J Cancer 2014; 5(5):328-335. doi:10.7150/jca.8310 This issue

Research Paper

Differentiation of Benign Fluid Collections from Soft-Tissue Sarcomas on FDG-PET/CT

Behrang Amini1✉, John E. Madewell1, Hubert H. Chuang2, Tamara Miner Haygood1, Brian P. Hobbs3, Patricia S. Fox3, Roland L. Bassett3, Colleen M. Costelloe1

1. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center;
2. Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center;
3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.

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Amini B, Madewell JE, Chuang HH, Haygood TM, Hobbs BP, Fox PS, Bassett RL, Costelloe CM. Differentiation of Benign Fluid Collections from Soft-Tissue Sarcomas on FDG-PET/CT. J Cancer 2014; 5(5):328-335. doi:10.7150/jca.8310. Available from https://www.jcancer.org/v05p0328.htm

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Objective: To assess the diagnostic performance of 18F-FDG PET-CT in differentiating soft tissue sarcomas (STSs) from benign fluid collections (BFs).

Materials and methods: Four readers independently reviewed 100 lesions on 18F-FDG PET-CT and subjectively classified each lesion as an STS or BF and scored the spatial pattern of 18F-FDG avidity (SP) of each on a 4-point ordered scale (thin, moderate, thick, solid).

Results: Subjective assessment by readers allowed sensitive (91%-98%) differentiation of STSs from BFs, with lower specificity (59%-91%). The STSs had significantly higher SUVmax (median 10.7, range: 2.0-33.7) than BFs (median 2.8, range: 1.1-12.3). Reader agreement in assessment of SP had average κ = 0.61 (range 0.46-0.70). Classification of thick or solid SP as STS yielded an inter-reader averaged sensitivity and specificity of 69% and 98%, respectively. The presence of thick or solid SP resulted in 14.1-fold increase in partial odds of STS. Each unit increase in SUVmax resulted in 1.35-fold increase in partial odds of STS. The receiver operating characteristic (ROC) curves and 95% intervals for SUVmax alone and SUVmax + SP overlapped. The average subjective assessments for the four readers and estimated performance of using SP alone were both contained within the 95% intervals of the two ROC curves.

Conclusions: 18F-FDG PET-CT is a sensitive modality for differentiating STSs from BFs. SUVmax and SP are significantly associated with STS. Classification schemes based upon SUVmax alone or augmented with SP can be useful for distinguishing STS from BF.

Keywords: FDG PET-CT, Sarcoma, Benign Fluid Collections, Hematoma, Seroma, Abscess.