Positron Emission Tomography Using 18F-Fluorodeoxyglucose for the Evaluation of Residual Hodgkin's Disease Mediastinal Masses

Abstract

Given its obvious prognostic implications, the correct interpretation of the significance of any residual mediastinal mass following Hodgkin's disease (HD) treatment keeps maintaining its paramount importance. In this respect, 18F-fluorodeoxyglucose positron emission tomography (PET) is proving very effective for both active disease detection and relapse prediction. Twenty-nine consecutive HD patients, in whom computed tomography (CT) scan performed after therapy completion had documented a residual mediatinal mass of at least 2 cm, prospectively entered the study and underwent PET within 1 week from CT scan. With a median follow-up of 28 months from PET execution, no relapse was recorded among the 17 patients presenting with a negative PET. On the contrary, 9 of the 12 patients presenting with a positive PET relapsed/progressed within one year from PET execution. PET's negative and positive predictive values at 1 year were 100% and 75%, respectively. A negative PET seems to possibly exclude relapse in HD patient with a residual mediastinal mass. On the contrary, a positive PET result indicates a significantly higher risk of relapse. However, due to possible false positive results, a closer follow-up for all and a pathologic study in few selected patients is warranted.

Preliminary experience with 18f-fluoro-deoxy-glucose positron emission tomography/computed tomography in pediatric oncology patients

“…This was confirmed in a prospective study on alteration of therapy of lymphoma, based on the results of PET scans for initial staging, restaging, or suspected recurrence 20 . There are few studies reporting on high negative predictive value of PET in HD patients 14,21 suggesting that PET is an excellent tool in persistent mediastinal masses but is best used to rule out relapse rather than to definitively diagnose recurrent disease. Accordingly, in our study, patients in which PET/CT showed no abnormal FDG uptake were considered disease free.…”

Altered glycolysis results in drug‑resistant in clinical tumor therapy (Review)

“…Furthermore, 2-DG combined with 5-fluorouracil can significantly improve its therapeutic effect in a high glucose microenvironment (75). 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) is a metabolic imaging tool used to detect lesions with increased glycolysis based on the glucose analog, fluorine-18 fluorodeoxyglucose (76). 18F-FDG PET can predict overall tumor behavior and sensitivity to treatment.…”

PET/CT in the management of haematological malignancies

“…Since changes in tissue function predate volume changes, it is possible to assess response using functional imaging. FDG‐PET seems to be able, at least to a large extent, to distinguish between viable lymphoma and necrosis or fibrosis in residual masses after treatment of Hodgkin lymphoma and aggressive non‐Hodgkin lymphomas, whereas the situation is less clear in indolent lymphomas (19, 20, 23, 28, 89–112). In a retrospective analysis of 54 patients with non‐Hodgkin lymphomas, patients with a residual mass on CT were classified as complete remission (CR) if FDG‐PET was negative (113).…”