Prognostic Value of Positron Emission Tomography (PET) With Fluorine-18 Fluorodeoxyglucose ([<sup>18</sup>F]FDG) After First-Line Chemotherapy in Non-Hodgkin’s Lymphoma: Is [<sup>18</sup>F]FDG-PET a Valid Alternative to Conventional Diagnostic Methods?

Spaepen, Karoline; Stroobants, Sigrid; Dupont, Patrick; Steenweghen, Steven Van; Thomas, José; Vandenberghe, Peter; Vanuytsel, L.; Bormans, Guy; Balzarini, Jan; Wolf‐Peeters, C. De; Mortelmans, Luc; Verhoef, Gregor

doi:10.1200/jco.2001.19.2.414

Cited by 432 publications

(203 citation statements)

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“…PET/CT has become a standard of care in both Hodgkin lymphoma and non-Hodgkin lymphoma as part of the restaging assessment. 38 Patients with a negative PET scan result have an excellent outcome, and multiple studies have shown that FDG-PET performed after treatment is highly predictive of progression-free survival and overall survival in aggressive non-Hodgkin lymphoma [39][40][41][42][43] and follicular lymphoma. 44 PET scans can also be particularly useful in patients with lymphoma who have a residual mass at the completion of therapy.…”

Section: Posttreatment Scans (To Document Remission)mentioning

confidence: 99%

Positron Emission Tomographic Scans in Lymphoma: Convention and Controversy

Ansell

Armitage

2012

Mayo Clinic Proceedings

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The use of sensitive and specific imaging techniques for accurate initial staging and evaluation of response to therapy in patients with lymphoma is essential for their optimal management. Fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) integrated with computed tomography (CT) has emerged as a powerful imaging tool and is being routinely used in staging, response evaluation, and posttreatment surveillance in patients with non-Hodgkin lymphoma and Hodgkin lymphoma. PET/CT is currently widely used in clinical practice, but the established clinical benefit is currently restricted to the posttreatment evaluation of Hodgkin lymphoma, diffuse large B-cell lymphoma, and follicular lymphoma. Although used in other histologic subtypes and in other clinical situations including response assessment, its impact on patient outcome remains to be demonstrated. We performed a literature search of PubMed from 1999 to 2011 using the following keywords: PET scan, FDG-PET, PET/CT, lymphoma. This review addresses the challenges and controversies in the use of PET/CT scans in the management of patients with lymphoma. I n most patients with lymphoma, positron emission tomographic (PET) scans show abnormalities at diagnosis. Normal findings on the scan after therapy is highly predictive of a good prognosis, particularly in patients with diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, and Hodgkin lymphoma. However, the optimal application of PET scans to the management of all patients with lymphoma remains problematic. The major controversies include the optimal timing of PET scans (for staging, during therapy, after completion of therapy, surveillance in remission), standardization of PET scan interpretation (visual interpretation compared with standard uptake value [SUV] calculation), what constitutes a positive PET scan result, and whether PET scans should be used to direct management (eg, does changing therapy in patients with positive findings on PET change outcome, should biopsies of sites with positive PET results be done routinely before a management change). Although a large body of literature addressing these topics exists, the studies are often difficult to compare, making definitive conclusions on all these issues difficult. The previously published studies often used different designs and variable reporting, making interpretation and comparison of the results difficult. In the early studies particularly, heterogeneous populations with different stages of disease and different histologic subtypes were included, making the clinical applicability of the studies' results difficult. More recent studies focusing on efforts to standardize the conduct and interpretation of PET scans and on riskadapted therapies based on interim PET scan results will, it is hoped, improve the management and outcome of patients with lymphoma. A literature search of PubMed from 1999 to 2011 was performed using the following keywords: PET scan, FDG-PET, PET/CT, lymphoma. We highlight the current standard use ...

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Section: Posttreatment Scans (To Document Remission)mentioning

confidence: 99%

Positron Emission Tomographic Scans in Lymphoma: Convention and Controversy

Ansell

Armitage

2012

Mayo Clinic Proceedings

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“…FDG-PET imaging after some cycles of chemotherapy may give prognostic information on recurrence and survival in lymphoma patients [4][5][6][7], and FDG uptake has been reported to be correlated with the histological grade of malignancy and proliferation rate in untreated NHL patients [8][9][10][11]. However, the role of FDG-PET in pretreatment risk stratification has not been investigated in a homogeneous group of DLBCL patients [12].…”

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confidence: 99%

Tumor Burden Assessed by the Maximum Standardized Uptake Value and Greatest Diameter on FDG-PET Predicts Prognosis in Untreated Diffuse Large B-cell Lymphoma

