F‐18 <scp>FDG PET</scp>/<scp>CT</scp> quantization parameters as predictors of outcome in patients with diffuse large <scp>B</scp>‐cell lymphoma

Gallicchio, Rosj; Mansueto, Giovanna; Simeon, Vittorio; Nardelli, Anna; Guariglia, Roberto; Capacchione, Daniela; Soscia, Ernesto; Pedicini, P.; Gattozzi, Domenico A.; Musto, Pellegrino; Storto, Giovanni

doi:10.1111/ejh.12268

Cited by 75 publications

(82 citation statements)

References 37 publications

(41 reference statements)

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“…[27][28][29][30] Among these functional parameters, TLG appears of particular interest as a prognostic pointer in DLBCL. 27,[31][32][33][34][35] However, no specific study has so far addressed PMBCL as a distinct subtype [2][3][4][5][6] in which the metabolic response rate appears clearly inferior to that seen in other DLBCLs and Hodgkin lymphoma. 7,8,36 Although the overall results of treatment of PMBCL are favorable, 7,8 there remains a clear minority in whom the initial treatment fails, following which second-line treatment is frequently unsuccessful.…”

Section: Discussionmentioning

confidence: 99%

“…Different methods and a wide range of threshold levels have been proposed to calculate the volume-based PET parameters either in solid tumors or in different subtypes of lymphoma (mainly DLBCL). [25][26][27][28][29][30][31][32][33][34][35][42][43][44][45] Moreover, there are no published technical references about the methodology for the calculation of the volumebased PET parameters and definition of specific cutoff values in PMBCL.…”

Section: Discussionmentioning

confidence: 99%

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Utility of baseline 18FDG-PET/CT functional parameters in defining prognosis of primary mediastinal (thymic) large B-cell lymphoma

Ceriani

Martelli

Zinzani

et al. 2015

Blood

150

142

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Key Points• 18FDG PET/CT is a very important staging tool for patients with PMBCL. • Metabolic activity defined by TLG on the baseline PET scan is a powerful predictor of PMBCL outcome.The International Extranodal Lymphoma Study Group (IELSG) 26 study was designed to evaluate the role of 18 F-fluorodeoxyglucose (18FDG) positron emission tomography/ computed tomography (PET/CT) in the management of primary mediastinal (thymic) large B-cell lymphoma (PMBCL). We examined the prognostic impact of functional PET parameters at diagnosis. Metabolic activity defined by the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) was measured on baseline 18FDG PET/CT following a standard protocol in a prospectively enrolled cohort of 103 PMBCL patients. All received combination chemoimmunotherapy with doxorubicin-and rituximab-based regimens; 93 had consolidation radiotherapy. Cutoff values were determined using the receiver-operating characteristic curve. At a median follow-up of 36 months, progression-free survival (PFS) and overall survival (OS) were 87% and 94%, respectively. In univariate analysis, elevated MTV and TLG were significantly associated with worse PFS and OS. Only TLG retained statistical significance for both OS (P 5 .001) and PFS (P < .001) in multivariate analysis. At 5 years, OS was 100% for patients with low TLG vs 80% for those with high TLG (P 5 .0001), whereas PFS was 99% vs 64%, respectively (P < .0001). TLG on baseline PET appeared to be a powerful predictor of PMBCL outcomes and warrants further validation as a biomarker. The IELSG 26 study was registered at www.clinicaltrials.gov as #NCT00944567. (Blood. 2015;126(8):950-956)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Utility of baseline 18FDG-PET/CT functional parameters in defining prognosis of primary mediastinal (thymic) large B-cell lymphoma

Ceriani

Martelli

Zinzani

et al. 2015

Blood

150

142

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“…SUVmax was a predictor of survival. 65,66 One study did not find a predictive value for TLG, 66 whereas the other study did. 65 High MTV was a better predictor of survival than SUVmax in 165 patients with Ann Arbor stage IE or IIE primary gastrointestinal DLBCL and was an independent prognostic factor for PFS and OS in multivariate analysis.…”

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confidence: 98%

The Role of Functional Imaging in Lymphoma: Current Controversies and Future Directions

2014

Lymphoma and Chronic Lymphocytic Leukemias

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Fluorodeoxyglucose positron emission tomography (FDG-PET)/computerized tomography (CT) has revolutionized the management of several lymphoma subtypes, yet controversy remains regarding its cost-effectiveness and the appropriate interpretation of equivocal or false-positive PET scans. In this review, we examine the current evidence base informing the management of these controversial aspects of PET, and look ahead to the emerging uses of PET imaging and the application of novel tracers and quantification tools.

