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Grading of Tumors and Tumorlike Lesions of Bone: Evaluation by FDG PET

Departments of Trauma, Hand and Reconstructive Surgery; Nuclear Medicine; and Pathology, University of Ulm, Ulm, Germany

Clinical diagnosis of skeletal tumors can be difficult, because such lesions compose a large, heterogeneous group of entities with different biologic behaviors. The aim of this prospective study was to assess the value of PET in grading tumors and tumorlike lesions of bone. Methods: Two hundred two patients with suspected primary bone tumors were investigated using FDG PET. Uptake of FDG was evaluated semiquantitatively by determining the tumor-to-background ratio (T/B). All patients underwent biopsy, resulting in the histologic detection of 70 high-grade sarcomas, 21 low-grade sarcomas, 40 benign tumors, 47 tumorlike lesions, 6 osseous lymphomas, 6 plasmacytomas, and 12 metastases of an unknown primary tumor. Results: All lesions, with the exception of 3 benign tumors, were detected by increased FDG uptake. Although sarcomas showed significantly higher T/Bs than did latent or active benign lesions (P < 0.001), aggressive benign lesions could not be distinguished from sarcomas. Using a T/B cutoff level for malignancy of 3.0, the sensitivity of FDG PET was 93.0%, the specificity was 66.7%, and the accuracy was 81.7%. Conclusion: FDG PET provides a promising tool for estimating the biologic activity of skeletal lesions, implicating consequences for the choice of surgical strategy.

Key Words: diagnosis of bone neoplasms • bone neoplasms in infants and children • sarcoma • staging of bone neoplasms • radionuclide imaging in diagnosis of neoplasms

Received May 24, 1999; revision accepted Aug. 31, 1999.

For correspondence or reprints contact: Michael Schulte, MD, Department of Trauma, Hand and Reconstructive Surgery, Steinhövelstr. 9, D 89075 Ulm, Germany.

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