101
|
Ujjani CS, Cheson BD. Overestimated value of FDG-PET based bone marrow evaluation in lymphoma: Response to Adams and Kwee. Br J Haematol 2016; 179:337-339. [PMID: 27391783 DOI: 10.1111/bjh.14216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Chaitra S Ujjani
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Bruce D Cheson
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC, USA
| |
Collapse
|
102
|
Chaganti S, Illidge T, Barrington S, Mckay P, Linton K, Cwynarski K, McMillan A, Davies A, Stern S, Peggs K. Guidelines for the management of diffuse large B-cell lymphoma. Br J Haematol 2016; 174:43-56. [PMID: 27196701 DOI: 10.1111/bjh.14136] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
MESH Headings
- Humans
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/therapeutic use
- Disease Management
- Doxorubicin/therapeutic use
- Frailty/therapy
- HIV Infections/complications
- HIV Infections/therapy
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/therapy
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/therapy
- Prednisone/therapeutic use
- Rituximab
- Salvage Therapy/methods
- United Kingdom
- Vincristine/therapeutic use
Collapse
Affiliation(s)
- Sridhar Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Tim Illidge
- Department of Clinical Oncology, Christie Hospital, Manchester, UK
| | - Sally Barrington
- PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital, London, UK
| | - Pam Mckay
- Department of Haematology, West of Scotland Cancer Centre, Glasgow, UK
| | - Kim Linton
- Department of Medical Oncology, Christie Hospital, Manchester, UK
| | - Kate Cwynarski
- Department of Haematology, Royal Free Hospital, London, UK
| | | | - Andy Davies
- Department of Medical Oncology, Southampton General Hospital, Southampton, UK
| | - Simon Stern
- Department of Haematology, St Helier Hospital, Carshalton, UK
| | - Karl Peggs
- Department of Haematology, University College Hospital, London, UK
| |
Collapse
|
103
|
Valls L, Badve C, Avril S, Herrmann K, Faulhaber P, O'Donnell J, Avril N. FDG-PET imaging in hematological malignancies. Blood Rev 2016; 30:317-31. [PMID: 27090170 PMCID: PMC5298348 DOI: 10.1016/j.blre.2016.02.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 02/12/2016] [Accepted: 02/19/2016] [Indexed: 12/12/2022]
Abstract
The majority of aggressive lymphomas is characterized by an up regulated glycolytic activity, which enables the visualization by F-18 FDG-PET/CT. One-stop hybrid FDG-PET/CT combines the functional and morphologic information, outperforming both, CT and FDG-PET as separate imaging modalities. This has resulted in several recommendations using FDG-PET/CT for staging, restaging, monitoring during therapy, and assessment of treatment response as well as identification of malignant transformation. FDG-PET/CT may obviate the need for a bone marrow biopsy in patients with Hodgkin's lymphoma and diffuse large B cell lymphoma. FDG-PET/CT response assessment is recommended for FDG-avid lymphomas, whereas CT-based response evaluation remains important in lymphomas with low or variable FDG avidity. The treatment induced change in metabolic activity allows for assessment of response after completion of therapy as well as prediction of outcome early during therapy. The five-point scale Deauville Criteria allows the assessment of treatment response based on visual FDG-PET analysis. Although the use of FDG-PET/CT for prediction of therapeutic response is promising it should only be conducted in the context of clinical trials. Surveillance FDG-PET/CT after complete remission is discouraged due to the relative high number of false-positive findings, which in turn may result in further unnecessary investigations. Future directions include the use of new PET tracers such as F-18 fluorothymidine (FLT), a surrogate biomarker of cellular proliferation and Ga-68 CXCR4, a chemokine receptor imaging biomarker as well as innovative digital PET/CT and PET/MRI techniques.
