The Utility of 18FDG PET/CT Versus Bone Scan for Identification of Bone Metastases in a Pediatric Sarcoma Population and a Review of the Literature

Background: Outcome of patients with osteosarcoma (OS) and Ewing sarcoma (EWS) is dependent on presence of metastases. Imaging guidelines for OS and EWS include radiographs, computed tomography (CT), and magnetic resonance imaging for primary tumor evaluation and CT chest and bone scintigraphy (BS) for metastatic detection. (18)Fluorodeoxyglucose ((18)FDG) positron emission tomography (PET)/CT has become more common for disease evaluation, yet there is no consensus for its use in this population. Objective: We aimed to compare identification of osseous metastases using BS versus (18)FDG PET/CT in our patient population. We hypothesized that (18)FDG PET/CT is more likely to detect osseous metastases both at diagnosis and relapse. Materials and Methods: We performed retrospective chart reviews of pediatric sarcoma patients treated at our institution from 2008 to 2019. Paired BS and (18)FDG PET/CT scans were reviewed. Review of the literature was also performed. Results: Thirty-three patients had paired BS and (18)FDG PET/CT during diagnosis or treatment. Fifteen patients had distant osseous metastases. In the OS cohort, 8/16 patients had osseous metastases; 100% of these patients were detected on (18)FDG PET/CT and 75% on BS. Thirty-one bony lesions were seen on imaging in OS patients; 100% of these were identified on (18)FDG PET/CT but only 29% on BS. In the EWS cohort, 6/15 patients had osseous metastases; 100% of these patients were detected on (18)FDG PET/CT and 50% on BS. Eighteen bony lesions were seen on imaging in EWS patients; 94% of these were identified on (18)FDG PET/CT, but only 28% on BS. Conclusion: For patients in our institution with OS or EWS, osseous metastases were more likely detected using (18)FDG PET/CT.