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Diagnostic Applications of Nuclear Medicine: Sarcomas

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  • First Online:
Book cover Nuclear Oncology

  • 2005 Accesses

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 are 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 with99mTc-MDP is still routinely used because of its sensitivity in detection of bone metastases and to occasionally identify metastatic lesions in soft tissues.18F-Fluoride is increasingly being used as a sensitive bone scanning agent for metastatic surveys.

[18F]FDG PET/CT can reliably distinguish low-grade from high-grade soft tissue sarcoma based on the SUV. Special features and [18F]FDG uptake are related to specific histologic types. Moreover, by identifying areas of increased 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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Abbreviations

[18F]FDG:

2-Deoxy-2-[18F]fluoro-d-glucose

99mTc-HDP:

99mTc-hydroxyethylenediphosphonate

99mTc-MDP:

99mTc-methylenediphosphonate

AJCC:

American Joint Committee on Cancer

CT:

X-ray computed tomography

EWS-FL1:

Ewing’s sarcoma fusion gene encoding for a transcriptional activator

FNCLCC:

Fédération Nationale des Centres de Lutte Contre le Cancer

G:

Histologic tumor grade

GIST:

Gastrointestinal stromal tumor

M:

Metastasis status according to the AJCC TNM staging system

MFH:

Malignant fibrous histiocytoma

MRI:

Magnetic resonance imaging

N:

Lymph node status according to the AJCC TNM staging system

NF:

Neurofibromatosis

PET:

Positron emission tomography

PET/CT:

Positron emission tomography/computed tomography

PET/MR:

Positron emission tomography/magnetic resonance

PNET:

Primitive neuroectodermal tumor/peripheral neuroepithelioma

RECIST:

Response evaluation criteria in solid tumors

SUV:

Standardized uptake value

SUVmax :

Standardized uptake value at point of maximum

T:

Tumor status according to the AJCC TNM staging system

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Suggested Reading

  • Helman U, Meltzer P. Mechanisms of sarcoma development. Nat Rev Cancer. 2003;3:685–94.

    Article  CAS  PubMed  Google Scholar 

  • Kelloff GJ, Hoffman JM, Johnson B, et al. Progress and promise of FDG-PET imaging for cancer patient management and oncologic drug development. Clin Cancer Res. 2005a;11:2785–808.

    Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Schuetze SM, Baker LH, Benjamin RS, Canetta R. Selection of response criteria for clinical trials of sarcoma treatment. Oncologist. 2008;13 Suppl 2:32–40.

    Article  PubMed  Google Scholar 

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Author notes

  1. Janet F. Eary

    Present address: Cancer Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

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    1. Janet F. Eary
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    Correspondence to Janet F. Eary .

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    Editors and Affiliations

    1. Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA

      H. William Strauss

    2. University of Pisa, Regional Center of Nuclear Medicine, Pisa, Italy

      Giuliano Mariani

    3. University of Pisa, Regional Center of Nuclear Medicine, Pisa, Italy

      Duccio Volterrani

    4. Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA

      Steven M. Larson

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    Eary, J.F. (2017). Diagnostic Applications of Nuclear Medicine: Sarcomas. In: Strauss, H., Mariani, G., Volterrani, D., Larson, S. (eds) Nuclear Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-26236-9_23

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    • DOI: https://doi.org/10.1007/978-3-319-26236-9_23

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