Purpose: To evaluate the diagnostic accuracy of (18)F-FDG PET/CT for detecting recurrence in patients with primary skeletal Ewing sarcoma.
Methods: We retrospectively analysed data from 53 patients (age 20.1 ± 10.5 years, 39 male) who had undergone 71 (18)F-FDG PET/CT studies for suspected recurrence (52 studies) or for routine follow-up (19 studies) after primary therapy of skeletal Ewing sarcoma. (18)F-FDG PET/CT studies were evaluated qualitatively and quantitatively (maximum standardized uptake value, SUVmax) by two nuclear medicine physicians in consensus. Sensitivity, specificity, predictive values and accuracy were calculated on per study basis. Clinical/imaging follow-up (minimum 6 months) and/or histopathology (when available) were taken as the reference standard.
Results: Of the total of 71 (18)F-FDG PET/CT studies, 42 (59.1%) were positive for recurrence and 29 (40.9%) were negative for recurrence. Local recurrence was most common (38 studies) followed by bone metastasis (9 studies), and node and lung metastasis (2 studies each). Of the 71 studies, 38 were true-positive, 27 were true-negative, 4 were false-positive and 2 were false-negative. Overall per study based sensitivity was 95%, specificity was 87%, PPV was 90%, NPV was 93% and accuracy was 91.5%. No significant difference was found in the accuracy of PET/CT between the suspected recurrence group and the routine follow-up group (94% vs. 84%; P = 0.390). Overall mean lesion SUVmax was 7.8 ± 4.1 (range 1.9-17.2). No site-based difference was found in SUVmax.
Conclusion: (18)F-FDG PET/CT demonstrates high diagnostic accuracy for detecting recurrence in patients with primary skeletal Ewing sarcoma, when it is suspected (clinically or on imaging) or during routine follow-up.