The role of FDG-PET scans in patients with lymphoma

Seam, Pamela; Juweid, Malik E.; Cheson, Bruce D.

doi:10.1182/blood-2007-06-097238

Cited by 273 publications

(198 citation statements)

References 86 publications

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“…26 Fluorine 18 fluorodeoxyglucose-PET is important in staging of lymphoma; FDG-PET leads to a change in stage of disease in up to 20% to 40% of patients, and in 5% to 15% of patients, this changes the treatment choice. [27][28][29][30][31][32][33][34][35][36][37] At present, the use of FDG-PET scans in the staging of lymphoma is the standard of care in most patients.…”

Section: Current Use Of Pet Scans In Managing Lymphoma Stagingmentioning

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: Current Use Of Pet Scans In Managing Lymphoma Stagingmentioning

confidence: 99%

Positron Emission Tomographic Scans in Lymphoma: Convention and Controversy

Ansell

Armitage

2012

Mayo Clinic Proceedings

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“…Diffuse high FDG uptake of the bone marrow can occur due to the reactive changes of chemotherapy or the use of Colony-stimulating Growth factors (CSGF), in our study we insisted that the patient do not receive chemotherapy or CSGF at least two weeks prior to their PET scan. On the other hand, minimal bone marrow disease may be missed by FDG-PET, and thus FDG-PET should not be considered a replacement for bone marrow biopsy [13][14][15]. Conversely, mass lesions identified by CT may present as negative by PET.…”

Section: Discussionmentioning

confidence: 99%

“…It is clear that PET alone cannot replace CT for the purposes of pretreatment staging of lymphoma. Positive predictive value of FDG in aggressive NHL and HL are middle-range of value (80 and 50%, respectively), these values are substantially higher than the corresponding values for CT (about 40 and 20%, respectively [14][15][16][17], suggesting that FDG-PET is more accurate than CT in the response assessment of lymphoma. The low accuracy of CT is mainly due to the fact that CT cannot distinguish residual active tumor from inactive fibrosis or necrosis.…”

Section: Discussionmentioning

confidence: 99%

Role of 18F-FDG PET versus CT Scan in Evaluation of Extra-Nodal Lymphoma

El-Haddad¹,

Omar²,

Mahdy³

2015

J Nucl Med Radiat Ther

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Purpose: To compare findings in fluorine 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) in patients with extra-nodal lymphoma by using a combined PET/CT scanner. Methods and Materials:Between 2011 and April 2013, seventy seven patients with confirmed pathology of Hodgkin (32 patients) and Non Hodgkin lymphoma (45 patients) with extranodal involvement diagnosed at Nasser Institute Cancer Center (NICC), ministry of health, Cairo, Egypt. After collection of the two reports separately, combined reading was allowed afterwards, and the differences were recorded for our study.Results: PET-CT is very effective in detection of lesions in the bone and bone marrow, few patients may have CT finding without corresponding FDG uptake, CT without PET may be very effective in detecting recurrences in soft tissue, renal and GIT extrannodal lymphoma. Conclusion:PET scan is more sensitive than the CT used alone, and the combination PET-CT can be considered the standard of care for detection of extranodal lymphomas excluding soft tissue, renal and GI lymphomas.

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“…Various groups have used care-dose CT without the injection of intravenous iodinated contrast agent for attenuation, correction, or anatomical correlation. Previous studies revealed that 18 F-FDG PET-CT has a higher sensitivity and specificity than CE-CT in the evaluation of HL and high-grade NHL (3,4,(7)(8)(9)(10)(11). Moreover, several studies have suggested that PET imaging with care-dose unenhanced CT alone might be sufficient for staging, therapy monitoring, or follow-up in patients with HL and aggressive NHL, except in special cases (7,12).…”

Section: Discussionmentioning

confidence: 99%

“…This provides a significant advantage for the evaluation of lymphoproliferative malignancies, particularly for the detection of lymphomatous involvement in organs and nodes of normal size without any mass. Several studies suggest that the sensitivity and specificity of 18 F-FDG PET-CT for the assessment of nodal and extranodal involvement were higher than those of standard contrast-enhanced CT (CE-CT) (3,4,(7)(8)(9)(10)(11). These benefits make 18 F-FDG PET-CT the standard imaging technique for the initial staging, therapy response evaluation and restaging of patients with lymphoma.…”

mentioning

confidence: 99%

Fluorine-18 fluorodeoxyglucose PET-CT for extranodal staging of non-Hodgkin and Hodgkin lymphoma

Ömür

Baran

Oral³

et al. 2014

Diagn Interv Radiol

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NUCLEAR MEDICINE AND MOLECULAR IMAGINGF-FDG PET-CT imaging, following a diagnostic contrast-enhanced CT (CE-CT) performed within the last month, were included in our study. A total of 129 PET-CT images, and all radiologic, clinical, and pathological records of these patients were retrospectively reviewed. RESULTSIn total, 137 hypermetabolic extranodal infiltration sites were detected by 18 F-FDG PET-CT in 62 of 110 patients. There were no positive findings by CE-CT that reflected organ involvement in 40 of 137 18 F-FDG-positive sites. The κ statistics revealed fair agreement between PET-CT and CE-CT for the detection of extranodal involvement (κ=0.60). The organs showing a disagreement between the two modalities were the spleen, bone marrow, bone, and thyroid and prostate glands. In all lesions that were negative at CE-CT, there was a diffuse 18 F-FDG uptake pattern in the PET-CT images. The frequency of extranodal involvement was 51% and 58% in Hodgkin and non-Hodgkin lymphoma patients, respectively. There was a high positive correlation between the maximum standardized uptake values of the highest 18 F-FDG-accumulating lymph nodes and extranodal sites (r=0.67) in patients with nodal and extranodal involvement. CONCLUSION 18 F-FDG PET-CT is a more effective technique than CE-CT for the evaluation of extranodal involvement in Hodgkin and non-Hodgkin lymphoma patients. PET-CT has a significant advantage for the diagnosis of diffusely infiltrating organs without mass lesions or contrast enhancement compared to CE-CT.

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The role of FDG-PET scans in patients with lymphoma

Abstract: 18-Fluoro-deoxyglucose positron emission tomography (FDG-PET) is a noninvasive, 3-dimensional imaging modality that has become widely used in the management of patients with malignant lymphomas. This technology has been demonstrated to be more sensitive and specific than either 67

Cited by 273 publications

References 86 publications

Positron Emission Tomographic Scans in Lymphoma: Convention and Controversy

Positron Emission Tomographic Scans in Lymphoma: Convention and Controversy

Role of 18F-FDG PET versus CT Scan in Evaluation of Extra-Nodal Lymphoma

Fluorine-18 fluorodeoxyglucose PET-CT for extranodal staging of non-Hodgkin and Hodgkin lymphoma

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