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“…In aggressive B-cell lymphoma (DLBCL), multiple retrospective studies investigated pretreatment PET-derived volumetrics as a potential predictor of survival in patients undergoing R-CHOP therapy (5)(6)(7)(8)(9). A systematic review of 7 retrospective DLBCL studies (n 5 703) suggested that both SUV max and MTV were significant prognostic factors for PFS (P 5 0.038 and 0.000, respectively) (5).…”

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confidence: 99%

“…These summarized studies used different segmentation techniques varying from fixed-threshold methods based on absolute SUV max (8) or percentage thresholding using 25% (11), 37% (9), 40% (10), 41% (1), or 42% of the SUV max (7). This methodologic variability resulted in widely disparate cutoff values ranging from 11 to 30 for SUV max , from 130 to 550 mL for MTV, and from 415 to 2,955 for TLG in the prediction survival in various lymphoma subtypes.…”

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confidence: 99%

Metabolic Tumor Volume: We Still Need a Platinum-Standard Metric

Gallamini

Kostakoglu

2016

J Nucl Med

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In this issue of The Journal of Nuclear Medicine, Cottereau et al.(1) retrospectively evaluate data compiled from a cohort of 106 peripheral T cell lymphoma patients, 50% of whom were previously enrolled in Lymphoma Study Association (LYSA) studies coordinated by 5 French and Belgian centers between 2006 and 2014. The objective was to determine the prognostic value of baseline total metabolic tumor volume (TMTV) calculated with adaptive thresholding methods as compared with TMTV measured with a fixed threshold. The methods used to calculate TMTV included the Daisne method, based on the tumorto-background ratios to segment tumor volumes, and the Nestle method, which compares the intensity of the tumor to that of the background. Despite substantial differences in cutoff values across different TMTV computing methods (631%), the authors reported excellent intraclass correlation coefficients (from 0.97 to 0.98) for discriminating low versus high TMTV.Tumor burden has long been considered an important prognostic marker in several lymphoma subtypes, hence its surrogates See page 276 such as bulky lesions, stage III-IV, or extranodal disease have been incorporated in several prognostic models including the IPI (international prognostic index), IPS (international prognostic score for Hodgkin lymphoma [HL]), FLIPI 1 and 2 (prognostic score for follicular lymphoma), MIPI (prognostic score for mantle cell lymphoma), PIT (prognostic index for peripheral T cell lymphoma), and AIP (prognostic model for angioimmunoblastic lymphoma). These prognostic models, however, are not considered sufficient to accurately stratify disease risk categories across patient populations. With the advent of advanced imaging techniques such as 18 F-FDG PET/CT and the availability of software offering sophisticated computer algorithms necessary for accurate tumor segmentation to calculate the sum of voxels of the tumor bulk, it became possible to quantify the functional activity and the total tumor burden.Earlier 18 F-FDG PET/CT studies found that a high metabolic tumor volume (MTV) was independently associated with progressionfree survival (PFS) and overall survival (OS) in HL patients treated with standard ABVD (doxorubicine, bleomycine, vinblastine, and dacarbazine), with or without involved-field radiotherappy (2,3), suggesting that pretherapy MTV as a measure of metabolically active whole-body tumor bulk was a predictor of outcome when the conventionally described tumor burden did not reach a significance. However, there is also evidence for contrasting results, showing that baseline MTV could not predict survival when IPS did, whereas percentage change (D) in both MTVand SUV max at interim PET was associated with PFS and OS (4). It is difficult to generalize these divergent results on the basis of retrospective analyses associated with no statistical design to determine a sufficiently high number of patient cohorts, inherent risk of bias for population selection, treatment protocols, and segmentation methodologies resulting in various MTV cut...

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F‐18 FDG PET/CT quantization parameters as predictors of outcome in patients with diffuse large B‐cell lymphoma

Cited by 75 publications

References 37 publications

Utility of baseline 18FDG-PET/CT functional parameters in defining prognosis of primary mediastinal (thymic) large B-cell lymphoma

Utility of baseline 18FDG-PET/CT functional parameters in defining prognosis of primary mediastinal (thymic) large B-cell lymphoma

The Role of Functional Imaging in Lymphoma: Current Controversies and Future Directions

Metabolic Tumor Volume: We Still Need a Platinum-Standard Metric

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