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Sarcoma

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Nuclear Oncology

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Abstract

Sarcomas most commonly occur in the muscles, bones, fat, and connective tissues. These tumors constitute approximately 1% of cancers in adults and about 20% of pediatric cancer. The American Joint Committee on Cancer (AJCC) criteria is often used clinically for staging soft tissue sarcoma patients. Bone tumor staging follows the schemes utilized for other tumors. Adverse prognostic factors include deep tumor location, largest dimension >5 cm, locally recurrent disease, proximal lower extremity site, and presence of metastasis.

Imaging studies—including plain films, chest x-ray, CT with and without contrast, MRI, and [18F]FDG PET—are used in combination to stage and restage sarcoma patients. Serial imaging studies, especially [18F]FDG PET scans, can identify treatment response to neoadjuvant chemo- and radiation therapy. The bone scan with 99mTc-MDP is still routinely used because of its sensitivity in detection of bone metastases and occasionally identify metastatic lesions in soft tissues. 18F-Fluoride is increasingly being used as a sensitive bone scanning agent for metastatic surveys for sarcomas.

[18F]FDG PET/CT can reliably distinguish low-grade from high-grade soft tissue sarcoma. Additionally, special features and [18F]FDG uptake are related to specific histologic types. Moreover, by identifying areas of increased [18F]FDG uptake within a lesion, [18F]FDG PET can be helpful to localize a site for diagnostic biopsy. [18F]FDG PET has been used for tumor staging identifying bone and soft tissue metastases and nodal metastases. A high-resolution contrast chest CT is preferred to visualize small lung metastases.

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Suggested Reading

  • Pisters PW, Leung DH, Woodruff J, Shi W, Brennan MF. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol. 1996;14:1679–89.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology/Nuclear Medicine, University of Washington Medical Center, 356113, Seattle, WA, 98195, USA

    Janet F. Eary MD

  2. Department of Orthopedics, University of Washington, 356500, Seattle, WA, 98195, USA

    Ernest U. Conrad MD

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  1. Janet F. Eary MD
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  2. Ernest U. Conrad MD
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Correspondence to Janet F. Eary MD .

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Editors and Affiliations

  1. Dept. Radiology, Div. Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, York Ave. 1275, New York, 10021, New York, USA

    H. William Strauss

  2. Centro Regionale di Medicina Nucleare, Universita di Pisa, Via Roma 67, Pisa, 56100, Italy

    Giuliano Mariani

  3. Centro Regionale di Medicina Nucleare, Universita di Pisa, Via Roma 67, Pisa, 56100, Italy

    Duccio Volterrani

  4. Cancer Center, Department of Radiology, Memorial Sloan-Kettering, York Ave. 1275, New York, 10021, New York, USA

    Steven M. Larson

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Eary, J.F., Conrad, E.U. (2013). Sarcoma. In: Strauss, H., Mariani, G., Volterrani, D., Larson, S. (eds) Nuclear Oncology. Springer, New York, NY. https://doi.org/10.1007/978-0-387-48894-3_23

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  • DOI: https://doi.org/10.1007/978-0-387-48894-3_23

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