Abstract
BackgroundEwing sarcoma (ES) is currently staged using Radiography, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and skeletal scintigraphy (bone scan). 18F- fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET-CT) is increasingly used for staging and follow-up, but its role is still under evaluation.ObjectiveTo evaluate the added information from 18F-FDG PET-CT studies compared to conventional imaging and to estimate radiation doses received from radiological and nuclear medicine imaging during staging of Ewing sarcoma.Material and methodsSixty-one patients under the age of 30 years (mean 16, range 5–26) were diagnosed with Ewing sarcoma in Norway during the period 2005–2012. Nineteen patients met the inclusion criteria for this population-based study: pre therapeutic 18F-FDG PET-CT and a minimum follow-up of 12 months. Imaging reports, medical records and pathology reports were collected and compared for all patients. Biopsy histology, supplementary imaging and long-term follow-up (median 27 months) were taken as composite gold standard.Results18F-FDG PET-CT detected more lesions than conventional imaging in four patients (21%) but this did not change planned treatment as they all had extensive metastatic disease. The 18F-FDG PET-CT study was false negative in one patient and showed false positive lesions in three patients (16%). The estimated mean (range) effective total radiation dose was from CT: 7 mSv (2–16), skeletal scintigraphy: 3 mSv (0–5) and 18F-FDG PET-CT: 5 mSv (4–6).Conclusion18F-FDG PET-CT is useful for staging of Ewing sarcoma and increase detection of metastases. False positive lesions are quite common, emphasizing the need for supplementary imaging or biopsy of suspected FDG positive metastases.
Highlights
Ewing sarcoma is a rare malignant tumour arising from neuroectodermal-derived cells in bone or soft tissue
18F-FDG Positron emission tomography (PET)-computed tomography (CT) is useful for staging of Ewing sarcoma and increase detection of metastases
In this population-based national cohort of children and young adults diagnosed with Ewing sarcoma during the period 2005–2012, we found that 18F-FDG Positron emission tomography –computed tomography (PET-CT) detected
Summary
Ewing sarcoma is a rare malignant tumour arising from neuroectodermal-derived cells in bone or soft tissue. With the presence of pulmonary metastases fiveyear survival is reduced to 30% while patients with both pulmonary and skeletal metastases have a five-year survival rate of less than 10% (Helsedirektoratet Avdeling sykehustjenester Oslo Norway, 2015). The Norwegian National Guidelines (Helsedirektoratet Avdeling sykehustjenester Oslo Norway, 2015) are largely based on protocols from the Italian and Scandinavian Sarcoma Groups (ISG/SSG) (Italian Sarcoma Group (Bologna Italy), Scandinavian Sarcoma Group (Oncologic Center Lund Sweden), 1999a; Italian Sarcoma Group (Bologna Italy), Scandinavian Sarcoma Group (Oncologic Center Lund Sweden), 1999b) and recommend a combination of some, or all, of the following imaging modalities for staging of Ewing Sarcoma: Radiography, ultrasound, CT, MRI, skeletal scintigraphy with 99mTc- labelled bisphosphonates (bone scan) and 18F- FDG PET-CT. Ewing sarcoma (ES) is currently staged using Radiography, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and skeletal scintigraphy (bone scan). Ewing sarcoma (ES) is currently staged using Radiography, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and skeletal scintigraphy (bone scan). 18F- fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET-CT) is increasingly used for staging and follow-up, but its role is still under evaluation
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