High SUV uptake on FDG–PET/CT predicts for an aggressive B-cell lymphoma in a prospective study of primary FDG–PET/CT staging in lymphoma

Ngeow, Joanne; Quek, Richard; Ng, David Chee Eng; Hee, Siew Wan; Tao, Miriam; Lim, Lay Cheng; Tan, Yao; Lim, Soon Thye

doi:10.1093/annonc/mdp030

Cited by 137 publications

(96 citation statements)

References 11 publications

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“…For example, our median 18 F-FDG highest SUV max for FL (10.9, Table 2) is higher than the threshold of 10 proposed by Schöder et al, excluding indolent lymphoma with a specificity of 81% (9). 18 F-FDG avidity seems to be related to the histologic subtype of indolent lymphoma and its transformation (16,24,25 and chronic lymphocytic leukemia (10). We therefore suggest that thresholds indicating transformation should be investigated in homogeneous patient cohorts.…”

Section: Discussionmentioning

confidence: 89%

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¹⁸F-FDG or 3′-Deoxy-3′-¹⁸F-Fluorothymidine to Detect Transformation of Follicular Lymphoma

et al. 2015

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Considering the different treatment strategy for transformed follicular lymphoma (TF) as opposed to follicular lymphoma (FL), diagnosing transformation early in the disease course is important. There is evidence that 18 F-FDG has utility as a biomarker of transformation. However, quantitative thresholds may require inclusion of homogeneous non-Hodgkin lymphoma subtypes to account for differences in tracer uptake per subtype. Moreover, because proliferation is a hallmark of transformation, 3′-deoxy-3′-18 F-fluorothymidine ( 18 F-FLT) might be superior to 18 F-FDG in this setting. To define the best tracer for detection of TF, we performed a prospective a headto-head comparison of 18 F-FDG and 18 F-FLT in patients with FL and TF. Methods: 18 F-FDG and 18 F-FLT PET scans were obtained in 17 patients with FL and 9 patients with TF. We measured the highest maximum standardized uptake value (SUV max ), defined as the lymph node with the highest uptake per patient, and SUV range , defined as the difference between the SUV max of the lymph node with the highest and lowest uptake per patient. To reduce partial-volume effects, only lymph nodes larger than 3 cm 3 (A50 isocontour) were analyzed. Scans were acquired 1 h after injection of 185 MBq of 18 F-FDG or 18 F-FLT. To determine the discriminative ability of SUV max and SUV range of both tracers for TF, receiver-operatingcharacteristic curve analysis was performed. Results: The highest SUV max was significantly higher for TF than FL for both 18 F-FDG and 18 F-FLT (P , 0.001). SUV range was significantly higher for TF than FL for 18 F-FDG (P 5 0.029) but not for 18 F-FLT (P 5 0.075). The ability of 18 F-FDG to discriminate between FL and TF was superior to that of 18 F-FLT for both the highest SUV max (P 5 0.039) and the SUV range (P 5 0.012). The cutoff value for the highest SUV max of 18 F-FDG aiming at 100% sensitivity with a maximum specificity was found to be 14.5 (corresponding specificity, 82%). For 18 F-FLT, these values were 5.1 and 18%, respectively. When the same method was applied to SUV range , the cutoff values were 5.8 for 18 F-FDG (specificity, 71%) and 1.5 for 18 F-FLT (specificity, 36%). Conclusion: Our data suggest that 18 F-FDG PET is a better biomarker for TF than 18 F-FLT PET. The proposed thresholds of highest SUV max and SUV range should be prospectively validated.

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Section: Discussionmentioning

confidence: 89%

“…However, because 18 F-FDG uptake may strongly vary among histologic subtypes of indolent lymphoma (16) and their transformation (10), thresholds of 18 F-FDG uptake (standardized uptake value) to detect transformation may be a function of the subtype.…”

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confidence: 99%

¹⁸F-FDG or 3′-Deoxy-3′-¹⁸F-Fluorothymidine to Detect Transformation of Follicular Lymphoma

et al. 2015

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“…In addition, the majority of PCNSLs are diffuse large B-cell lymphomas. It is well-known that FDG uptake on diffuse large B-cell lymphoma is higher than that on other types of lymphoma [18], and this characteristic feature could be helpful in differentiating between B-cell lymphoma and other histological tumors. Likewise, in the brain tumors, previous reports clearly demonstrate that PCNSL has an extremely high FDG uptake compared to other brain tumors, such as anaplastic astrocytoma and glioblastoma [13,19].…”