Collapse
Affiliation(s)
- L Valls
- Department of Radiology, University Hospitals Case Medical Center, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - C Badve
- Department of Radiology, University Hospitals Case Medical Center, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - S Avril
- Department of Pathology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
| | - K Herrmann
- Department of Nuclear Medicine, University Hospital Würzburg, 97080 Würzburg, Germany; Ahmanson Translational Imaging Division, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7370, USA
| | - P Faulhaber
- Department of Radiology, University Hospitals Case Medical Center, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - J O'Donnell
- Department of Radiology, University Hospitals Case Medical Center, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - N Avril
- Department of Radiology, University Hospitals Case Medical Center, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA.
| |
Collapse
|
104
|
Clinical approach to diffuse large B cell lymphoma. Blood Rev 2016; 30:477-491. [PMID: 27596109 DOI: 10.1016/j.blre.2016.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 05/26/2016] [Accepted: 06/20/2016] [Indexed: 12/19/2022]
Abstract
Diffuse large B cell lymphoma (DLBCL) is the most common subtype of lymphoma. We now recognize that DLBCL corresponds to a biologically heterogeneous family of diseases. Given the potential for cure for most DLBCL patients, appropriate diagnostic and staging evaluation and therapy are essential. Here we review areas of consensus as well as controversy in the evaluation, treatment and monitoring of patients with DLBCL and its related subtypes.
Collapse
|
105
|
Soltani Z, Davatchi F. 25 Years Old Women With Inflammatory Low Back Pain. Med Arch 2016; 70:219-22. [PMID: 27594751 PMCID: PMC5010057 DOI: 10.5455/medarh.2016.70.219-222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/15/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Diffuse large B-cell lymphoma (DLBCL) is the most frequent histological type of malignant lymphomas (approximately 30% of cases). DLBCL is highly curable through chemotherapy. Rituximab in combination with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy as the most frequent of care for first - DLBCL therapy, improves long-term survival of patients effectively. CASE REPORT A young female (25 years old) complained about pain in her right back for two years. She was suffering from backache with priority in the right and contracture in mornings. Sacroiliac joint seemed normal but lytic and sclerotic lesions and also density changing of L5 and humerus head was revealed by CT scan. Biopsy was taken from the iliac bone and diffuse large B cell lymphoma was diagnosed. CONCLUSION Chronic pains especially in axial skeleton, pelvis area and main joints must be taken seriously and examined by CT scan and MRI. If no particular issue was reported primarily while the pain was remained, a complete diagnosis BMB associated with PET must be applied. Despite of dependency on diagnosis the treatment by CHOP in association with rituximab is the most recommended chemotherapy alternative for patients with DLBCL.
Collapse
Affiliation(s)
- Zahra Soltani
- Rheumatologic Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Fereydon Davatchi
- Rheumatologic Research Center, Tehran University of Medical Science, Tehran, Iran
| |
Collapse
|
106
|
Barrington SF, Mikhaeel NG. PET Scans for Staging and Restaging in Diffuse Large B-Cell and Follicular Lymphomas. Curr Hematol Malig Rep 2016; 11:185-95. [PMID: 27095319 PMCID: PMC4858550 DOI: 10.1007/s11899-016-0318-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Positron emission tomography (PET)-CT was recommended in updated international guidelines for staging/restaging of diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). In FL, PET was previously regarded as a research application only. This review concentrates on new publications related to PET in these diseases. In DLBCL, PET appears appropriate for staging using prognostic indices established with CT and baseline PET parameters, e.g. metabolic tumour volume, are prognostic of outcome. Early complete metabolic response (CMR) predicts end-of-treatment CMR with excellent prognosis. Patients without CMR at interim should not have treatment altered, but have a worse prognosis, and patients with other high risk features may need closer monitoring. The end-of-treatment scan is confirmed as the standard for remission assessment using Deauville criteria, which are also predictive for patients undergoing ASCT. In FL, PET is more sensitive for staging than CT but misses bone marrow involvement. PET-CT identifies patients at risk of progression after induction chemotherapy better than CT.
Collapse
MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bone Marrow/pathology
- Fluorodeoxyglucose F18/chemistry
- Humans
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/diagnostic imaging
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/mortality
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Neoplasm Staging
- Positron-Emission Tomography
- Prognosis
- Survival Rate
- Tomography, X-Ray Computed
Collapse
Affiliation(s)
- Sally F Barrington
- PET Imaging Centre at St Thomas' Hospital, Division of Imaging Sciences and Biomedical Engineering, King's College London, Westminster Bridge Road, London, SE1 7EH, UK.
