2-(fluorine-18)fluoro-2-deoxy-D-glucose positron emission tomography in the detection and staging of malignant lymphoma

Abstract

BACKGROUND The authors undertook a prospective evaluation of the clinical value of 2‐fluoro [18‐]‐2‐deoxyglucose positron emission tomography (FDG‐PET) in the detection and staging of malignant lymphoma compared with computed tomography (CT) and bone marrow biopsy (BMB). METHODS Fifty‐two consecutive patients with untreated malignant lymphoma were evaluated prospectively in a bicenter study. FDG‐PET, CT, and BMB were performed for investigating lymph node/extranodal manifestations and bone marrow infiltration. Thirty‐three percnt of the discrepant results were verified by biopsy, magnetic resonance imaging, or clinical follow‐up (range, 4–24 month). RESULTS Altogether, 1297 anatomic regions (lymph nodes, organs, and bone marrow) were evaluated. FDG‐PET and CT scans were compared by receiver operating characteristic (ROC) curve analysis. The area under the ROC curve were as follows: lymph nodes, 0.996 (PET) and 0.916 (CT); extranodal, 0.999 (PET) and 0.916 (CT); supradiaphragmatic, 0.996 (PET) and 0.905 (CT); and infradiaphragmatic, 0.999 (PET) and 0.952 (CT). In these analyses, FDG‐PET was significantly superior to CT (P < 0.05), except in infradiaphragmatic regions, in which the two methods produced equivalent results. In detecting bone marrow infiltration, FDG‐PET was superior to CT and was equivalent to BMB. In 4 of 52 patients (8%), FDG‐PET led to an upstaging and a change of therapy. CONCLUSIONS Noninvasive FDG‐PET is very accurate in the staging of malignant lymphoma. Compared with standard staging modalities (CT and BMB), PET was significantly superior and led to changes in the therapy regimen for 8% of patients. Cancer 2001;91:889–99. © 2001 American Cancer Society.

Positron Emission Tomographic Scans in Lymphoma: Convention and Controversy

“…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.…”

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

“…18 F-FDG-PET has several advantages over 67 Ga, including sameday results and high resolution. 1,2 There have been several reports comparing the usefulness of 18 F-FDG-PET with conventional imaging modalities, such as computed tomography (CT) and 67 Ga for detecting tumors, [10][11][12][13] and examining the relations between 18 F-FDG-PET and histologic subtypes based on the World Health Organization (WHO) classification system. [15][16][17][18] However, those studies were not systematic, and they involved relatively small numbers of patients.…”

“…[15][16][17][18] However, those studies were not systematic, and they involved relatively small numbers of patients. [9][10][11][12][13][14] Comparisons between 18 F-FDG-PET and conventional imaging modalities using large numbers of patients would help to further our understanding of the biologic differences between lymphoma cell types, establish guidelines for the selection of appropriate clinical management, and verify the clinical relevance of lymphoma classification systems. 1,2,6 The distinction between indolent and aggressive lymphomas is important clinically, because the choice of treatment is influenced by histologic subtype.…”

The impact of pre‐ and post‐transplantation positron emission tomography using 18‐fluorodeoxyglucose on poor‐prognosis lymphoma patients undergoing autologous stem cell transplantation

“…[10][11][12][13][14][15][16] Its increasing availability also has provided an obvious alternative to 67-gallium citrate scans. Many reports have demonstrated the ability of FDG-PET/CT to assess the extension of lymphoma with greater sensitivity than anatomic imaging modalities.…”