Nguyen

Lee

Amin

et al. 2010

Nucl Med Mol Imaging

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Purpose It is uncertain whether the tumor burden as assessed using FDG-PET has prognostic significance in newly diagnosed diffuse large B-cell lymphoma (DLBCL). The authors undertook this study to determine whether a parameter that reflects both FDG uptake magnitude and the greatest tumor diameter is a prognostic indicator in DLBCL. Materials and Methods Forty-two DLBCL patients (age, 57.4±15.5 years; male/female=25/17; stage I/II/III/IV=5/ 17/10/10) who underwent FDG-PET before chemotherapy were enrolled. A lesion with the highest maximum standardized uptake value (MaxSUV) on the PET image was selected, and size-incorporated MaxSUV (SIMaxSUV) of mass was calculated as MaxSUV × greatest diameter (mm) on the transaxial PET image. Median follow-up duration was 20.0 months. Results Twelve (28.6%=12/42) patients experienced disease progression, and 10 (23.8%=10/42) died during follow-up. Among six variables [Ann Arbor stage, %Ki-67 expression, International Prognostic Index (IPI), MaxSUV, greatest diameter, and SIMaxSUV] investigated, only SIMaxSUV was found to be a single determinant of progression-free and overall survivals by multivariate analyses (p<0.05). Conclusion These results suggest that SIMaxSUV, a new FDG-PET parameter that incorporates FDG uptake magnitude and the greatest tumor diameter, may be a useful indicator of prognosis in untreated DLBCL.

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“…In particular, its role in managing lymphoma patients has grown progressively and its use is now often recommended in disease staging [2][3][4][5], monitoring during therapy [6][7][8][9][10], posttreatment restaging [11][12][13][14][15], and modeling radiotherapy field [16]. Less is known about the role of 18 FDG-PET during follow-up, especially its capability to detect relapse earlier with respect to CT or ultrasound imaging.…”

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confidence: 99%

Role of 18FDG-PET/CT in detecting relapse during follow-up of patients with Hodgkin’s lymphoma

et al. 2009

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The role of 18 FDG-PET/CT during follow-up of patients affected by Hodgkin's lymphoma (HL) in complete remission after treatment is not fully elucidated, since a wide use of 18 F fluorodeoxyglucose positron emission tomography/computed tomography ( 18 FDG-PET/CT) in this setting could be limited by a relative high rate of false-positive results. Herein, we summarize a retrospective analysis of 27 patients with Hodgkin's lymphoma in complete remission after the first-line (n=20) or salvage (n=7) therapy receiving serial 18 FDG-PET/CT scans during follow-up. Out of 165 scans, 13 were suspected for relapse, which was confirmed in seven patients. All relapses were correctly identified by 18 FDG-PET/CT positivity, with a 100% sensitivity; false-positive rate was 46% and negative predictive value was 100%. True-positive findings were mostly associated with multiple sites, subdiaphragmatic involvement, and/or previous sites of disease. According to our results, we conclude that performing routine PET/CT scan during follow-up of those patients who are at high risk of relapse would be advisable, although caution must be adopted when interpreting PET/CT results due to the relatively high rate of false-positive findings. If FDG abnormal uptake is present at multiple nodal sites, subdiaphragmatic lymph nodes, or previous sites of disease, histological verification of PET abnormal findings is warranted.

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Prognostic Value of Positron Emission Tomography (PET) With Fluorine-18 Fluorodeoxyglucose ([¹⁸F]FDG) After First-Line Chemotherapy in Non-Hodgkin’s Lymphoma: Is [¹⁸F]FDG-PET a Valid Alternative to Conventional Diagnostic Methods?

Abstract: Persistent abnormal [18F]FDG uptake after first-line chemotherapy in NHL is highly predictive for residual or recurrent disease. In relapsing patients, PFS was significantly shorter after a positive scan than after a negative scan.

Cited by 432 publications

References 22 publications

Positron Emission Tomographic Scans in Lymphoma: Convention and Controversy

Positron Emission Tomographic Scans in Lymphoma: Convention and Controversy

Tumor Burden Assessed by the Maximum Standardized Uptake Value and Greatest Diameter on FDG-PET Predicts Prognosis in Untreated Diffuse Large B-cell Lymphoma

Role of 18FDG-PET/CT in detecting relapse during follow-up of patients with Hodgkin’s lymphoma

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Prognostic Value of Positron Emission Tomography (PET) With Fluorine-18 Fluorodeoxyglucose ([18F]FDG) After First-Line Chemotherapy in Non-Hodgkin’s Lymphoma: Is [18F]FDG-PET a Valid Alternative to Conventional Diagnostic Methods?

Abstract: Persistent abnormal [18F]FDG uptake after first-line chemotherapy in NHL is highly predictive for residual or recurrent disease. In relapsing patients, PFS was significantly shorter after a positive scan than after a negative scan.

Cited by 432 publications

References 22 publications

Positron Emission Tomographic Scans in Lymphoma: Convention and Controversy

Positron Emission Tomographic Scans in Lymphoma: Convention and Controversy

Tumor Burden Assessed by the Maximum Standardized Uptake Value and Greatest Diameter on FDG-PET Predicts Prognosis in Untreated Diffuse Large B-cell Lymphoma

Role of 18FDG-PET/CT in detecting relapse during follow-up of patients with Hodgkin’s lymphoma

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Prognostic Value of Positron Emission Tomography (PET) With Fluorine-18 Fluorodeoxyglucose ([¹⁸F]FDG) After First-Line Chemotherapy in Non-Hodgkin’s Lymphoma: Is [¹⁸F]FDG-PET a Valid Alternative to Conventional Diagnostic Methods?