Article

The Utility of FDG-PET for Managing Patients with Malignant Lymphoma: Analysis of Data from a Single Cancer Center

Division of Hematology & Stem Cell Transplantation, Shizuoka Cancer Center, Shizuoka.
Internal Medicine (Impact Factor: 0.97). 02/2009; 48(17):1509-13. DOI: 10.2169/internalmedicine.48.1856
Source: PubMed

ABSTRACT (18)F-fluorodeoxyglucose (FDG) positron-emission tomography (PET) has been widely applied to malignant lymphoma both for initial staging and response evaluation. The objective is to compare the efficacy of the less common, but more easily implemented modality, CT, with that of FDG.
We retrospectively reviewed consecutive patients diagnosed with malignant lymphoma in our hospital between October 2002 and March 2006, and compared the efficacy of FDG-PET and CT. The standard reference was defined by the pathology and clinical course of patients followed for more than 3 months.
Thirty-three cases for staging and 62 cases for response evaluation after treatment were included. We calculated the sensitivity and specificity of each modality. The accuracy of the diagnostic modality was evaluated using receiver operating characteristic (ROC) analysis. The sensitivity and specificity of the initial staging were 87% and 100% on CT evaluation and 87% and 100% on FDG-PET, respectively. Sensitivity and specificity of the re-staging were 81% and 78% on CT evaluation and 82% and 97% on FDG-PET, respectively. The diagnostic accuracy of FDG-PET was comparable with that of CT both in initial staging and response evaluation. The maximum standardized uptake value was not associated with patient survival. In subgroup analysis, a tendency of lower sensitivity in the initial staging was found in FDG-PET for follicular lymphoma and CT for diffuse large B-cell lymphoma.
Although different staging procedures appear better suited to certain subtypes of lymphoma, in general CT imaging might be as useful as FDG-PET in initial staging in selected patients.

0 Followers
 · 
55 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hematopoietic malignancies that can be encountered in the breast include lymphoma, leukemia, and multiple myeloma/plasmacytoma. These are readily imaged via [18]F-fluorodeoxyglucose position emission tomography (PET)/computed tomography (CT) and can manifest as unilateral, bilateral, single, multiple, round/oval masses, or diffuse. These malignancies can occasionally mimic primary breast cancers. Conversely, benign conditions, such as the lactating breast can resemble hematopoietic malignancies of the breast. Although uncommon, familiarity with hematopoietic malignancies of the breast is important for proper interpretation of PET/CT. In this pictorial review, the PET/CT imaging features of patients with hematopoietic malignancies of the breast will be described, including pathology-proven cases of acute myelogenous leukemia, diffuse B-cell lymphoma, follicular lymphoma, acute myeloid leukemia with neutropenic granulocytic) sarcoma, and plasmacytoma. In addition, potential pitfalls will be discussed.
    Academic radiology 08/2010; 17(8):1026-30. DOI:10.1016/j.acra.2010.03.023 · 2.08 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A 38-year-old man presented to our hospital with abdominal pain and melena. Gastrointestinal endoscopy revealed a large gastric ulcer, and the pathological diagnosis of diffuse large B-cell lymphoma (DLBCL) was made based on immunohistochemical findings. Left diplopia developed soon after commencement of chemotherapy. Despite normal findings from head MRI, orbital involvement in DLBCL was detected with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). The patient was treated with salvage chemotherapy with success. Treatment analysis using FDG-PET for patients with DLBCL, especially for those with clinical symptoms and negative findings on conventional modalities, may be useful for assessing disease status and adjusting treatments.
    Internal Medicine 01/2011; 50(18):1953-6. DOI:10.2169/internalmedicine.50.5524 · 0.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We present findings concerning (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) at end-treatment evaluation in follicular lymphoma (FL) in order to establish possible predictive factors for progression-free survival (PFS) and patient outcome. We retrospectively analysed data from 91 consecutive FL patients (M:F = 51:40, mean age 61) referred to our PET Unit at therapy completion: 38 with an indolent form (grade 1-2) and 53 with an aggressive FL (grade 3a and b) according to the World Health Organization (WHO) classification. A total of 148 FDG PET/CT scans were analysed and findings reported as positive or negative for disease. The overall response to treatment was assessed according to the revised International Workshop Criteria (IWC). The final outcome was defined as remission or disease by taking clinical, instrumental and histological data as standards of reference, with a mean follow-up period of 3 years (range 1-8). A statistical analysis was performed with respect to PFS and patient outcome for FDG PET result, tumour grading, Follicular Lymphoma International Prognostic Index (FLIPI), disease stage and number of relapses, on uni- and multivariate analyses, with p < 0.05 considered as significant. Overall patients presented a mean PFS of 35 months (range 3-86), with a relapse rate of 42%. At final outcome, remission was achieved in 67 of 91 patients (74%). Of the different predictive factors, only FDG PET result significantly correlated with patient outcome (p = 0.0002). PET/CT performance at the end of treatment was as follows: 100% sensitivity, 99% specificity, 89% positive predictive value and 100% negative predictive value. The Kaplan-Meier analysis demonstrated a statistically significant correlation with PFS for FDG PET (p < 0.0001), FLIPI score (0-1 versus ≥ 2) (p = 0.0451) and number of relapses (none versus ≥ 1) (p = 0.0058). These findings were confirmed at the univariate analysis, whereas at the multivariate analysis only FDG PET (p = 0.0006892) and number of relapses (p = 0.01947) were independent predictive factors for PFS. End-treatment PET/CT in FL has high accuracy and appears to be a good predictor of PFS and patient outcome, irrespective of grading. As expected, patients facing more than one relapse seem to have significantly shorter PFS in the presence of a positive FDG PET.
    European Journal of Nuclear Medicine 02/2012; 39(5):864-71. DOI:10.1007/s00259-012-2079-y · 5.22 Impact Factor