Comparison of 18FDG-PET with CT scans in the evaluation of patients with residual and recurrent Hodgkin's lymphoma

Dittmann, Helmut; Sökler, Martin; Kollmannsberger, C.; Dohmen, Bernhard M.; Baumann, Cédric; Kopp, A.; Bares, Roland; Claussen, Claus D.; Kanz, Lothar; Bokemeyer, Carsten

doi:10.3892/or.8.6.1393

Cited by 34 publications

(30 citation statements)

References 31 publications

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“…Before PET imaging should be routinely utilized in general practice, familiarity with the interpretation and limitations of nuclear imaging for lymphoma is necessary. Future studies will determine whether quantitative PET may minimize false-positive results, although one study comparing PET with CT scans suggested that SUV was not helpful in that regard [47]. Until then, PET may replace gallium imaging but, similar to previous experiences with gallium, it is prudent to correlate PET findings with other conventional imaging modalities and biopsy results before committing a patient to additional toxic therapy in response to an FDG-avid lesion at the completion of chemotherapy or in follow-up after treatment.…”

Section: Figure 2 Image Coregistration Transaxial Slices At the Lowmentioning

confidence: 99%

PET Scans in the Staging of Lymphoma: Current Status

Friedberg

Chengazi

2003

The Oncologist

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Positron emission tomography (PET) is a novel functional imaging technique that provides several inherent advantages over conventional nuclear scintigraphy. Several studies have suggested a role for PET using the positron emitter fluorine-18 in the diagnosis and followup of patients with lymphoma. This review summarizes the existing data evaluating the role of 2-fluoro-2-deoxy-D-glucose (FDG)-PET in both the staging and follow-up of patients with lymphoma. Most studies of PET involve patients with either Hodgkin's disease or diffuse large Bcell non-Hodgkin's lymphoma. PET detects more disease sites above and below the diaphragm on staging of lymphoma than gallium scintigraphy and may have particular utility in the evaluation of the spleen. Moreover, persistently positive PET scans during and after chemotherapy appear to have a high sensitivity for predicting subsequent relapse. A negative PET scan at the end of therapy provides very favorable prognostic information. Persistently positive PET scans at the end of therapy warrant close follow-up or additional diagnostic procedures, since some of those patients may remain in prolonged remission. Clearly, additional studies, including prospective blinded trials and cost-effectiveness analyses, are warranted to determine which subsets of patients with lymphoma ultimately will benefit from this modality.

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Section: Figure 2 Image Coregistration Transaxial Slices At the Lowmentioning

confidence: 99%

PET Scans in the Staging of Lymphoma: Current Status

Friedberg

Chengazi

2003

The Oncologist

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“…In this setting, PET has consistently been shown to have a very high negative predictive value or NPV (a measure of the ability of a negative PET scan to exclude persistent disease or future relapse) averaging about 90% and exceeding 80% in virtually all reported studies. [23][24][25][26][27][28][29][30][31][32][33] The 10-20% false-negative rate with PET is mostly related to its inability to detect microscopic disease resulting in future relapse, a feature common to PET and all other conventional imaging methods, such as CT or MRI. The positive predictive value (PPV) of PET (a measure of the ability of a positive PET scan to predict persistent disease or future relapse) is substantially lower and considerably more variable averaging approximately 65% with most studies reporting values exceeding 50%.…”

Section: Pet For Restagingmentioning

confidence: 99%

“…The positive predictive value (PPV) of PET (a measure of the ability of a positive PET scan to predict persistent disease or future relapse) is substantially lower and considerably more variable averaging approximately 65% with most studies reporting values exceeding 50%. [23][24][25][26][27][28][29][30][31][32][33] Still, the PPV of PET is substantially higher than that of CT with a reported PPV in HL of about 20%; the NPV of CT is similar to that of PET. [23][24][25][26][27][28][29][30][31][32][33] The overall result is a considerably higher accuracy of PET for response assessment compared with CT (85% vs. 40%, respectively).…”

Section: Pet For Restagingmentioning

confidence: 99%

“…This higher accuracy is largely related to the clear superiority of PET in distinguishing between viable tumor and necrosis or fibrosis in residual mass(es) (RM) demonstrated by CT, which is generally unable to differentiate between these entities. 1,2,34 This is particularly relevant in patients with HL where about twothirds of patients have RMs by CT without any other clinical or biochemical evidence of disease; only a small fraction of these patients (i.e., 10-15%) have residual HL explaining the very poor PPV of CT. [23][24][25][26][27][28][29][30][31][32][33]34 Overall, more than two-thirds of RMs by CT are interpreted as negative by PET with relapse occurring in < 10% of these patients and these patients can, therefore, be safely observed. The other one-third of patients with a positive PET are clearly at a higher risk of progression or relapse, which occur in about 60-70% of patients (Figure 2; see Color Figures, page 510).…”