Section: Discussionmentioning

confidence: 99%

The diagnostic role of 18F-FDG PET for primary central nervous system lymphoma

et al. 2014

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Objective 18F-FDG PET has become one of the most important methods for studying malignant lymphoma, but its diagnostic role for primary central nervous system lymphoma (PCNSL) has not been established. The aim of this study is to determine the appropriate cut-off values of FDG uptake and to investigate how corticosteroid administration influences PCNSL. MethodsWe retrospectively reviewed 82 patients with contrast-enhanced brain tumors who underwent an FDG PET scan at onset, including 19 PCNSLs. FDG uptake of the lesion was assessed by the maximum standardized uptake value (SUVmax) and the ratio of tumor to normal contralateral cortex activity (T/N ratio). Receiver operating characteristic (ROC) curves were generated from the SUVmax and T/N ratios. To investigate the influence of corticosteroid application before a FDG PET scan, we evaluated the association between the FDG uptake of the lesion and the cumulative dose of corticosteroid administration on 13 PCNSL patients who had received steroid treatment before an FDG PET examination. ResultsThe mean FDG SUVmax and T/N ratio of PCNSLs were 22.6 and 2.79, respectively, and these values were significantly higher than that of the other malignant brain tumors.ROC analysis indicated that the evaluation of FDG uptake using the T/N ratio was more reliable than the SUVmax with respect to the differential diagnosis. When PCNSL patients went without steroid application before FDG PET, the accuracy of the T/N ratio with a cut-off point of 2.0 was 91.1%, the sensitivity was 94.7%, and the specificity was 87.3%. Although there are no significant differences in the FDG T/N ratio for PCNSL patients with or without steroid treatment, a negative correlation was found between the T/N ratio and cumulative dose of corticosteroid before PET study (r = 0.71, p = 0.032). ConclusionsWe concluded that the T/N ratio was superior to SUVmax for FDG uptake assessment as for distinguishing PCNSLs from other malignant brain tumors; the appropriate T/N ratio cut-off point was 2.0. In addition, FDG uptake could be influenced by cumulative doses of corticosteroid before a PET scan, and thus this fact should be taken into consideration when evaluating FDG PET for PCNSL diagnosis.

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“…PET using fluorine-18 fluorodeoxyglucose ( 18 F-FDG) is a well-established imaging tool for detection of malignancy [8][9][10][11][12]. Inflammatory cells and tumor cells share a similar molecular basis of 18 F-FDG uptake, for example overexpression of glucose transporter (GLUT-1 and GLUT-3) and glycolytic enzymes.…”

Section: Introductionmentioning

confidence: 99%

Determinants of diagnostic performance of 18F-FDG PET/CT in patients with fever of unknown origin

Pereira¹,

Husmann²,

Sah³

et al. 2016

Nuclear Medicine Communications

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OBJECTIVES There is uncertainty about patient selection and the adequate timing at which fluorine-18 fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) is indicated in the diagnostic work-up of fever of unknown origin (FUO). The aim of this study was to determine the diagnostic performance of F-FDG PET/CT in patients with FUO. METHODS All consecutive patients who underwent F-FDG PET/CT at the University Hospital Zurich because of FUO between 2006 and 2012 were included in this retrospective, observational study. RESULTS A total of 76 patients [70% men, median (interquartile range) age 60 (47-67) years] were included. F-FDG PET/CT showed characteristically increased F-FDG activity in 56 patients (74%), leading to confirmation of or change in the suspected cause of FUO in 57 and 17%, respectively. The final diagnosis after F-FDG PET/CT included infection (21%), malignancy (22%), noninfectious inflammatory disease (12%), others (5%), or an unknown cause (40%). The success rate, sensitivity, and specificity of F-FDG PET/CT were 60, 77, and 31%, respectively. Sensitivity was highest in patients with suspected malignancy (100%, 95% confidence interval 79-100%). Diagnostic performance was independent of the investigated variables other than suspected infection as a cause of FUO (odds ratio 0.1, 95% confidence interval 0.01-0.8, P=0.033). CONCLUSION The diagnostic performance of F-FDG PET/CT was significantly higher in patients with suspected malignancy causing a FUO compared with suspected infection or noninfectious inflammatory disease. However, it was independent of the baseline characteristics and duration of fever. This supports the recommendation to perform F-FDG PET/CT early in the diagnostic work-up of FUO, which may shorten disease duration and lower health costs, particularly when infection or malignancy is suspected.

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High SUV uptake on FDG–PET/CT predicts for an aggressive B-cell lymphoma in a prospective study of primary FDG–PET/CT staging in lymphoma

Cited by 137 publications

References 11 publications

¹⁸F-FDG or 3′-Deoxy-3′-¹⁸F-Fluorothymidine to Detect Transformation of Follicular Lymphoma

¹⁸F-FDG or 3′-Deoxy-3′-¹⁸F-Fluorothymidine to Detect Transformation of Follicular Lymphoma

The diagnostic role of 18F-FDG PET for primary central nervous system lymphoma

Determinants of diagnostic performance of 18F-FDG PET/CT in patients with fever of unknown origin

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High SUV uptake on FDG–PET/CT predicts for an aggressive B-cell lymphoma in a prospective study of primary FDG–PET/CT staging in lymphoma

Cited by 137 publications

References 11 publications

18F-FDG or 3′-Deoxy-3′-18F-Fluorothymidine to Detect Transformation of Follicular Lymphoma

18F-FDG or 3′-Deoxy-3′-18F-Fluorothymidine to Detect Transformation of Follicular Lymphoma

The diagnostic role of 18F-FDG PET for primary central nervous system lymphoma

Determinants of diagnostic performance of 18F-FDG PET/CT in patients with fever of unknown origin

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¹⁸F-FDG or 3′-Deoxy-3′-¹⁸F-Fluorothymidine to Detect Transformation of Follicular Lymphoma

¹⁸F-FDG or 3′-Deoxy-3′-¹⁸F-Fluorothymidine to Detect Transformation of Follicular Lymphoma