Radioguided lymph node biopsy of a chemoresistant lymph node detected on interim FDG PET-CT in Hodgkin lymphoma

Abstract

A 32-year-old male patient was diagnosed with nodular lymphocyte-predominant Hodgkin lymphoma. Staging FDG PET-CT detected a large right axillary lymph node conglomerate and splenic manifestation. Interim PET-CT following two cycles of ABVD chemotherapy revealed good metabolic response with the exception of a single axillary lymph node. A second ''interim'' PET-CT after two further cycles showed a similar result. A biopsy of the metabolically active non-palpable lymph node was performed using radioguided occult lesion localization (ROLL) with ultrasound guidance. The lymph node was successfully removed by minimally invasive surgery. Histological evaluation of the lymph node revealed a T cell-rich diffuse large B cell lymphoma. Based on this finding, a more aggressive treatment regimen followed by high dose chemotherapy with autologous stem cell rescue was adopted. To our knowledge, this is the first report of a lymphoma case in which the ROLL method was used in the radioguided biopsy of a chemoresistant lymph node detected by interim FDG PET-CT.

PET Molecular Imaging–Directed Biopsy: A Review

“…The study showed that 3D FDG PET/CT may be a promising tool for further implementation of image-guided surgery. Györke et al [34] described a case of lymphoma in which an occult lesion localization method was used for radioguided biopsy of a chemoresistant lymph node detected with interim FDG PET/CT. Biopsy of the metabolically active, nonpalpable lymph node was performed with ultrasound guidance (Fig.…”

“…Several similarly enlarged but metabolically inactive further lymph nodes are present in right axilla ( G–I ). (Reprinted with permission from [34])…”

Guidelines for the investigation and management of nodular lymphocyte predominant Hodgkin lymphoma

“…Second line treatment should not be initiated on the basis of a residual PET‐positive lesion alone. Biopsy is recommended to confirm the presence or absence of viable lymphoma and to assess for high‐grade transformation (Gyorke et al , ; Banzo et al , ). If biopsy is not performed, clinical follow‐up and early re‐assessment is recommended.…”

Aplicación clínica de la técnica ROLL en patología no mamaria. Uso complementario tras estudio PET-TAC

“…Varios autores han descrito buenos resultados al ser utilizada como técnica de cirugía de rescate tras estudio PET-TAC, realizándose en algunas publicaciones igualmente confirmación previa con PAAF 10,15 . En otros trabajos la técnica ROLL fue aplicada satisfactoriamente como método de biopsia excisional con intención diagnóstica 6,16 .…”

“…No obstante, el material obtenido puede resultar insuficiente o el método tener escaso valor diagnóstico por la presencia de numerosas células reactivas y pocas células neoplásicas en la lesión, planteándose como primera opción la biopsia excisional 5,6 .…”