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Sarcoma
Volume 2012 (2012), Article ID 960194, 7 pages
http://dx.doi.org/10.1155/2012/960194
Clinical Study

FDG PET/CT in Initial Staging of Adult Soft-Tissue Sarcoma

1Department of Radiation Oncology, McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, Canada H3G 1A4
2Department of Radiation Oncology, Notre-Dame Hospital, CHUM, 1560 Sherbrooke Street East, Montreal, QC, Canada H2L 4M1
3Department of Nuclear Medicine, McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, Canada H3G 1A4
4Department of Orthopaedic Surgery, McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, Canada H3G 1A4

Received 9 September 2012; Accepted 8 November 2012

Academic Editor: Alberto Pappo

Copyright © 2012 David Roberge et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Soft-tissue sarcomas spread predominantly to the lung and it is unclear how often FDG-PET scans will detect metastases not already obvious by chest CT scan or clinical examination. Adult limb and body wall soft-tissue sarcoma cases were identified retrospectively. Ewing’s sarcoma, rhabdomyosarcoma, GIST, desmoid tumors, visceral tumors, bone tumors, and retroperitoneal sarcomas were excluded as were patients imaged for followup, response assessment, or recurrence. All patients had a diagnostic chest CT scan. 109 patients met these criteria, 87% of which had intermediate or high-grade tumors. The most common pathological diagnoses were leiomyosarcoma (17%), liposarcoma (17%), and undifferentiated or pleomorphic sarcoma (16%). 98% of previously unresected primary tumors were FDG avid. PET scans were negative for distant disease in 91/109 cases. The negative predictive value was 89%. Fourteen PET scans were positive. Of these, 6 patients were already known to have metastases, 3 were false positives, and 5 represented new findings of metastasis (positive predictive value 79%). In total, 5 patients were upstaged by FDG-PET (4.5%). Although PET scans may be of use in specific circumstances, routine use of FDG PET imaging as part of the initial staging of soft-tissue sarcomas was unlikely to alter management in our series.