Federico Mercolini1, Pietro Zucchetta2, Nina Jehanno3, Nadege Corradini4, Rick R Van Rijn5, Timothy Rogers6, Alison Cameron7, Giovanni Scarzello8, Beatrice Coppadoro9, Veronique Minard-Colin10, Soledad Gallego11, Julia Chisholm12, J Hans Merks13, Gianni Bisogno9. 1. Pediatric Hematology and Oncology Unit, Department of Pediatrics, Bolzano Hospital, Bolzano, Italy. Electronic address: federico.mercolini@sabes.it. 2. Nuclear Medicine Unit, Department of Medicine - DIMED, University Hospital of Padova, Padova, Italy. 3. Department of Nuclear Medicine, Institut Curie, PSL Research University, Paris, France. 4. Department of Pediatric Hematology and Oncology-IHOPe, Centre Léon Bérard, Lyon, France. 5. Department of Radiology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. 6. Department of Paediatric Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK. 7. Bristol Haematology and Oncology Hospital, University Hospitals Bristol and Weston, Bristol, UK. 8. Radiotherapy Division, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy. 9. Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy. 10. Département de cancérologie de l'enfant et l'adolescent, INSERM U1015, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France. 11. Servicio de Oncología y Hematología Pediatrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain. 12. Children and Young Peoples Unit, Royal Marsden Hospital, Down's Road, Sutton, Surrey, UK. 13. Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
Abstract
BACKGROUND: Initial staging of rhabdomyosarcoma is crucial for prognosis and to tailor the treatment. The standard radiology workup (SRW) includes magnetic resonance imaging, chest computed tomography (CT) and bone scintigraphy, but 18 Fluorine-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) (18F-FDG-PET/CT (PET-CT)) use is increasing. The aim of this study was to evaluate the impact of PET-CT in the initial staging of patients with metastatic rhabdomyosarcoma enrolled in the European protocol MTS2008. METHODS: Two authors retrospectively reviewed the SRW and PET-CT reports comparing the number and sites of metastases detected. For bone marrow involvement, PET-CT and bone marrow aspirates/biopsies were compared. RESULTS: Among 263 metastatic patients enrolled from October 2008 to December 2016, 121 had PET-CT performed at diagnosis, and for 118 of 121 patients, both PET-CT and radiological reports were available for review. PET-CT showed higher sensitivity than SRW in the ability to detect locoregional (96.2% versus 78.5%, P value = 0.0013) and distant lymph node involvement (94.8% versus 79.3%, P value = 0.0242), but sensitivity was lower for intrathoracic sites (lung 79.6% versus 100%, P value = 0.0025). For bone metastasis, PET-CT was more sensitive than bone scintigraphy (96.4% versus 67.9%, P value = 0.0116). The PET-CT sensitivity and specificity to detect marrow involvement were 91.8% and 93.8%, respectively. The mean number of metastatic sites was 1.94 (range 0-5) with PET-CT and 1.72 (range 0-5) with SRW. In four patients (3.4%), PET-CT changed the staging from localised to metastatic disease. CONCLUSION: PET can identify metastatic disease not evident on SRW in a small number of patients. This is because of its higher ability to recognise lymph node and bone involvement. Chest CT remains essential to detect lesions in intrathoracic sites, which can be performed in a one stop-shot routine examination or on a dedicated chest CT scan. PET-CT could replace bone scintigraphy to study bone involvement.
BACKGROUND: Initial staging of rhabdomyosarcoma is crucial for prognosis and to tailor the treatment. The standard radiology workup (SRW) includes magnetic resonance imaging, chest computed tomography (CT) and bone scintigraphy, but 18 Fluorine-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) (18F-FDG-PET/CT (PET-CT)) use is increasing. The aim of this study was to evaluate the impact of PET-CT in the initial staging of patients with metastatic rhabdomyosarcoma enrolled in the European protocol MTS2008. METHODS: Two authors retrospectively reviewed the SRW and PET-CT reports comparing the number and sites of metastases detected. For bone marrow involvement, PET-CT and bone marrow aspirates/biopsies were compared. RESULTS: Among 263 metastatic patients enrolled from October 2008 to December 2016, 121 had PET-CT performed at diagnosis, and for 118 of 121 patients, both PET-CT and radiological reports were available for review. PET-CT showed higher sensitivity than SRW in the ability to detect locoregional (96.2% versus 78.5%, P value = 0.0013) and distant lymph node involvement (94.8% versus 79.3%, P value = 0.0242), but sensitivity was lower for intrathoracic sites (lung 79.6% versus 100%, P value = 0.0025). For bone metastasis, PET-CT was more sensitive than bone scintigraphy (96.4% versus 67.9%, P value = 0.0116). The PET-CT sensitivity and specificity to detect marrow involvement were 91.8% and 93.8%, respectively. The mean number of metastatic sites was 1.94 (range 0-5) with PET-CT and 1.72 (range 0-5) with SRW. In four patients (3.4%), PET-CT changed the staging from localised to metastatic disease. CONCLUSION: PET can identify metastatic disease not evident on SRW in a small number of patients. This is because of its higher ability to recognise lymph node and bone involvement. Chest CT remains essential to detect lesions in intrathoracic sites, which can be performed in a one stop-shot routine examination or on a dedicated chest CT scan. PET-CT could replace bone scintigraphy to study bone involvement.
Authors: Gabriel C Fine; Matthew F Covington; Bhasker R Koppula; Ahmed Ebada Salem; Richard H Wiggins; John M Hoffman; Kathryn A Morton Journal: Cancers (Basel) Date: 2022-06-08 Impact factor: 6.575