| | - N George Mikhaeel
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
| |
Collapse
|
107
|
Sun M, Cheng J, Zhang Y, Wang F, Meng Y, Fu X. Application value of diffusion weighted whole body imaging with background body signal suppression in monitoring the response to treatment of bone marrow involvement in lymphoma. J Magn Reson Imaging 2016; 44:1522-1529. [PMID: 27160047 DOI: 10.1002/jmri.25300] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 04/21/2016] [Accepted: 04/21/2016] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To investigate the application value of diffusion weighted whole body imaging with background body signal suppression (DWIBS) in monitoring the response to treatment of bone marrow involvement in lymphoma. MATERIALS AND METHODS Twenty-one lymphoma patients with bone marrow involvement underwent 1.5 Tesla DWIBS before chemotherapy and after the second chemotherapy session (median interval, 8 weeks; range 7-11 weeks). Apparent diffusion coefficient (ADC) values of bone marrow lesions were measured before and after treatment. The difference in ADC values before and after treatment in responders and nonresponders was analyzed. RESULTS Seventy-three cases of bone marrow lesions were diagnosed in 21 lymphoma patients before the treatment. After the second chemotherapy session, 18 patients (57 lesions) and 3 patients (9 lesions) were categorized into the responder and nonresponder group, respectively. The mean pretreatment ADC value of all lesions was 0.90 ± 0.39 × 10-3 mm2 /s, of which the mean ADC values of the responder group and nonresponder group were 0.92 ± 0.40 × 10-3 mm2 /s and 0.79 ± 0.29 × 10-3 mm2 /s, respectively (between-group difference: t = -0.94; P = 0.351). The posttreatment ADC value of the responder group significantly increased (66.39% ± 83.11%; P < 0.001) while the posttreatment ADC value of the nonresponder group slightly increased (5.32% ± 17.31%). The difference in the rate of change of ADC values in the responder and nonresponder groups before and after the treatment was significant (P < 0.05). CONCLUSION DWIBS in combination with the measurement of ADC values enabled a good short-term response evaluation for bone marrow involvement in lymphoma. However, the pretreatment ADC value indicated no significant predictive value for responses to the treatment. J. Magn. Reson. Imaging 2016;44:1522-1529.
Collapse
Affiliation(s)
- Mengtian Sun
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P. R. China
| | - Jingliang Cheng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P. R. China
| | - Yong Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P. R. China
| | - Feifei Wang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P. R. China
| | - Yun Meng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P. R. China
| | - Xiaorui Fu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P. R. China
| |
Collapse
|
108
|
Ujjani CS, Hill EM, Wang H, Nassif S, Esposito G, Ozdemirli M, Cordova C, Cheson BD. (18) F-FDG PET-CT and trephine biopsy assessment of bone marrow involvement in lymphoma. Br J Haematol 2016; 174:410-6. [PMID: 27098364 DOI: 10.1111/bjh.14071] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 01/26/2016] [Indexed: 11/29/2022]
Abstract
The ability of positron emission tomography-computerized tomography (PET-CT) to accurately detect bone marrow involvement (BMI) has been suggested in Hodgkin lymphoma (HL) and diffuse large B-cell lymphoma (DLBCL), but its abilities in other histologies is less established. The aim of this retrospective study was to confirm the role of PET-CT in detecting BMI in DLBCL and HL, and to explore its usefulness in other subtypes. Of the 149 newly diagnosed patients, common subtypes included DLBCL, follicular lymphoma (FL) and HL. In DLBCL, the sensitivity and specificity of PET-CT at diagnosis were 75% and 92%. In FL, the sensitivity and specificity of PET-CT were 67% and 85% at diagnosis, and 73% and 89% at relapse. In HL, the sensitivity and specificity were 100% and 74%. PET-CT was able to detect BMI in patients with negative biopsies. Most of the patients in which PET-CT failed to identify BMI were already advanced stage by imaging. In this analysis, PET-CT was highly accurate for detecting BMI at diagnosis in DLBCL and HL and highly specific in FL at diagnosis and relapse. Results also suggested the diagnostic advantage of PET-CT over bone marrow biopsy in detecting BMI. Prospective evaluation is necessary and may eliminate biopsies in future patients.
