FDG PET/CT as a marker for grading sarcomas and for the individualization of disease management

The clinical course of sarcomas is difficult to predict on the basis of current clinical and pathologic prognostic criteria and further advancements for diagnosis, tumor–nodes–metastasis staging, grading and prognosis are actively being sought. This article discusses fluorodeoxyglucose (FDG) PET/CT as a marker for grading sarcomas and briefly touches on other roles of FDG PET/CT in the diagnosis and management of this disease. Incidence, risk factors, demographics, staging and grading systems are reviewed. Limitations of the major grading systems are discussed, with a focus on interobserver variability. Next, a summary of evidence to suggest that FDG PET/CT can be used for grading sarcomas is presented. Sarcoma grade is strongly associated with SUVmax; however, FDG PET/CT cannot entirely supplant histologic grading and the former should be used alone only when histopathology is not available. Certain limitations are touched upon in the metabolic grading of these tumors and finally, the future perspective ...