The Significance of PET/CT in the Initial Staging of Hodgkin Lymphoma: Experience Outside Clinical Trials

Angelopoulou, Maria K.; Mosa, Eftychia; Pangalis, Gerassimos A.; Rondogianni, Phoivi; Chatziioannou, Sofia; Prassopoulos, Vassilios; Moschogianni, Maria; Tsirkinidis, Pantelis; Asimakopoulos, John; Konstantinou, Iliana; Tsourouflis, Gerasimos; Sachanas, Sotirios; Yiakoumis, Xanthi; Boutsikas, Georgios; Arapaki, Maria; Gainaru, Gabriella; Kyrtsonis, Marie‐Christine; Siakantaris, Marina P.; Datseris, Ioannis; Panayiotidis, P.; Konstantopoulos, Kostas; Vassilakopoulos, Theodoros P.

doi:10.21873/anticanres.12011

Cited by 10 publications

(20 citation statements)

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“…Despite treatment, about 20% of HL patients still relapse (1). 18 F-Fluorodeoxyglucose ( 18 F-FDG) Positron Emission Tomography (PET) coupled with Computed Tomography (CT) plays a central role in HL patients management, whether in staging or response assessment settings (1).…”

Section: Introductionmentioning

confidence: 99%

“…The drawbacks of TMTV calculation (results depending on the segmentation method (9), time required for delineation (10), difficulty in evaluating bone involvement) led to ponder other prognostic markers, such as healthy organ 18 F-FDG uptake. In 2010, Hanaoka et al (11) reported an inverse correlation between cerebellar uptake and total lesion glycolysis (TLG) in a population with aggressive lymphoma.…”

Section: Introductionmentioning

confidence: 99%

“…In 2010, Hanaoka et al (11) reported an inverse correlation between cerebellar uptake and total lesion glycolysis (TLG) in a population with aggressive lymphoma. The mechanism underlying this phenomenon is poorly understood but could correspond to a metabolic theft of 18 F-FDG by the tumor mass. Because TLG is correlated with TMTV, Godard et al (12) speculated that cerebellar metabolism might have a prognostic value and suggested to normalize cerebellar 18 F-FDG uptake to hepatic 18 F-FDG uptake to account for differences between PET/CT systems.…”

Section: Introductionmentioning

confidence: 99%

“…The mechanism underlying this phenomenon is poorly understood but could correspond to a metabolic theft of 18 F-FDG by the tumor mass. Because TLG is correlated with TMTV, Godard et al (12) speculated that cerebellar metabolism might have a prognostic value and suggested to normalize cerebellar 18 F-FDG uptake to hepatic 18 F-FDG uptake to account for differences between PET/CT systems. This index has been shown to be a prognostic parameter for PFS prediction in diffuse large-B-cell lymphoma (10) and follicular lymphoma (12).…”

Section: Introductionmentioning

confidence: 99%

“…This index has been shown to be a prognostic parameter for PFS prediction in diffuse large-B-cell lymphoma (10) and follicular lymphoma (12). Normalization to liver was not optimal: liver 18 F-FDG uptake was also negatively correlated with TMTV as was cerebellar 18 F-FDG uptake (r = −0.34 and r = −0.42, respectively) (10). These two healthy organs could thus prove useful in predicting prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Healthy Organs Uptake on Baseline 18F-FDG PET/CT as an Alternative to Total Metabolic Tumor Volume to Predict Event-Free Survival in Classical Hodgkin's Lymphoma

et al. 2022

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PurposeHealthy organs uptake, including cerebellar and liver SUVs have been reported to be inversely correlated to total metabolic tumor volume (TMTV), a controversial predictor of event-free survival (EFS) in classical Hodgkin's Lymphoma (cHL). The objective of this study was to estimate TMTV by using healthy organs SUV measurements and assess the performance of this new index (UF, Uptake Formula) to predict EFS in cHL.MethodsPatients with cHL were retrospectively included. SUV values and TMTV derived from baseline 18F-FDG PET/CT were harmonized using ComBat algorithm across PET/CT systems. UF was estimated using ANOVA analysis. Optimal thresholds of TMTV and UF were calculated and tested using Cox models.Results163 patients were included. Optimal UF model of TMTV included age, lymphoma maximum SUVmax, hepatic SUVmean and cerebellar SUVmax (R2 14.0% - p < 0.001). UF > 236.8 was a significant predictor of EFS (HR: 2.458 [1.201–5.030], p = 0.01) and was not significantly different from TMTV > 271.0 (HR: 2.761 [1.183–5.140], p = 0.001). UF > 236.8 remained significant in a bivariate model including IPS score (p = 0.02) and determined two populations with different EFS (63.7 vs. 84.9%, p = 0.01).ConclusionThe Uptake Formula, a new index including healthy organ SUV values, shows similar performance to TMTV in predicting EFS in Hodgkin's Lymphoma. Validation cohorts will be needed to confirm this new prognostic parameter.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Healthy Organs Uptake on Baseline 18F-FDG PET/CT as an Alternative to Total Metabolic Tumor Volume to Predict Event-Free Survival in Classical Hodgkin's Lymphoma

et al. 2022

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Texture analysis of 18F‐FDG PET/CT and CECT: Prediction of refractoriness of Hodgkin lymphoma with mediastinal bulk involvement

