PET Scans in the Staging of Lymphoma: Current Status

Abstract

Positron emission tomography (PET) is a novel functional imaging technique that provides several inherent advantages over conventional nuclear scintigraphy. Several studies have suggested a role for PET using the positron emitter fluorine-18 in the diagnosis and followup of patients with lymphoma. This review summarizes the existing data evaluating the role of 2-fluoro-2-deoxy-D-glucose (FDG)-PET in both the staging and follow-up of patients with lymphoma. Most studies of PET involve patients with either Hodgkin's disease or diffuse large Bcell non-Hodgkin's lymphoma. PET detects more disease sites above and below the diaphragm on staging of lymphoma than gallium scintigraphy and may have particular utility in the evaluation of the spleen. Moreover, persistently positive PET scans during and after chemotherapy appear to have a high sensitivity for predicting subsequent relapse. A negative PET scan at the end of therapy provides very favorable prognostic information. Persistently positive PET scans at the end of therapy warrant close follow-up or additional diagnostic procedures, since some of those patients may remain in prolonged remission. Clearly, additional studies, including prospective blinded trials and cost-effectiveness analyses, are warranted to determine which subsets of patients with lymphoma ultimately will benefit from this modality.

89Zr-trastuzumab and 89Zr-bevacizumab PET to Evaluate the Effect of the HSP90 Inhibitor NVP-AUY922 in Metastatic Breast Cancer Patients

“…2[18F]fluoro-2-deoxy-D-glucose (FDG)-PET for assessing tumor glucose metabolism, is used to monitor early drug response to anticancer agents (18)(19)(20)(21). More target-based imaging of HSP90 inhibition effect was performed in preclinical studies, in which critical client proteins VEGF and HER2 could be visualized with zirconium-89 ( 89 Zr)-bevacizumab PET, gallium-68-(Fab'2) trastuzumab PET, and 89 Zr-trastuzumab PET imaging (22)(23)(24).…”

“…More target-based imaging of HSP90 inhibition effect was performed in preclinical studies, in which critical client proteins VEGF and HER2 could be visualized with zirconium-89 ( 89 Zr)-bevacizumab PET, gallium-68-(Fab'2) trastuzumab PET, and 89 Zr-trastuzumab PET imaging (22)(23)(24). In human breast cancer xenograft mouse model models, tumor uptake of 18 F-FDG was unaffected by treatment with the HSP90 inhibitor 17-N-allylamino-17-demethoxygeldanamycin (17AAG), whereas radiolabeled trastuzumab tumor uptake was on average reduced by 50%. This indicates that target-based imaging may be more useful as an early biomarker for HSP90 inhibition than metabolic 18 F-FDG imaging (24).…”

Prognostic value of FDG-PET scans at diagnosis in small cell lung cancer

“…Its clinical application has been validated in the diagnosis, staging, prognosis and response to therapy in many cancers including lymphoma [1] , breast cancer [2] , lung adenocarcinoma [3] and other solid tumors [4] .…”

Salvage Therapy in Hodgkin’s Lymphoma

“…Although response to salvage chemotherapy has been traditionally measured via the international criteria for nonHodgkin's lymphomas [9], more recent data suggest that functional imaging (FI) prior to HDCT/ASCT may provide a clearer picture [10]. For instance, in patients with negative FI (measured via positron emission tomography or gallium scan) prior to HDCT/ASCT, the 3-year PFS and OS rates were 69% and 87%, respectively, versus 23% and 58%, respectively, for patients with positive FI [11].…”