Clinical features and 18F-FDG PET/CT for distinguishing of malignant lymphoma from inflammatory lymphadenopathy in HIV-infected patients

Abstract

Background It is vital to distinguish between inflammatory and malignant lymphadenopathy in human immunodeficiency virus (HIV) infected individuals. The purpose of our study was to differentiate the variations in the clinical characteristics of HIV patients, and apply 18F-FDG PET/CT parameters for distinguishing of malignant lymphoma and inflammatory lymphadenopathy in such patients. Methods This retrospective cross-sectional study included 59 consecutive HIV-infected patients who underwent whole-body 18F-FDG PET/CT. Of these patients, 37 had biopsy-proven HIV-associated lymphoma, and 22 with HIV-associated inflammatory lymphadenopathy were used as controls. The determined parameters were the maximum of standard uptake value (SUVmax), SUVmax of only lymph nodes (SUVLN), the most FDG-avid lesion-to-liver SUVmax ratio (SURmax), laboratory examinations and demographics. The optimal cut-off of 18F-FDG PET/CT value was analyzed by receiver operating characteristic curve (ROC). Results Considering the clinical records, the Karnofsky Performance Status (KPS) scores in patients with inflammatory lymphadenopathy were obviously higher than those in patients with malignant lymphoma (P = 0.015), whereas lymphocyte counts and lactate dehydrogenase (LDH) were obviously lower (P = 0.014 and 0.010, respectively). For the 18F-FDG PET/CT imaging, extra-lymphatic lesions, especially digestive tract and Waldeyer’s ring, occurred more frequently in malignant lymphoma than inflammatory lymphadenopathy. Furthermore, the SURmax and SUVLN in malignant lymphoma were markedly higher than those in inflammatory lymphadenopathy (P = 0.000 and 0.000, respectively). The cut-off point of 3.1 for SURmax had higher specificity (91.9%) and relatively reasonable sensitivity (68.2%) and the cut-off point of 8.0 for the SUVLN had high specificity (89.2%) and relatively reasonable sensitivity (63.6%). Conclusion Our study identified the distinctive characteristics of the clinical manifestations, the SURmax, SUVLN and detectability of extra-lymphatic lesions on 18F-FDG PET, and thus provides a new basis for distinguishing of malignant lymphoma from inflammatory lymphadenopathy in HIV-infected patients.

Research to develop a diagnostic ultrasound nomogram to predict benign or malignant lymph nodes in HIV-infected patients

“…As far as we know, there are some pieces of research about using PET/CT for distinguishing malignant lymphoma from inflammatory lymphadenopathy in HIV-infected patients and endobronchial ultrasound in HIV-infected patients with mediastinal lymphadenopathy [ 17 – 19 ]. However, PET/CT is uneconomical and difficult to obtain.…”

Clinical value of 18F-FDG PET/CT in the management of HIV-associated lymphoma

“…The cut-off point of 3.1 for SURmax showed the best equilibrium between sensitivity (68.2%) and specificity (91.9%), and the cut-off point of 8.0 for the SUV LN had also high specificity (89.2%) and relatively reasonable sensitivity (63.6%). The cut-off point of 5 for numbers of involved areas and 3.6 centimeter for maximum diameters of lymph node had relatively low sensitivity (62.2%, 64.9%, respectively) and specificity (72.7%, 86.4%, respectively) ( 32 ).…”

Differentiation of cancer of unknown primary and lymphoma in head and neck metastatic poorly differentiated cancer using 18F-FDG PET/CT tumor metabolic heterogeneity index

“…18 F-Fluorodeoxyglucose (FDG) PET/computed tomography (CT) is a widely used imaging tool in clinical cancer practice [13], which combines anatomical and metabolic information [14] and shows value in assessing the heterogeneity of tumors in a non-invasive manner. Generally, the average of SUV max ranges from 5 to 20 in CUPs [15–20] and ranges from 10 to 20 in lymphoma [21–25]. CUP and lymphoma tend to be more heterogenous than other types of tumors and exhibit metabolic differences in 18 F-FDG PET/CT imaging.…”

“…This means that patients may need to undergo multiple rounds of chemotherapy, radiation therapy, or surgical procedures, all of which come with a range of side effects and delay of effective treatment. the average of SUV max ranges from 5 to 20 in CUPs [15][16][17][18][19][20] and ranges from 10 to 20 in lymphoma [21][22][23][24][25]. CUP and lymphoma tend to be more heterogenous than other types of tumors and exhibit metabolic differences in 18 F-FDG PET/CT imaging.…”