The utility of 18F-FDG PET and PET/CT in the diagnosis and staging of chondrosarcoma: a meta-analysis

Abstract

Objective: Chondrosarcoma is the second most common primary bone sarcoma; however, unlike other tumors, the biopsy cannot easily make a definite diagnosis or predict the histological grade. This meta-analysis was performed to evaluate the utility of 18 F-FDG PET and PET/CT to differentiate chondrosarcoma from benign cartilaginous lesions and to predict the histopathological grade of chondrosarcoma. Material and methods: A comprehensive search was performed in three electronic databases including Medline/ PubMed, the Cochrane Library and Embase to retrieve diagnostic studies evaluating the role of 18 F-FDG PET or PET/ CT for appraising the status of chondrosarcoma. Reference lists of related articles were also scrutinized manually. Useful data were extracted to calculate the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), the summary receiver operating characteristic curve (sROC), and the area under the curve (AUC) of 18 F-FDG PET or PET/CT in diagnosing chondrosarcoma, and pooled weighted mean differences (WMD) of maximum standardized uptake value (SUVmax) between different entities of cartilaginous neoplasms by using Stata 19.0. Results: A total of twelve studies provided sufficient data for the quantitative analysis. For the diagnosis of chondrosarcoma, the pooled sensitivity, specificity, and DOR of 18 F-FDG PET were 0.84 (95% confidence interval [CI] 0.46 to 0.97), 0.82 (95% CI 0.55 to 0.94), and 24.244 (95% CI 1.985 to 96.148), respectively while those of 18 F-FDG PET/CT were 0.94 (95% CI 0.86 to 0.97), 0.89 (95% CI 0.82 to 0.93), and 112.999 (95% CI 41.341 to 308.866), respectively. The pooled WMD of SUVmax were − 0.89 (95% CI −1.67 to −0.10) between benign cartilaginous lesions and grade 1 (G1) chondrosarcoma, −1.94 (95% CI −2.76 to −1.12) between G1 and grade 2 (G2) chondrosarcoma, and − 2.37 (95% CI −5.79 to 1.05) between G2 and grade 3 (G3) chondrosarcoma. Conclusions: In a word, 18 F-FDG PET/CT revealed excellent accuracy in the diagnosis of chondrosarcoma and might assist in clinical decision-making. Meanwhile, although SUVmax alone showed restricted ability to differentiate benign cartilaginous lesions and G1 chondrosarcoma, as well as between G2 and G3 chondrosarcoma, it can identify intermediate/high-grade chondrosarcoma from low-grade ones.

Chondrosarcoma-from Molecular Pathology to Novel Therapies

“…The maximum standardized uptake value (SUVmax) seems to correlate with the grade of CHS, and the benign tumors would be rather characterized by lower SUVmax values [ 121 ]. Results published in a recent meta-analysis suggest that FDG PET/CT displays a high specificity and sensitivity in the diagnosis of CHS, superior to scintigraphy; it also seems beneficial for grading and monitoring the tumors [ 118 , 122 ]. However, it was also suggested that the value of SUVmax alone might not be sufficient to differentiate low-grade CHS from benign lesions [ 122 ].…”

Atypical Cartilaginous Tumors: Trends in Management

“… 26 Analysis is limited to variables provided by the database and may not include demographic or treatment considerations such as patient employment status, hospital size, types of imaging used for staging purposes, or the reported cause of death. Specific to this study, we were not able to determine whether there was utilization of dynamic gadolinium chelate-enhanced MRI and/or PET-CT 10 11 12 13 to obtain and underlying diagnosis. Ultimately, the NCDB is a database, and although there are highly standardized reporting protocols with a number of integrity checks and quality assurance measures to ensure accuracy of reporting, human error and ambiguous diagnoses must be considered in interpretation of results.…”

“… 30 Advanced imaging studies continue to improve as dynamic gadolinium chelate-enhanced MRI and/or PET-CT to aid differentiating between cartilaginous tumors. 10 11 12 13 However, if ambiguity remains and a cartilaginous tumor cannot reliably differentiated based on radiographic and advanced imaging with collaboration of a multidisciplinary team, a biopsy is still warranted.…”

“…Historically, this conundrum required a tissue biopsy to make a distinction. However, utilization of dynamic gadolinium chelate-enhanced MRI and/or positron emission tomography CT (PET-CT) can aid differentiating between enchondroma and an ACT, 10 11 12 13 negating the need for biopsy. If radiographic or advanced imaging demonstrates gross cortical erosion or soft-tissue infiltration, the lesion is approached as an intermediate- or high-grade chondrosarcoma until proven otherwise.…”

“… 9 Therefore, differentiating between an ACT and a high-grade chondrosarcoma is often less controversial. However, if there is still ambiguity, differentiation between these low-grade and high-grade lesions may also be conferred with advanced imaging, 10 11 12 13 again negating the need for biopsy.…”