Section: Pet For Restagingmentioning

confidence: 99%

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Utility of Positron Emission Tomography (PET) Scanning in Managing Patients with Hodgkin Lymphoma

Juweid¹

2006

Hematology

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Use of positron emission tomography (PET) or PET/ computed tomography (CT) in Hodgkin lymphoma (HL) continues to expand worldwide. PET is currently widely utilized for response assessment after completion of therapy and, to a lesser extent, for pretreatment staging and assessment of response during therapy (therapy monitoring). In pretreatment staging, PET cannot replace CT or bone marrow biopsy (BMB); however, it can provide complementary information to both CT and BMB, potentially resulting in a modification of disease stage (usually upstaging) in about 15-20% of patients with impact on management in about 5-15%. PET for response assessment at the conclusion of treatment is substantially more accurate than CT because of its ability to distinguish between viable tumor and necrosis or fibrosis in posttherapy residual mass (es) that are present in about two-thirds of patients with HL without any other clinical or biochemical evidence of disease. PET, therefore, provides more accurate response classifications compared with CTbased assessment. The role of PET for therapy monitoring is still evolving but may prove to be the most exciting with potentially high impact on patient management and outcome. PET evaluation during therapy appears to be at least as accurate for predicting patient outcome as evaluation after completion of therapy and its use is clearly justified if the purpose is to provide an early and yet accurate assessment of response with the clear intent of tailoring therapy according to the information provided by the scan. The role of PET scanning for post-therapy surveillance without clinical, biochemical or radiographic evidence of disease remains controversial, primarily because of the potential for a disproportionate fraction of falsepositive findings, potentially resulting in increasing cost without proven benefit from earlier PET detection of disease compared to standard surveillance methods. Large prospective studies are therefore needed to determine whether routine surveillance by PET is both cost-effective and whether it results in meaningful changes in patient management and/or outcome.

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“…These residual masses may consist of fibrotic tissue or active disease and CT scan and magnetic resonance imaging (MRI) cannot reliably differentiate between active disease and fibrosis (Hill et al, 1993;Zinzani et al, 1996). For these purposes, functional imaging with fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) can reveal decisive metabolic or functional tissue parameters and is more accurate than conventional radiological imaging techniques for restaging after chemotherapy (Jerusalem et al, 1999(Jerusalem et al, , 2001Zinzani et al, 1999a, b;Kostakoglu and Goldsmith, 2000;Dittmann et al, 2001). Several groups, including our own, have evaluated the efficiency of PET for restaging patients after completed therapy (Cremerius et al, 1998(Cremerius et al, , 2001De Wit et al, 2001;Naumann et al, 2001;Spaepen et al, 2001a, b;Weihrauch et al, 2001Weihrauch et al, , 2003Zinzani et al, 2002;Fihnont et al, 2003).…”

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confidence: 99%

Predictive role of positron emission tomography (PET) in the outcome of lymphoma patients

et al. 2004

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An extensive analysis of the reliability of positron emission tomography (PET) after induction treatment in patients with Hodgkin's disease (HD) or aggressive non-Hodgkin's lymphoma (NHL). In all, 75 untreated patients with HD (n ¼ 41) or aggressive NHL (n ¼ 34) were studied with both PET and CT scans following standard chemotherapy induction therapy (ABVD or MACOP-B) with/ without radiotherapy. Histopathological analysis was performed when considered necessary. After treatment, four out of five (80%) patients who were PET þ /CT À relapsed, as compared with zero out of 29 patients in the PET À /CT À subset. Among the 41 CT þ patients, 10 out of 11 (91%) who were PET þ relapsed, as compared with 0 out of 30 who were PET À . The actuarial relapse-free survival (RFS) rates were 9 and 100% in the PET þ and PET À subsets, respectively (P ¼ 0.00001). All five patients who were PET þ / CT À underwent a lymph node biopsy: in four (80%) cases, persistent lymphoma and was confirmed at histopathological examination. Two HD patients who were PET À /CT þ (with large residual masses in the mediastinum or lung) were submitted to biopsy, which in both cases revealed only fibrosis. In HD and aggressive NHL patients, PET positivity after induction treatment is highly predictive for the presence of residual disease, with significant differences being observable in terms of RFS. PET negativity at restaging strongly suggests the absence of active disease; histopathological verification is important in patients who show PET positivity.

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Comparison of 18FDG-PET with CT scans in the evaluation of patients with residual and recurrent Hodgkin's lymphoma

Cited by 34 publications

References 31 publications

PET Scans in the Staging of Lymphoma: Current Status

PET Scans in the Staging of Lymphoma: Current Status

Utility of Positron Emission Tomography (PET) Scanning in Managing Patients with Hodgkin Lymphoma

Predictive role of positron emission tomography (PET) in the outcome of lymphoma patients

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