Abenavoli,

Linguanti,

Anichini

et al. 2024

Hematological Oncology

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To recognize patients at high risk of refractory disease, the identification of novel prognostic parameters improving stratification of newly diagnosed Hodgkin Lymphoma (HL) is still needed. This study investigates the potential value of metabolic and texture features, extracted from baseline 18F‐FDG Positron Emission Tomography/Computed Tomography (PET) and Contrast‐Enhanced Computed Tomography scan (CECT), together with clinical data, in predicting first‐line therapy refractoriness (R) of classical HL (cHL) with mediastinal bulk involvement. We reviewed 69 cHL patients who underwent staging PET and CECT. Lesion segmentation and texture parameter extraction were performed using the freeware software LIFEx 6.3. The prognostic significance of clinical and imaging features was evaluated in relation to the development of refractory disease. Receiver operating characteristic curve, Cox proportional hazard regression and Kaplan‐Meier analyses were performed to examine the potential independent predictors and to evaluate their prognostic value. Among clinical characteristics, only stage according to the German Hodgkin Group (GHSG) classification system significantly differed between R and not‐R. Among CECT variables, only parameters derived from second order matrices (gray‐level co‐occurrence matrix (GLCM) and gray‐level run length matrix (GLRLM) demonstrated significant prognostic power. Among PET variables, SUVmean, several variables derived from first (histograms, shape), and second order analyses (GLCM, GLRLM, NGLDM) exhibited significant predictive power. Such variables obtained accuracies greater than 70% at receiver operating characteristic analysis and their PFS curves resulted statistically significant in predicting refractoriness. At multivariate analysis, only HISTO_EntropyPET extracted from PET (HISTO_EntropyPET) and GHSG stage resulted as significant independent predictors. Their combination identified 4 patient groups with significantly different PFS curves, with worst prognosis in patients with higher HISTO_EntropyPET values, regardless of the stage. Imaging radiomics may provide a reference for prognostic evaluation of patients with mediastinal bulky cHL. The best prognostic value in the prediction of R versus not‐R disease was reached by combining HISTO_EntropyPET with GHSG stage.

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Baseline PET/CT imaging parameters for prediction of treatment outcome in Hodgkin and diffuse large B cell lymphoma: a systematic review

Frood

Combes

Tsoumpas

et al. 2021

Eur J Nucl Med Mol Imaging

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Purpose To systematically review the literature evaluating clinical utility of imaging metrics derived from baseline fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for prediction of progression-free (PFS) and overall survival (OS) in patients with classical Hodgkin lymphoma (HL) and diffuse large B cell lymphoma (DLBCL). Methods A search of MEDLINE/PubMed, Web of Science, Cochrane, Scopus and clinicaltrials.gov databases was undertaken for articles evaluating PET/CT imaging metrics as outcome predictors in HL and DLBCL. PRISMA guidelines were followed. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Results Forty-one articles were included (31 DLBCL, 10 HL). Significant predictive ability was reported in 5/20 DLBCL studies assessing SUVmax (PFS: HR 0.13–7.35, OS: HR 0.83–11.23), 17/19 assessing metabolic tumour volume (MTV) (PFS: HR 2.09–11.20, OS: HR 2.40–10.32) and 10/13 assessing total lesion glycolysis (TLG) (PFS: HR 1.078–11.21, OS: HR 2.40–4.82). Significant predictive ability was reported in 1/4 HL studies assessing SUVmax (HR not reported), 6/8 assessing MTV (PFS: HR 1.2–10.71, OS: HR 1.00–13.20) and 2/3 assessing TLG (HR not reported). There are 7/41 studies assessing the use of radiomics (4 DLBCL, 2 HL); 5/41 studies had internal validation and 2/41 included external validation. All studies had overall moderate or high risk of bias. Conclusion Most studies are retrospective, underpowered, heterogenous in their methodology and lack external validation of described models. Further work in protocol harmonisation, automated segmentation techniques and optimum performance cut-off is required to develop robust methodologies amenable for clinical utility.

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The Significance of PET/CT in the Initial Staging of Hodgkin Lymphoma: Experience Outside Clinical Trials

Abstract: Baseline PET/CT findings may lead to treatment modification in <15% of patients with HL without a significant impact on outcome. Certain PET/CT parameters have potent prognostic significance.

Cited by 10 publications

References 0 publications

Healthy Organs Uptake on Baseline 18F-FDG PET/CT as an Alternative to Total Metabolic Tumor Volume to Predict Event-Free Survival in Classical Hodgkin's Lymphoma

Healthy Organs Uptake on Baseline 18F-FDG PET/CT as an Alternative to Total Metabolic Tumor Volume to Predict Event-Free Survival in Classical Hodgkin's Lymphoma

Texture analysis of 18F‐FDG PET/CT and CECT: Prediction of refractoriness of Hodgkin lymphoma with mediastinal bulk involvement

Baseline PET/CT imaging parameters for prediction of treatment outcome in Hodgkin and diffuse large B cell lymphoma: a systematic review

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