Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
BMC Musculoskelet Disord. 2011 Jul 21;12:166. doi: 10.1186/1471-2474-12-166.
To determine safe surgical margins for soft tissue sarcoma, it is essential to perform a general evaluation of the extent of tumor, responses to auxiliary therapy, and other factors preoperatively using multiple types of diagnostic imaging. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is a tool for diagnostic imaging that has recently spread rapidly in clinical use. At present, the roles played by FDG-PET/CT in determination of margins for surgical resection of sarcoma are unclear. The present study was undertaken to explore the roles of FDG-PET/CT in determination of surgical margins for soft tissue sarcoma and to examine whether PET can serve as a standard means for setting the margins of surgical resection during reduced surgery.
The study involved 7 patients with sarcoma who underwent surgery in our department and in whom evaluation with FDG-PET/CT was possible. Sarcoma was histologically rated as MFH in 6 cases and leiomyosarcoma in 1 case. In all cases, sarcoma was superficial (T1a or T2a). The tumor border was defined by contrast-enhanced MRI, and SUVs were measured at intervals of 1 cm over a 5-cm long area from the tumor border. Mapping of viable tumor cells was carried out on whole-mount sections of resected tissue, and SUVs were compared with histopathological findings.
Preoperative maximum SUVs (SUV-max) of the tumor averaged 11.7 (range: 3.8-22.1). Mean SUV-max was 2.2 (range: 0.3-3.8) at 1 cm from the tumor border, 1.1 (0.85-1.47) at 2 cm, 0.83 (0.65-1.15) at 3 cm, 0.7 (0.42-0.95) at 4 cm, and 0.64 (0.45-0.82) at 5 cm. When resected tissue was mapped, tumor cells were absent in the areas where SUV-max was below 1.0.
Our findings suggest that a safe surgical margin free of viable tumor cells can be ensured if the SUV cut-off level is set at 1.0. FDG-PET/CT is promising as a diagnostic imaging technique for setting of safe minimal margins for surgical resection of soft tissue sarcoma.
为了确定软组织肉瘤的安全手术切缘，术前使用多种类型的诊断影像学对肿瘤的范围、辅助治疗的反应和其他因素进行全面评估至关重要。18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）是一种诊断影像学工具，近年来在临床应用中迅速普及。目前，FDG-PET/CT 在确定肉瘤手术切除切缘中的作用尚不清楚。本研究旨在探讨 FDG-PET/CT 在确定软组织肉瘤手术切缘中的作用，并探讨 PET 是否可以作为缩小手术中确定手术切除切缘的标准手段。
本研究纳入了 7 名在我院及其他医院接受手术治疗且可进行 FDG-PET/CT 评估的肉瘤患者。6 例肉瘤组织学分级为恶性纤维组织细胞瘤，1 例为平滑肌肉瘤。所有患者的肉瘤均为表浅（T1a 或 T2a）。肿瘤边界由增强 MRI 定义，在肿瘤边界 5cm 长的区域内每隔 1cm 测量 SUV 值。对切除组织的全层切片进行活肿瘤细胞的映射，并将 SUV 值与组织病理学发现进行比较。
肿瘤术前最大 SUV 值（SUV-max）平均为 11.7（范围：3.8-22.1）。肿瘤边界 1cm 处 SUV-max 为 2.2（范围：0.3-3.8），2cm 处为 1.1（0.85-1.47），3cm 处为 0.83（0.65-1.15），4cm 处为 0.7（0.42-0.95），5cm 处为 0.64（0.45-0.82）。当对切除组织进行映射时，SUV 值低于 1.0 的区域无肿瘤细胞。
我们的研究结果表明，如果 SUV 截断值设定为 1.0，可以确保安全的无肿瘤细胞手术切缘。FDG-PET/CT 有望成为一种诊断影像学技术，用于确定软组织肉瘤手术切除的安全最小切缘。
