The usefulness of ¹⁸F‐fluorodeoxyglucose positron emission tomography (¹⁸F‐FDG‐PET) and a comparison of ¹⁸F‐FDG‐pet with ⁶⁷gallium scintigraphy in the evaluation of lymphoma

Abstract

BACKGROUND.Although studies comparing conventional imaging modalities with 18F‐fluorodeoxyglucose positron emission tomography (18F‐FDG‐PET) for the detection of lymphoma and although the relations between 18F‐FDG‐PET and histologic types were reported previously, most studies were not systematic and involved relatively small numbers of patients.METHODS.Two hundred fifty‐five patients with lymphoma had their disease staged using 18F‐FDG‐PET, and 191 of those patients also were assessed using gallium‐67 scintigraphy (67Ga). Disease sites were identified on a site‐by‐site basis using computed tomography scans and/or magnetic resonance imaging. The results of these conventional imaging modalities were compared with the results from 8F‐FDG‐PET and 67Ga, and correlations between the imaging results and pathologic diagnoses were evaluated by using the World Health Organization classification system.RESULTS.Of 913 disease sites in 255 patients, 18F‐FDG‐PET identified >97% of disease sites of Hodgkin lymphoma (HL) and aggressive and highly aggressive non‐Hodgkin lymphoma. For indolent lymphoma, the detection rate of 18F‐FDG‐PET was 91% for follicular lymphoma (FL); 82% for extranodal marginal zone B‐cell lymphoma of mucosa‐associated lymphoid tissue, irrespective of plasmacytic differentiation; and approximately 50% for small lymphocytic lymphoma (SLL) and splenic marginal zone lymphoma (SMZL). The results from 67Ga were similar to those from 18F‐FDG‐PET for most histologic subtypes. However, the sensitivity of 67Ga was unexpectedly poor for FL, for mantle cell lymphoma (MCL), and for the nasal type of natural killer/T‐cell lymphoma (NK/T‐nasal), ranging from 30% to 38%.CONCLUSIONS.18F‐FDG‐PET was useful for all histologic subtypes of lymphoma other than SLL and SMZL. Compared with 67Ga, the authors strongly recommend the use of 18F‐FDG‐PET in patients with FL, MCL, and NK‐nasal. Cancer 2007. © 2007 American Cancer Society.

Positron Emission Tomographic Scans in Lymphoma: Convention and Controversy

“…16 However, the intensity of uptake (ie, a higher SUV) is typically highest in DLBCL and lower in follicular lymphoma and mantle cell lymphoma. Indolent lymphomas such as small lymphocytic lymphoma and splenic marginal zone lymphoma are less FDG-avid, and FDG-PET may be less likely to detect sites of active disease.…”

“…Indolent lymphomas such as small lymphocytic lymphoma and splenic marginal zone lymphoma are less FDG-avid, and FDG-PET may be less likely to detect sites of active disease. 16 Less is known about FDG-PET in T-cell lymphomas, but FDG-PET results are positive in most T-cell lymphomas except indolent cutaneous T-cell lymphoma. [17][18][19] Although PET scans may be useful in identifying sites of disease, some studies have suggested that FDG-PET may not be predictive of outcome in certain histologic subtypes.…”

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

“…FL is a (18)F-FDG avid disease, since more than 90% of patients with FL show a PET positive disease and sensitivity of staging PET is usually higher than 95% [6][7][8][9]. 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.…”

Current and future management of NK/T-cell lymphoma based on clinical trials

“…For this purpose, strict pretreatment evaluation incorporating positron emission tomography [65][66][67][68][69][70][71] and in situ hybridization for EBVencoded RNA using a bone marrow specimen [72] are recommended. As chemotherapeutic regimens for ENKL are evolving, a new prognostic model among patients treated with chemotherapies without anthracycline is needed.…”