Collapse
Affiliation(s)
- Chaitra S Ujjani
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Elizabeth M Hill
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Hongkun Wang
- Department of Biostatistics, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Samer Nassif
- Department of Pathology, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Giuseppe Esposito
- Department of Nuclear Medicine, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Metin Ozdemirli
- Department of Pathology, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Christine Cordova
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Bruce D Cheson
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC, USA
| |
Collapse
|
109
|
Alzahrani M, El-Galaly TC, Hutchings M, Hansen JW, Loft A, Johnsen HE, Iyer V, Wilson D, Sehn LH, Savage KJ, Connors JM, Gascoyne RD, Johansen P, Clasen-Linde E, Brown P, Villa D. The value of routine bone marrow biopsy in patients with diffuse large B-cell lymphoma staged with PET/CT: a Danish-Canadian study. Ann Oncol 2016; 27:1095-1099. [PMID: 27002106 DOI: 10.1093/annonc/mdw137] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 03/10/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The added diagnostic and prognostic value of routine bone marrow biopsy (BMB) in patients with diffuse large B-cell lymphoma (DLBCL) undergoing positron emission tomography combined with computed tomography (PET/CT) staging is controversial. PATIENTS AND METHODS Patients with newly diagnosed DLBCL who underwent both staging PET/CT and BMB were retrospectively identified in British Columbia, Aalborg, and Copenhagen. Original written PET/CT and pathology reports were retrospectively reviewed to determine Ann Arbor stage and outcomes, with and without the contribution of BMB. RESULTS A total of 530 patients were identified: 146 (28%) had focal bone marrow (BM) lesions on PET/CT and 87 (16%) had positive BMB. Fifty-two of 146 patients (36%) with positive PET/CT had a positive BMB [39 DLBCL, 13 indolent non-Hodgkin lymphoma (iNHL)], while 35 of 384 patients (9%) with negative PET/CT had positive BMB (12 DLBCL, 23 iNHL). BMB upstaged 12/209 (6%) of stage I/II patients to stage IV, although this was the case for only 3 (1%) patients with DLBCL in the BMB. PET/CT identified BM involvement by BMB with sensitivity 60%, specificity 79%, positive predictive value 36%, and negative predictive value 91%. Concordant histological involvement of the BM by DLBCL was associated with worse overall survival and progression-free survival than discordant or no involvement in univariate and multivariate analyses. CONCLUSIONS In patients with DLBCL, staging PET/CT can miss BM involvement with concordant DLBCL (less common) or discordant iNHL (more common). Routine BMB does not add relevant diagnostic or prognostic value over PET/CT alone in the majority of patients with DLBCL.
Collapse
Affiliation(s)
- M Alzahrani
- Department of Hematology, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - T C El-Galaly
- Department of Hematology and Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg
| | | | | | - A Loft
- Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen
| | - H E Johnsen
- Department of Hematology and Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg
| | - V Iyer
- Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - D Wilson
- Department of Functional Imaging, British Columbia Cancer Agency and the University of British Columbia, Vancouver
| | | | | | | | - R D Gascoyne
- Department of Pathology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, Vancouver, Canada
| | - P Johansen
- Department of Pathology, Aalborg University Hospital, Aalborg
| | - E Clasen-Linde
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - D Villa
- Division of Medical Oncology.
