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Evaluation of fluorodeoxyglucose positron emission tomography in the management of soft-tissue sarcomas

J. D. Lucas, FRCS, Clinical Lecturer in Orthopaedics1; M. J. O’Doherty, FRCP, Senior Lecturer in Radiological Sciences and Honorary Consultant Physician1; J. C. H. Wong, FRACP, Consultant Physician and Clinical Senior Lecturer2; J. B. Bingham, FRCP, FRCR1; P. H. McKee, FRCPath, Senior Lecturer and Honorary Consultant in Histopathology1; C. D. M. Fletcher, FRCPath, Professor and Director of Surgical Pathology3; and M. A. Smith, FRCS, Consultant Orthopaedic Surgeon1

1 UMDS and Guy’s and St Thomas’ Hospital Trust, St Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH, UK.
2 Royal Brisbane Hospital, Herston, Queensland 4029, Australia.
3 Brigham and Women’s Hospital, Boston, Massachusetts 02115, USA.

Correspondence should be sent to Mr M. A. Smith.

We performed a retrospective analysis to evaluate the ability of whole-body 18F-fluorodeoxyglucose positron emission tomography (FDG PET) to identify local recurrence and pulmonary metastases in patients with soft-tissue tumours after treatment. We compared the results of FDG PET with those of MRI for the detection of local recurrence, and with CT of the chest for pulmonary metastases.

We assessed 62 patients of mean age 51 years, who had 15 types of soft-tissue sarcoma, after a mean follow-up of 3 years 2 months. For the detection of local disease, 71 comparisons showed that the sensitivity and specificity of FDG PET were 73.7% and 94.3%, respectively; there were 14 true-positive and five false-negative results. MRI had a sensitivity and specificity of 88.2% and 96.0% respectively. For the identification of lung metastases, 70 comparisons showed that the sensitivity and specificity of FDG PET were 86.7% and 100%, with 13 true-positive results and two false-negative results. CT of the chest had a sensitivity and specificity of 100% and 96.4%. Thirteen other sites of metastases were identified by FDG PET.

FDG PET can identify both local and distant recurrence of tumour as a one-step procedure and will detect other metastases. It seems that all three methods of imaging are needed to define accurately the extent of disease, both at initial staging and during follow-up.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General