUV, is a strong index of tumour grade in bone and soft tissue sarcomas.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others


  1. Weiss SW, Goldblum JR Enzinger and Weiss’s soft tissue tumors. 4th edn. St. Louis: Mosby, 2001

    Google Scholar 

  2. Costa J, Wesley RA, Glastein E, Rosenberg SA The grading of soft tissue sarcomas. Results of a clinicopathologic correlation in a series of 163 cases. Cancer 1984;53:530–541

    Article  PubMed  CAS  Google Scholar 

  3. Hasegawa T, Yamamoto S, Yokoyama R, Umeda T, Matsuno Y, Hirohashi S Prognostic significance of grading and staging systems using MIB-1 score in adult patients with soft tissue sarcoma of the extremities and trunk. Cancer 2002;95:843–851

    Article  PubMed  Google Scholar 

  4. Hasegawa T, Yamamoto S, Nojima T, Hirose T, Nikaido T, Yamashiro K, et al. Validity and reproducibility of histologic diagnosis and grading for adult soft-tissue sarcomas. Hum Pathol 2002;33:111–115

    Article  PubMed  Google Scholar 

  5. Bredella MA, Caputo GR, Steinbach LS Value of FDG positron emission tomography in conjunction with MR imaging for evaluating therapy response in patients with musculoskeletal sarcomas. AJR Am J Roentogenol 2002;179:1145–1150

    Google Scholar 

  6. Nieweg OE, Pruim J, van Ginkel RJ, Hoekstra HJ, Paans AM, Molenaar WM, et al. Fluorine-18-fluorodeoxyglucose PET imaging of soft-tissue sarcoma. J Nucl Med 1996;37:257–261

    PubMed  CAS  Google Scholar 

  7. Eary JF, Conrad EU, Bruckner JD, Folpe A, Hunt KJ, Mankoff DA, et al. Quantitative [F-18]fluorodeoxyglucose positron emission tomography in pretreatment and grading of sarcoma. Clin Cancer Res 1998;4:1215–1220

    PubMed  CAS  Google Scholar 

  8. Folpe AL, Lyles RH, Sprouse JT, Conrad EU 3rd, Eary JF (F-18) fluorodeoxyglucose positron emission tomography as a predictor of pathologic grade and other prognostic variables in bone and soft tissue sarcoma. Clin Cancer Res 2000;6:1279–1287

    PubMed  CAS  Google Scholar 

  9. Ioannidis JP, Lau J 18F-FDG PET for the diagnosis of soft-tissue sarcoma: a meta-analysis. J Nucl Med 2003;44:717–724

    PubMed  Google Scholar 

  10. 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  PubMed  CAS  Google Scholar 

  11. Chung JK, Lee YJ, Kim SK, Jeong JM, Lee DS, Lee MC Comparison of [18F]fluorodeoxyglucose uptake with glucose transporter-1 expression and proliferation rate in human glioma and non-small-cell lung cancer. Nucl Med Commun 2004;25(1):11–17

    Article  PubMed  CAS  Google Scholar 

  12. Mamede M, Higashi T, Kitaichi M, Ishizu K, Ishimori T, Nakamoto Y, Yanagihara K, Li M, Tanaka F, Wada H, Manabe T, Saga T [18F]FDG uptake and PCNA, Glut-1, and hexokinase-II expressions in cancers and inflammatory lesions of the lung. Neoplasia 2005;7:369–379

    Article  PubMed  CAS  Google Scholar 

  13. Brown RS, Leung JY, Fisher SJ, Frey KA, Ethier SP, Wahl RL Intratumoral distribution of tritiated-FDG in breast carcinoma: correlation between Glut-1 expression and FDG uptake. J Nucl Med 1996;37(6):1042–1047

    PubMed  CAS  Google Scholar 

  14. Reske SN, Grillenberger KG, Glatting G, Port M, Hildebrandt M, Gansauge F, et al. Overexpression of glucose transporter 1 and increased FDG uptake in pancreatic carcinoma. J Nucl Med 1997;38:1344–1348

    PubMed  CAS  Google Scholar 

  15. Higashi T, Tamaki N, Honda T, Torizuka T, Kimura T, Inokuma T, et al. Expression of glucose transporters in human pancreatic tumors compared with increased FDG accumulation in PET study. J Nucl Med 1997;38:1337–1344

    PubMed  CAS  Google Scholar 

  16. Higashi T, Saga T, Nakamoto Y, Ishimori T, Mamede MH, Wada M, et al. Relationship between retention index in dual-phase 18F-FDG PET, and hexokinase-II and glucose transporter-1 expression in pancreatic cancer. J Nucl Med 2002;43:173–180

