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Volume-based parameters on FDG PET may predict the proliferative potential of soft-tissue sarcomas

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Abstract

Introduction

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.

Results

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.

Conclusion

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.

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Abbreviations

CT:

Computed tomography

DRAMA:

Dynamic row-action maximum likelihood algorithm

FDG:

Fluorodeoxyglucose

FLT:

Fluorothymidine

FNCLCC:

Federation National des Centres de Lutte Contre le Cancer

FOV:

Field of view

H&E:

Hematoxylin and eosin

MET:

Methionine

MTV:

Metabolic tumor volume

OS:

Overall survival

PET:

Positron emission tomography

RAMLA:

Row-action maximum likelihood algorithm

STS:

Soft-tissue sarcomas

SUV:

Standardized uptake value

SUVmax:

Maximum of SUV

SUVmean:

Mean of SUV

TLG:

Total lesion glycolysis

US:

Ultrasound

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Acknowledgements

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.

Funding

Funding information is not applicable.

Author information

Authors and Affiliations

  1. Radiology Department, National Hospital Organization Hokkaido Cancer Center, 2-3-54, Kikusui-4, Shiroishi-Ku, Sapporo, 003-0804, Japan

    Tomoka Kitao & Mitsunori Sekizawa

  2. Department of Nuclear Medicine, Graduate School of Medicine, Hokkaido University, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan

    Tomoka Kitao, Tohru Shiga, Kenji Hirata, Toshiki Takei & Nagara Tamaki

  3. Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan

    Toshiki Takei

  4. Department of Pathology, Hokkaido Cancer Center, Sapporo, Japan

    Katsushige Yamashiro

  5. Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Nagara Tamaki

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  1. Tomoka Kitao
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  2. Tohru Shiga
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  7. Nagara Tamaki
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Contributions

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.

Corresponding author

Correspondence to Kenji Hirata.

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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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Kitao, T., Shiga, T., Hirata, K. et al. Volume-based parameters on FDG PET may predict the proliferative potential of soft-tissue sarcomas. Ann Nucl Med 33, 22–31 (2019). https://doi.org/10.1007/s12149-018-1298-0

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  • DOI: https://doi.org/10.1007/s12149-018-1298-0

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