Predictive value and diagnostic accuracy of F-18-fluoro-deoxy-glucose positron emission tomography treated grade 1 and 2 follicular lymphoma

Abstract

F-18-fluoro-deoxy-glucose positron emission tomography (PET) is a powerful tool for the imaging of aggressive B-cell lymphomas. In contrast, there is relatively little data on PET in follicular lymphoma grade 1 (FL-1) and grade 2 (FL-2). In this manuscript, we present our findings utilizing PET in treated FL-1 and FL-2. A retrospective review of patients who underwent PET examinations at our institution produced 95 PET examinations among 31 patients with FL-1 and FL-2. PET was obtained at initial staging, mid-induction and post-treatment. Results were compared with clinical follow-up. PET had high sensitivity (95%) and specificity (88%) for lesion detection in treated FL-1 and FL-2. Abnormal foci in FL-1 and FL-2 had similar intensities. Post-induction PET positive patients had shorter mean progression free survivals compared with PET negative patients (p-value < or =0.001), post-salvage PET positive trended toward shorter mean response duration compared with negative patients (p-value: 0.09). Our results indicate that PET is accurate in the diagnostic assessment of treated FL-1 and FL-2 and, post-treatment PET positive patients are likely to relapse prior to PET negative patients.

SIE, SIES, GITMO revised guidelines for the management of follicular lymphoma

“…Published literature includes 10 retrospective analyses [9][10][11][12][13][14][15][16][17][18] and 1 prospective one [19]: pooled analysis of 356 patients revealed that 24% were upstaged from Stage I-II to Stage III-IV. Baseline PET also showed to have a high prognostic value, irrespective of FLIPI [10,11,17,19].…”

End-Therapy Positron Emission Tomography for Treatment Response Assessment in Follicular Lymphoma: A Systematic Review and Meta-analysis

“…With regard to the type of PET scanner, five studies used combined PET/CT (15,(17)(18)(19)(20), one studies used standalone PET (21), and two studies used both (14,16). The criteria of treatment response assessment of PET results somewhat varied across the studies, as summarized in Table 1.…”

“…The majority of included patients underwent CIT such as R-CHOP or R-CVP according to the policy of institutions or oncologists, whereas participants in one study underwent RIT (18). In terms of reference standard, all included studies reported that they used all available clinical information including imaging follow-up as proof of disease recurrence/progression, whereas only two studies specifically mentioned histologic assessment for evaluation of recurrence/progression (14,19).…”

“…The following 22 articles were further excluded after reviewing the full texts: 13 articles whose topics were outside the field of interest of our study (three studies evaluating efficacy of chemotherapeutic strategy or stem-cell transplantation, two studies evaluating role of end-therapy CT, five studies evaluating diagnostic role of PET in staging or surveillance, and three studies that do not have data specific to follicular lymphoma), eight studies that had no or insufficient survival data for the meta-analysis (9, 10, 26-31), and one study with patient overlap (32). The remaining eight studies were used for qualitative and quantitative review (14)(15)(16)(17)(18)(19)(20)(21).…”

“…Although there have been several studies to evaluate PET in postchemotherapy assessment in follicular lymphoma (14)(15)(16)(17)(18)(19)(20)(21), to our knowledge, there has been no research to generate a more evidence-based systematic summary about the value of PET for therapeutic response assessment of follicular lymphoma. From this perspective, we aim to systematically review the published literature and determine the predictive value of PET in predicting outcome after chemotherapy, which could provide data for a more evidenced-based standardized management of follicular lymphoma.…”