An 18F-FDG-PET maximum standardized uptake value > 10 represents a novel valid marker for discerning Richter’s Syndrome

PET Scan in Hodgkin Lymphoma

“…Some of the textural image features (such as entropy and maximum probability) were superior in predicting morphological changes of radiotracer uptake regions longitudinally, compared to SUVmax. This result is consistent with a previous report [109], while in another prior report, pre-therapeutic FDG SUVmax was not predictive of the tumor response to 90 Y-ibritumomab tiuxetan therapy [110]. In this study, pre-therapeutic FDG SUVmax was predictive of the tumor response to 90 Y-ibritumomab tiuxetan therapy on a lesion-by-lesion basis.…”

“…The preliminary results of the US intergroup trial S0816 on behalf of four cooperative groups have been presented at the twelfth ICML meeting of Lugano [ 90 ]. Secondary intra-arm randomizations are planned in the RATHL study (ABVD vs. AVD in PET-2negative patients) and in the HD 0607 study (consolidation radiotherapy vs. no further treatment in PET-2-negative arm).…”

“…Recently, Falchi et al evaluated and reported that SUVmax ≥10, international prognostic score (IPS) ≥2, bulky disease, and age ≥65 were independently associated with shorter OS in CLL patients (n = 332) [89]. Corroborating these results, Michallet et al identified a threshold of tumor SUV max >10 as the most effective discriminating cutoff value which yielded a sensitivity and specificity of 91 % and 95 %, respectively, for identifying transformation by PET in CLL patients (n = 250) [90]. Corroborating these results, Michallet et al identified a threshold of tumor SUV max >10 as the most effective discriminating cutoff value which yielded a sensitivity and specificity of 91 % and 95 %, respectively, for identifying transformation by PET in CLL patients (n = 250) [90].…”

NCCN Guidelines Insights: Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma, Version 2.2019

“…[19][20][21][22] A maximum standardized uptake value (SUV max ) ≥10 on PET scan has been shown to be a valid marker to distinguish Richter's transformation from CLL among patients not treated with kinase inhibitor therapy. 23 However, PET SUV max ≥10 alone lacks both sensitivity and specificity to distinguish Richter's transformation from CLL in patients who develop Richter's transformation while on ibrutinib. 24 Tissue biopsy is required for the definitive diagnosis of Richter's transformation.…”

Chronic Lymphocytic Leukemia: Rapidly Changing Treatment Landscape

“…When RT is suspected a comprehensive evaluation with a PET/CT, image guided biopsy as well as a bone marrow biopsy is required. SUV of greater than 10 can distinguish RT form CLL with high sensitivity (91%) and specificity (95%) [70]. However, this has been disputed in the setting of novel agents and thus a concern for RT necessitates a biopsy of the index lesion preferably.…”