FDG PET in lymphoma: The need for standardization of interpretation. An observer variation study

Zijlstra, Josée M.; Comans, Emile F.I.; Lingen, Arthur van; Hoekstra, Otto S.; Gundy, Chad M.; Coebergh, Jan Willem; Bongers, Vivian

doi:10.1097/mnm.0b013e3282eff2d5

Cited by 37 publications

(59 citation statements)

References 10 publications

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“…Therefore, even when blinded, readers may often disagree. In a study by Zijlstra et al, 64 the scoring of PET scans by 11 nuclear medicine physicians was compared with the interpretation by an expert. When the expert interpretation was that the PET scan result was positive, the agreement was 82% to 94%, but when the expert interpretation was that the PET findings were negative, the concordance was only 45%.…”

Section: Controversies In the Use Of Pet Scansmentioning

confidence: 99%

“…The investigators also found that more experienced PET readers tended to have fewer false-positive results. 64 This raises the question of whether all PET scans need expert review. Particularly in the context of clinical trials, it may be desirable to have the opinion of several experts to reduce interobserver variability.…”

Section: Controversies In the Use Of Pet Scansmentioning

confidence: 99%

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Positron Emission Tomographic Scans in Lymphoma: Convention and Controversy

Ansell

Armitage

2012

Mayo Clinic Proceedings

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The use of sensitive and specific imaging techniques for accurate initial staging and evaluation of response to therapy in patients with lymphoma is essential for their optimal management. Fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) integrated with computed tomography (CT) has emerged as a powerful imaging tool and is being routinely used in staging, response evaluation, and posttreatment surveillance in patients with non-Hodgkin lymphoma and Hodgkin lymphoma. PET/CT is currently widely used in clinical practice, but the established clinical benefit is currently restricted to the posttreatment evaluation of Hodgkin lymphoma, diffuse large B-cell lymphoma, and follicular lymphoma. Although used in other histologic subtypes and in other clinical situations including response assessment, its impact on patient outcome remains to be demonstrated. We performed a literature search of PubMed from 1999 to 2011 using the following keywords: PET scan, FDG-PET, PET/CT, lymphoma. This review addresses the challenges and controversies in the use of PET/CT scans in the management of patients with lymphoma. I n most patients with lymphoma, positron emission tomographic (PET) scans show abnormalities at diagnosis. Normal findings on the scan after therapy is highly predictive of a good prognosis, particularly in patients with diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, and Hodgkin lymphoma. However, the optimal application of PET scans to the management of all patients with lymphoma remains problematic. The major controversies include the optimal timing of PET scans (for staging, during therapy, after completion of therapy, surveillance in remission), standardization of PET scan interpretation (visual interpretation compared with standard uptake value [SUV] calculation), what constitutes a positive PET scan result, and whether PET scans should be used to direct management (eg, does changing therapy in patients with positive findings on PET change outcome, should biopsies of sites with positive PET results be done routinely before a management change). Although a large body of literature addressing these topics exists, the studies are often difficult to compare, making definitive conclusions on all these issues difficult. The previously published studies often used different designs and variable reporting, making interpretation and comparison of the results difficult. In the early studies particularly, heterogeneous populations with different stages of disease and different histologic subtypes were included, making the clinical applicability of the studies' results difficult. More recent studies focusing on efforts to standardize the conduct and interpretation of PET scans and on riskadapted therapies based on interim PET scan results will, it is hoped, improve the management and outcome of patients with lymphoma. A literature search of PubMed from 1999 to 2011 was performed using the following keywords: PET scan, FDG-PET, PET/CT, lymphoma. We highlight the current standard use ...

