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. 2023 Oct 13;13(20):3202.
doi: 10.3390/diagnostics13203202.

Diagnostic Superiority of Dual-Time Point [18F]FDG PET/CT to Differentiate Malignant from Benign Soft Tissue Tumors

Philippe d'Abadie  1 , Olivier Gheysens  1 , Renaud Lhommel  1 , François Jamar  1 , Thomas Kirchgesner  2 , Filomena Mazzeo  3 , Laurent Coubeau  4 , Halil Yildiz  5 , An-Katrien De Roo  6 , Thomas Schubert  7
Affiliations

Diagnostic Superiority of Dual-Time Point [18F]FDG PET/CT to Differentiate Malignant from Benign Soft Tissue Tumors

Philippe d'Abadie et al. Diagnostics (Basel). .

Abstract

[18F]FDG PET/CT is used in the workup of indeterminate soft tissue tumors (STTs) but lacks accuracy in the detection of malignant STTs. The aim of this study is to evaluate whether dual-time point [18F]FDG PET/CT imaging (DTPI) can be useful in this indication. In this prospective study, [18F]FDG PET/CT imaging was performed 1 h (t1) and 3 h (t2) after injection. Tumor uptake (SUVmax) was calculated at each time point to define a retention index (RI) corresponding to the variation between t1 and t2 (%). Sixty-eight patients were included, representing 20 benign and 48 malignant tumors (including 40 sarcomas). The RI was significantly higher in malignant STTs than in benign STTs (median: +21.8% vs. -2%, p < 0.001). An RI of >14.3% predicted STT malignancy with a specificity (Sp) of 90% and a sensitivity (Se) of 69%. An SUVmaxt1 of >4.5 was less accurate with an Sp of 80% and an Se of 60%. In a subgroup of tumors with at least mild [18F]FDG uptake (SUVmax ≥ 3; n = 46), the RI significantly outperformed the diagnostic accuracy of SUVmax (AUC: 0.88 vs. 0.68, p = 0.01). DTPI identifies malignant STT tumors with high specificity and outperforms the diagnostic accuracy of standard PET/CT.

Keywords: FDG PET/CT; dual-time point acquisition; sarcoma; soft tissue tumor.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A,B) Tumor in the soft tissue of the right buttock (arrow) with high [18F]FDG uptake at standard acquisition time (A, SUVmax = 16.9) and with a significant increase of [18F]FDG uptake during delayed acquisition (B, SUVmax = 23.4; RI = +39%). Pathological analysis confirmed a high-grade liposarcoma.
Figure 2
Figure 2
SUVmax in benign and malignant tumors. The groups were significantly different (p: 0.002). Orange and pink shapes show individual results for each tumor.
Figure 3
Figure 3
Retention index (RI) in benign and malignant tumors. The groups were significantly different (p < 0.0001).
Figure 4
Figure 4
Diagnostic performance for tumors with at least mild metabolic activity at t1 (SUVmax ≥ 3). In this tumor population, an RI of >17.9% identified malignant tumors with an Sp of 100% and an Se of 70.3% (AUC = 0.88) and significantly outperformed SUVmax (AUC = 0.68, p: 0.01). The red line indicates the line of identity of the ROC curve.
See this image and copyright information in PMC

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