Baseline PET/CT imaging parameters for prediction of treatment outcome in Hodgkin and diffuse large B cell lymphoma: a systematic review

Abstract

Purpose To systematically review the literature evaluating clinical utility of imaging metrics derived from baseline fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for prediction of progression-free (PFS) and overall survival (OS) in patients with classical Hodgkin lymphoma (HL) and diffuse large B cell lymphoma (DLBCL). Methods A search of MEDLINE/PubMed, Web of Science, Cochrane, Scopus and clinicaltrials.gov databases was undertaken for articles evaluating PET/CT imaging metrics as outcome predictors in HL and DLBCL. PRISMA guidelines were followed. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Results Forty-one articles were included (31 DLBCL, 10 HL). Significant predictive ability was reported in 5/20 DLBCL studies assessing SUVmax (PFS: HR 0.13–7.35, OS: HR 0.83–11.23), 17/19 assessing metabolic tumour volume (MTV) (PFS: HR 2.09–11.20, OS: HR 2.40–10.32) and 10/13 assessing total lesion glycolysis (TLG) (PFS: HR 1.078–11.21, OS: HR 2.40–4.82). Significant predictive ability was reported in 1/4 HL studies assessing SUVmax (HR not reported), 6/8 assessing MTV (PFS: HR 1.2–10.71, OS: HR 1.00–13.20) and 2/3 assessing TLG (HR not reported). There are 7/41 studies assessing the use of radiomics (4 DLBCL, 2 HL); 5/41 studies had internal validation and 2/41 included external validation. All studies had overall moderate or high risk of bias. Conclusion Most studies are retrospective, underpowered, heterogenous in their methodology and lack external validation of described models. Further work in protocol harmonisation, automated segmentation techniques and optimum performance cut-off is required to develop robust methodologies amenable for clinical utility.

Radiomics as a New Frontier of Imaging for Cancer Prognosis: A Narrative Review

“…Frood et al investigated the role of baseline nuclear medicine imaging in the prediction of treatment outcome in Hodgkin and diffuse large B cell lymphoma [198] and concluded that further work in harmonization, segmentation and performance cut-off is required to develop robust methodologies that are amenable for clinical utility.…”

Radiomic Features of 18F-FDG PET in Hodgkin Lymphoma Are Predictive of Outcomes

“…The currently available prognostic indicators fail to identify high-risk patients [ 4 , 5 ]. Therefore, it is urgently necessary to identify patients with a low or high risk of recurrence [ 6 ].…”

Combination of FDG PET/CT Radiomics and Clinical Parameters for Outcome Prediction in Patients with Hodgkin’s Lymphoma

“…This is concordant with a few earlier studies that evaluated a similar question, including rst order parameters such as SUVmax. For example, Frood et al [27] recently published a meta-analysis for baseline PET/CT imaging parameters as predictor of treatment outcome in Hodgkin and diffuse large B-cell lymphomas (DLBCL). In the metaanalysis 10 studies assessing SUVmax as predictor of response, however, none none of the studies evaluated radiomics features.…”

“…This suggests that radiomic biomarkers can be developed and crossreferenced with established clinical cellular and molecular biomarkers to better predict outcomes and in uence evidence based clinical decision making in patients with lymphoma. [22][23][24][25][26][27][28][29][30] The aim of this study is to evaluate the prognostic value of joint PET-and CT radiomics combined with standard clinical parameters in patients with HL. We hypothesize that some hidden radiomics features content within the baseline PET/CT may predict survival outcomes.…”