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Section: Controversies In the Use Of Pet Scansmentioning

confidence: 99%

Section: Controversies In the Use Of Pet Scansmentioning

confidence: 99%

Positron Emission Tomographic Scans in Lymphoma: Convention and Controversy

Ansell

Armitage

2012

Mayo Clinic Proceedings

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“…18F-fluoro-2-deoxyglucose positron emission tomography with/without computed tomography ( 18 F-FDG PET or 18 F-FDG PET/CT) has been increasingly used for the evaluation of several malignant tumors, including lymphoma [1,2]. Its most promising applications in lymphoma are the determination of the clinical stage of disease at initial presentation, and the evaluation of treatment response and recurrence [3].…”

Section: Introductionmentioning

confidence: 99%

“…Its most promising applications in lymphoma are the determination of the clinical stage of disease at initial presentation, and the evaluation of treatment response and recurrence [3]. The ability of 18 F-FDG PET to evaluate both nodal and extranodal sites, such as, spleen, liver, and bone marrow (BM), has been a matter of extensive investigation. In particular, BM infiltration is of crucial importance when staging lymphoma, since it signifies advanced-stage disease, and thus, may affect both treatment and prognosis.…”

Section: Introductionmentioning

confidence: 99%

“…However, early lymphomatous bone involvement with a normal CT appearance may be depicted by 18 F-FDG PET [5]. Moog and coworkers found 18 F-FDG PET/CT to be more sensitive and specific than 99m Tc-methylene diphosphonate bone scintigraphy for the detection of osseous involvement by lymphoma [6], and many recent studies have concluded that 18 F-FDG PET/CT has a significant role to play at baseline and for the evaluation of treatment response and restaging of malignant lymphoma.…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of 18F-FDG PET/CT for the Evaluation of Bone Marrow Involvement in Patients with High-Grade Non-Hodgkin’s Lymphoma

Lee

Hwang

Hong

et al. 2012

Nucl Med Mol Imaging

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Is local review of positron emission tomography scans sufficient in diffuse large B‐cell lymphoma clinical trials? A CALGB 50303 analysis

et al. 2023

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Background Quantitative methods of Fluorodeoxyglucose Positron Emission Tomography (FDG‐PET) interpretation, including the percent change in FDG uptake from baseline (ΔSUV), are under investigation in lymphoma to overcome challenges associated with visual scoring systems (VSS) such as the Deauville 5‐point scale (5‐PS). Methods In CALGB 50303, patients with DLBCL received frontline R‐CHOP or DA‐EPOCH‐R, and although there were no significant associations between interim PET responses assessed centrally after cycle 2 (iPET) using 5‐PS with progression‐free survival (PFS) or overall survival (OS), there were significant associations between central determinations of iPET ∆SUV with PFS/OS. In this patient cohort, we retrospectively compared local vs central iPET readings and evaluated associations between local imaging data and survival outcomes. Results Agreement between local and central review was moderate (kappa = 0.53) for VSS and high (kappa = 0.81) for ∆SUV categories (<66% vs. ≥66%). ∆SUV ≥66% at iPET was significantly associated with PFS (p = 0.03) and OS (p = 0.002), but VSS was not. Associations with PFS/OS when applying local review vs central review were comparable. Conclusions These data suggest that local PET interpretation for response determination may be acceptable in clinical trials. Our findings also highlight limitations of VSS and call for incorporation of more objective measures of response assessment in clinical trials.

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FDG PET in lymphoma: The need for standardization of interpretation. An observer variation study

Abstract: There are substantial disparities among nuclear medicine physicians' interpretations of FDG PET scans of lymphoma patients, which may affect patient care and results of multi-institutional clinical trials. A well-defined set of criteria is urgently needed to improve consistency.

Cited by 37 publications

References 10 publications

Positron Emission Tomographic Scans in Lymphoma: Convention and Controversy

Positron Emission Tomographic Scans in Lymphoma: Convention and Controversy

Usefulness of 18F-FDG PET/CT for the Evaluation of Bone Marrow Involvement in Patients with High-Grade Non-Hodgkin’s Lymphoma

Is local review of positron emission tomography scans sufficient in diffuse large B‐cell lymphoma clinical trials? A CALGB 50303 analysis

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