FDG and L-[1-11C]-tyrosine imaging of soft-tissue tumors before and after therapy

This study was undertaken to investigate the relationship of PET using fluorodeoxyglucose (FDG) or L-[1-C-11]-tyrosine (TYR) with histopathologic findings in soft-tissue tumors, before and after therapy. Histopathologic parameters that were studied were tumor grade, mitotic rate, proliferation activity and amount of necrosis. Methods: PET with either FDG or TYR was performed in 55 patients with a lesion suspected to be a malignant soft-tissue tumor. In 28 patients, a second PET study was performed after therapy. Metabolic rate of glucose consumption (MRglc) and protein synthesis rate (PSR) were calculated. Histologic parameters were obtained from a biopsy specimen that was taken just after the first PET study and from the tumor remnant that was resected after therapy. Results: MRglc correlated with tumor grade (r = 0.71) and mitotic rate (r = 0.68) but not with proliferation or necrosis. After therapy, there was no longer a correlation with mitotic rate. PSR correlated with tumor grade (r = 0.53), mitotic rate (r = 0.73) and proliferation (r = 0.66). After therapy, correlation with mitosis and proliferation had improved, and a negative correlation was found between PSR and necrosis (r = -0.74). Conclusion: These results validate the use of both FDG and TYR to give an in vivo indication of histologic tumor parameters. However, FDG gives a better indication of tumor grade, whereas TYR is more accurate in predicting mitotic rate and proliferation, especially after therapy. FDG may therefore not be the most suited tracer for monitoring therapy. TYR might be more appropriate for that purpose.