Nucl Med Mol Imaging.  2007 Dec;41(6):553-560.

The Differentiation of Malignant and Benign Musculoskeletal Tumors by F-18 FDG PET/CT Studies: Determination of maxSUV by Analysis of ROC Curve

• Kong EJ
• Cho IH
• Chun KA
• Won KC
• Lee HW
• Choi JH
• Shin DS

Abstract

PURPOSE: We evaluated the standard uptake value (SUV) of F-18 FDG at PET/CT for differentiation of benign from malignant tumor in primary musculoskeletal tumors.
MATERIALS AND METHODS
Forty-six tumors (11 benign and 12 malignant soft tissue tumors, 9 benign and 14 malignant bone tumors) were examined with F-18 FDG PET/CT (Discovery ST, GE) prior to tissue diagnosis. The maxSUV(maximum value of SUV) were calculated and compared between benign and malignant lesions. The lesion analysis was based on the transverse whole body image. The maxSUV with cutoff of 4.1 was used in distinguishing benign from malignant soft tissue tumor and 3.05 was used in bone tumor by ROC curve.
RESULTS
There was a statistically significant difference in maxSUV between benign (n=11; maxSUV 3.4+/-3.2) and malignant (n=12; maxSUV 14.8+/-12.2) lesions in soft tissue tumor (p=0.001). Between benign bone tumor (n=9; maxSUV 5.4+/-4.0) and malignant bone tumor (n=14; maxSUV 7.3+/-3.2), there was not a significant difference in maxSUV. The sensitivity and specificity for differentiating malignant from benign soft tissue tumor was 83% and 91%, respectively. There were four false positive malignant bone tumor cases to include fibrous dysplasia, Langerhans-cell histiocytosis (n=2) and osteoid osteoma. Also, one false positive case of malignant soft tissue tumor was nodular fasciitis.
CONCLUSION
The maxSUV was useful for differentiation of benign from malignant lesion in primary soft tissue tumors. In bone tumor, the low maxSUV correlated well with benign lesions but high maxSUV did not always mean malignancy.

Keyword

F-18 FDG; PET/CT; bone neoplasm; soft tissue neoplasm; sarcoma

MeSH Terms

Body Image
Bone Neoplasms
Diagnosis
Fasciitis
Histiocytosis, Langerhans-Cell
Osteoma, Osteoid
Positron-Emission Tomography and Computed Tomography*
ROC Curve*
Sarcoma
Sensitivity and Specificity
Soft Tissue Neoplasms