    PubMed  CAS  Google Scholar 

  17. Kunkel M, Reichert TE, Benz P, Lehr HA, Jeong JH, Wieand S, et al. Overexpression of Glut-1 and increased glucose metabolism in tumors are associated with a poor prognosis in patients with oral squamous cell carcinoma. Cancer 2003;97:1015–1024

    Article  PubMed  CAS  Google Scholar 

  18. Kato H, Takita J, Miyazaki T, Nakajima M, Fukai Y, Masuda N, et al. Correlation of 18-F-fluorodeoxyglucose (FDG) accumulation with glucose transporter (Glut-1) expression in esophageal squamous cell carcinoma. Anticancer Res 2003;23:3263–3272

    PubMed  CAS  Google Scholar 

  19. Yen TC, See LC, Lai CH, Yah-Huei CW, Ng KK, Ma SY, et al. 18F-FDG uptake in squamous cell carcinoma of the cervix is correlated with glucose transporter 1 expression. J Nucl Med 2004;45:22–29

    PubMed  CAS  Google Scholar 

  20. Kurokawa T, Yoshida Y, Kawahara K, Tsuchida T, Okazawa H, Fujibayashi Y, et al. Expression of GLUT-1 glucose transfer, cellular proliferation activity and grade of tumor correlate with [F-18]-fluorodeoxyglucose uptake by positron emission tomography in epithelial tumors of the ovary. Int J Cancer 2004;109:926–932

    Article  PubMed  CAS  Google Scholar 

  21. Ito S, Nemoto T, Satoh S, Sekihara H, Seyama Y, Kubota S Human rhabdomyosarcoma cells retain insulin-regulated glucose transport activity through glucose transporter 1. Arch Biochem Biophys 2000;373:72–82

    Article  PubMed  CAS  Google Scholar 

  22. Guillou L, Coindre JM, Bonichon F, Nguyen BB, Terrier P, Collin F, et al. Comparative study of the National Cancer Institute and French Federation of Cancer Centers Sarcoma Group grading systems in a population of 410 adult patients with soft tissue sarcoma. J Clin Oncol 1997;15:350–362

    PubMed  CAS  Google Scholar 

  23. Kawai A, Noguchi M, Beppu Y, Yokoyama R, Mukai K, Hirohashi S, et al. Nuclear immunoreaction of p53 protein in soft tissue sarcomas. A possible prognostic factor. Cancer 1994;73:2499–2505

    Article  PubMed  CAS  Google Scholar 

  24. Latres E, Drobnjak M, Pollack D, Oliva MR, Ramos M, Karpeh M, et al. Chromosome 17 abnormalities and TP53 mutations in adult soft tissue sarcomas. Am J Pathol 1994;145:345–355

    PubMed  CAS  Google Scholar 

  25. Toffoli G, Doglioni C, Cernigoi C, Frustaci S, Perin T, Canal B, Boiocchi M p53 overexpression in human soft tissue sarcomas: relation to biological aggressiveness. Ann Oncol 1994;5:167–172

    PubMed  CAS  Google Scholar 

  26. Medina RA, Owen GI Glucose transporters: expression, regulation and cancer. Biol Res 2002;35:9–26

    Article  PubMed  CAS  Google Scholar 

  27. Strauss LG, Dimitrakopoulou-Strauss A, Koczan D, Bernd L, Haberkorm U, Ewerbeck V, et al. 18F-FDG kinetics and gene expression in giant cell tumors. J Nucl Med 2004;45:1528–1535

    PubMed  CAS  Google Scholar 

  28. Borbely K, Fulham MJ, Brooks RA, DiChiro G PET-fluorodeoxyglucose of cranial and spinal neuromas. J Nucl Med 1992;33:1931–1934

    PubMed  CAS  Google Scholar 

  29. Beaulieu S, Rubin B, Djang D, Conrad E, Turcotte E, Eary JF Positron emission tomography of schwannomas: emphasizing its potential in preoperative planning. AJR Am J Roentogenol 2004;182:971–974

    Google Scholar 

Download references


We thank Hiromitsu Daisaki, Takeshi Murano, and Masashi Suzuki for helping to develop the criteria for the technical quality of the FDG PET/CT imaging; Tetsuo Maeda and Mototaka Miyake for assisting with the literature search; and Yasuo Beppu, Hirokazu Chuman, Akira Kawai and Fumihiko Nakatani for assisting with clinical information. This work was supported in part by grants from Scientific Research Expenses for Health and Welfare Programs, No. 17-12, the promotion and standardization of diagnostic accuracy in PET/CT imaging and BMS Freedom to Discovery Grant. This work was also supported by Travel Grant of the Princess Takamatsu Cancer Research Fund.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ukihide Tateishi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tateishi, U., Yamaguchi, U., Seki, K. et al. 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 33, 683–691 (2006).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: