Contribution of PET imaging to the initial staging and prognosis of patients with Hodgkin's disease

Munker, Reinhold; Glass, J.; Griffeth, Landis K.; Sattar, Tanvir; Zamani, Reza; Heldmann, Maureen; Shi, Runhua; Lilien, David L.

doi:10.1093/annonc/mdh426

Cited by 91 publications

(34 citation statements)

References 24 publications

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“…Our results are in keeping with earlier reports 11,[13][14][15][16] that PET stages HL patients differently to ceCT in ;15% to 30% of cases. Early reports had fewer patients, were retrospective, and were published prior to the widespread introduction of PET-CT. [11][12][13][14][15][16] More recently, Hutchings et al 3 compared PET with CT staging prospectively in 99 patients with HL (61 with PET-CT), and Rigacci et al 10 in 186 patients (56 with PET-CT).…”

Section: Discussionsupporting

confidence: 93%

“…[11][12][13][14][15][16] Previous publications compared imaging techniques but do not report the impact of imaging on the more relevant final clinical stage, inclusive of bone marrow biopsy, and some publications included patients with HL and non-Hodgkin lymphoma (NHL). [17][18][19][20][21] Response assessment with the 5-PS has been reported by a number of investigators to have good interobserver agreement in a training set of 50 patients, 22 in a study of 260 advanced HL patients with international expert readers, 23 and in pediatric HL.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study

Barrington

Kirkwood

Franceschetto

et al. 2016

Blood

157

101

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Key Points• PET-CT is the modern standard for staging Hodgkin lymphoma and can replace contrast enhanced CT in the vast majority of cases.• Agreement between expert and local readers is sufficient for the Deauville criteria to assess response in clinical trials and the community.International guidelines recommend that positron emission tomography-computed tomography (PET-CT) should replace CT in Hodgkin lymphoma (HL). The aims of this study were to compare PET-CT with CT for staging and measure agreement between expert and local readers, using a 5-point scale (Deauville criteria), to adapt treatment in a clinical trial: Response-Adapted Therapy in Advanced Hodgkin Lymphoma (RATHL). Patients were staged using clinical assessment, CT, and bone marrow biopsy (RATHL stage). PET-CT was performed at baseline (PET0) and after 2 chemotherapy cycles (PET2) in a response-adapted design. PET-CT was reported centrally by experts at 5 national core laboratories. Local readers optionally scored PET2 scans. The RATHL and PET-CT stages were compared. Agreement among experts and between expert and local readers was measured. RATHL and PET0 stage were concordant in 938 (80%) patients. PET-CT upstaged 159 (14%) and downstaged 74 (6%) patients. Upstaging by extranodal disease in bone marrow (92), lung (11), or multiple sites (12) on PET-CT accounted for most discrepancies. Follow-up of discrepant findings confirmed the PET characterization of lesions in the vast majority. Five patients were upstaged by marrow biopsy and 7 by contrast-enhanced CT in the bowel and/or liver or spleen. PET2 agreement among experts (140 scans) with a k (95% confidence interval) of 0.84 (0.76-0.91) was very good and between experts and local readers (300 scans) at 0.77 (0.68-0.86) was good. These results confirm PET-CT as the modern standard for staging HL and that response assessment using Deauville criteria is robust, enabling translation of RATHL results into clinical practice. (Blood. 2016;127(12):1531-1538

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study

Barrington

Kirkwood

Franceschetto

et al. 2016

Blood

157

101

View full text Add to dashboard Cite

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“…Furthermore, an early FDG-PET assessment of response to chemotherapy is becoming a routine part of management in HL and histologically aggressive NHL. Although the total number of reported NL cases diagnosed by FDG-PET/CT is still small, positive findings are highly suggestive of a diagnosis of NL, particularly in patients with a known history of hematologic malignancy [1,6]. Furthermore, FDG-PET/CT can often diagnose NL when other diagnostic modalities have failed [7], and can allow disease extent to be visualized and therapeutic response to be determined [8].…”

Section: Case Reportmentioning

confidence: 99%

Neurolymphomatosis on F-18 FDG PET/CT and MRI Findings: A Case Report

Hong

Lee

et al. 2010

Nucl Med Mol Imaging

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Neurolymphomatosis is a rare manifestation of malignant lymphoma. A 74-year-old man, in complete remission from diffuse large B cell lymphoma, presented with a loss of pain and temperature sensation in the left hemiface and left upper extremity, and motor weakness in the left upper and both lower extremities. Cerebrospinal fluid analysis and brain magnetic resonance imaging (MRI) findings were negative. Combined fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) revealed multiple linear hypermetabolic lesions along the mandibular branch of the left trigeminal nerve, left brachial plexus, right axillary nerve, right suprarenal plexus, right adrenal gland, right femoral nerve, and both sciatic nerves, which corresponded to the patient's complex neurologic symptoms. C-spine and pelvic MRI revealed diffuse thickening with enhancement in the left brachial plexus and in the proximal portion of the left sciatic nerve, but negative findings for other sites identified by FDG-PET/CT. These findings suggest that FDG-PET/CT can detect peripheral nerve infiltration by malignant lymphoma earlier than MRI. Thus, if a patient with a history of lymphoma presents with neurologic symptoms, FDG-PET/ CT should be performed to evaluate neurolymphomatosis.

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“…The use of PET in initial staging of HD up-staged 28.8% of the patients as compared to other imaging modalities and only 2.7% of the patients were down-staged. 12 The results indicate that PET use in initial staging and diagnosis can impact the expected prognosis of patients with HD. In a meta-analysis of twenty studies that looked at the diagnostic performance of PET in staging lymphoma, PET was found to have a median sensitivity of 90.3% and a median specificity of 91.1%.…”

Section: Lymphomamentioning

confidence: 92%

PET in Halifax

Chung¹,

Zoost²,

Burrell³

2011

DMJ

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With the recent installation of a PET-CT scanner in Halifax, local clinicians may now take advantage of PET's various applications in the field of oncology, where it has become a standard of care. PET also plays a role in the areas of cardiology and neurology although it has not yet been approved for these uses in Nova Scotia. This article describes the basic principles of PET and radiopharmaceuticals as well as PET's increasing role in the management of patients in the areas of oncology, neurology and cardiology. PET shows significant promise in these areas and clinicians should be familiar with its many applications.

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Contribution of PET imaging to the initial staging and prognosis of patients with Hodgkin's disease

Cited by 91 publications

References 24 publications

PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study

PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study

Neurolymphomatosis on F-18 FDG PET/CT and MRI Findings: A Case Report

PET in Halifax

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