Early 18F-FDG PET for Prediction of Prognosis in Patients with Diffuse Large B-Cell Lymphoma: SUV-Based Assessment Versus Visual Analysis

Abstract

The purpose of this study was to assess the prognostic value of early 18 F-FDG PET using standardized uptake value (SUV) compared with visual analysis in patients with diffuse large B-cell lymphoma (DLBCL). Methods: Ninety-two patients with newly diagnosed DLBCL underwent 18 F-FDG PET prospectively before and after 2 cycles of chemotherapy (at midtherapy). Maximum SUV (SUVmax) and mean SUV (SUVmean) normalized to body weight and body surface area, as well as tumor-to-normal ratios, were computed on the most intense uptake areas. The SUVs, tumor-to-normal ratios, and their changes over time were compared with visual analysis for predicting event-free survival (EFS) and overall survival, using receiver-operating-characteristic (ROC) analysis. Survival curves were estimated with KaplanMeier analysis and compared using the log-rank test. Results: With visual analysis, the accuracy of early PET to predict EFS was 65.2%. The 2-y estimate for EFS was 51% (95% confidence interval [CI], 34%-68%) in the PET-positive group compared with 79% (95% CI, 68%-90%) in the PET-negative group (P 5 0.009). An optimal cutoff value of 65.7% SUVmax reduction from baseline to midtherapy obtained from ROC analysis yielded an accuracy of 76.1% to predict EFS. The 2-y estimate for EFS was 21% (95% CI, 0%-42%) in patients with SUVmax reduction # 65.7% compared with 79% (95% CI, 69%-88%) in those with reduction . 65.7% (P , 0.0001). Fourteen patients considered as positive on visual analysis could have been reclassified as good responders. Conclusion: SUV-based assessment of therapeutic response during first-line chemotherapy improves the prognostic value of early 18 F-FDG PET compared with visual analysis in DLBCL.

Positron Emission Tomographic Scans in Lymphoma: Convention and Controversy

“…Assessments during treatment or in clinical trials, however, may require quantification. [8][9][10] This is often challenging because cutoff levels of SUV to determine response to therapy are likely to depend on the tumor type and treatment administered and therefore need to be evaluated in prospective clinical trials. With the demonstration of the prognostic value of interim FDG-PET in classic Hodgkin lymphoma, different trials have now been initiated to use this information to direct individual treatment.…”

Midtreatment 18F‐fluorodeoxyglucose positron‐emission tomography in aggressive non‐Hodgkin lymphoma

“…[1][2][3][4] In particular, several studies that have evaluated the role of PET as a prognostic tool during chemotherapy have reported its ability to predict outcomes in aggressive NHL. [5][6][7][8][9][10][11] In force of the pivotal role played by PET in staging, restaging, and response evaluation, the International Workshop Criteria for malignant lymphoma 12 have been revised to incorporate the PET data in NHL outcome assessment, but only at the end of therapy.…”

“…Recent reports of PET evaluation have demonstrated a greater degree of accuracy in early response assessment compared with computed tomography. [5][6][7][8][9][10][11] However, the benefit of midtreatment (or interim) PET evaluation in aggressive NHL is still a matter of debate, 24 and a meta-analysis conducted by Terasawa et al 3 indicated that interim PET has unproven reliability in routine clinical practice.…”

Chemotherapy response assessment in stage IV melanoma patients—comparison of 18F-FDG-PET/CT, CT, brain MRI, and tumormarker S-100B

“…or average SUV (32). This approach takes a little more time if multiple lesions are present but is highly reproducible and superior to visual analysis in specific tumors such as recently shown in lymphoma patients (33). More sophisticated and time-consuming measurements like total lesion glycolysis (TLG) promise to be more exactly to determine the tumor burdon because size and FDG-uptake of all lesions are assessed.…”