| |
Collapse
|
110
|
Iioka F, Honjo G, Misaki T, Toda Y, Izumi K, Kamoda Y, Nagai Y, Akasaka T, Kitamura K, Nakagwa M, Fukutsuka K, Okumura A, Ohno H. A unique subtype of diffuse large B-cell lymphoma primarily involving the bone marrow, spleen, and liver, defined by fluorodeoxyglucose-positron emission tomography combined with computed tomography. Leuk Lymphoma 2016; 57:2593-602. [DOI: 10.3109/10428194.2016.1154959] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
111
|
Perry C, Lerman H, Joffe E, Sarid N, Amit O, Avivi I, Kesler M, Ben-Ezra J, Even-Sapir E, Herishanu Y. The Value of PET/CT in Detecting Bone Marrow Involvement in Patients With Follicular Lymphoma. Medicine (Baltimore) 2016; 95:e2910. [PMID: 26945387 PMCID: PMC4782871 DOI: 10.1097/md.0000000000002910] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Follicular lymphoma (FL) is the 2nd most common type of lymphoma diagnosed in the Western World. Bone marrow (BM) involvement is an adverse prognostic factor in FL, routinely assessed by an arbitrary biopsy of the iliac crest. This study was aimed to investigate the role of positron emission tomography/computed tomography (PET/CT) in identifying BM involvement by FL. In this retrospective, single-center study we reviewed the records of consecutive patients with FL at diagnosis or relapse who underwent staging/restaging workup visual assessment of BM uptake was categorized as either normal, diffusely increased, or focally increased. Quantitative BM fluorine-18-fluro-deoxyglucose (FDG) uptake was measured using mean standardized uptake value (BM-SUVmean). The diagnosis of BM involvement was based on either BM histological findings or disappearance of increased uptake at end-treatment PET/CT in patients who responded to treatment. Sixty eight cases with FL were included. Sixteen (23.5%) had BM involvement, 13 (19.1%) had a biopsy proven involvement, and 3 (4.4%) had a negative BM biopsy, but increased medullary uptake that normalized post-treatment. BM FDG uptake in these patients was diffuse in 8 (50%) and focal in 8 (50%). Focal increased uptake was indicative of BM involvement; however, diffuse uptake was associated with 17 false positive cases (32.7%). Overall, visual assessment of BM involvement had a negative predictive value (NPV) of 100% and a positive predictive value (PPV) of 48.5%. On a quantitative assessment, BM-SUVmean was significantly higher in patients with BM involvement (SUVmean of 3.7 [1.7-6] vs 1.4 [0.4-2.65], P < 0.001). On receiver operator curve (ROC) analysis, BM-SUVmean > 2.7 had a PPV of 100% for BM involvement (sensitivity of 68%), while BM-SUVmean < 1.7 had an NPV of 100% (specificity of 73%). Visual assessment of PET/CT is appropriate for ruling out BM involvement by FL. Although focal increased uptake indicates marrow involvement, diffuse uptake is nonspecific. SUV measurement improves PET/CT diagnostic accuracy, identifying additional 19% of patients with BM involvement that would have been otherwise missed.
Collapse
Affiliation(s)
- Chava Perry
- From the Department of Hematology (CP, EJ, NS, OA, IA, YH); Department of Nuclear Medicine (HL, MK, EES); Department of Pathology, Tel Aviv Sourasky Medical Center (B-E); and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (B-E, EES, IA, YH)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
112
|
Abstract
The management of diffuse large B-cell lymphoma depends on the initial diagnosis including molecular and immunophenotypic characteristics, Ann Arbor staging, and International Prognostic Index (IPI score). Treatment approaches with different chemotherapy regimens used is discussed in detail. The role of radiation as a consolidation is discussed including: (1) the prerituximab randomized trials that challenged the role of radiation, (2) recent prospective studies (UNFOLDER/RICOVER-60), and (3) retrospective studies; the last 2 showed a potential benefit of radiation both for early and advanced stage. The document also discusses the role of positron emission tomography/computed tomography for predicting outcome and potentially guiding therapy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
Collapse
|
113
|
Gheysens O, Thielemans S, Morscio J, Boeckx N, Goffin KE, Deroose CM, Sagaert X, Wlodarska I, Verhoef G, Dierickx D, Tousseyn T. Detection of bone marrow involvement in newly diagnosed post-transplant lymphoproliferative disorder:18F-fluorodeoxyglucose positron emission tomography/computed tomographyversusbone marrow biopsy. Leuk Lymphoma 2016; 57:2382-8. [DOI: 10.3109/10428194.2016.1140162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
114
|
Oh EJ, Kim EK, Yang WI, Yoon SO. Activation of the polycomb repressive complex pathway in the bone marrow resident cells of diffuse large B-cell lymphoma patients. Leuk Lymphoma 2016; 57:1921-32. [PMID: 26757888 DOI: 10.3109/10428194.2015.1121261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The present study investigated the activation of polycomb repressive complex 2 (PRC2) pathway proteins in the resident cells within the bone marrow hematopoietic microenvironment of diffuse large B-cell lymphoma (DLBCL) patients. PRC2 proteins (enhancer of zeste homolog 2, suppressor of zeste 12 homolog, and embryonic ectoderm development), histone methylation mark (H3K27me3), and c-MYC activation were evaluated in pretreatment bone marrow from 208 DLBLC patients. Positive expression of the PRC2, H3K27me3, and c-MYC in the bone marrow resident cells was more frequent in cases with bone marrow involvement of tumor. The expression among PRC2, H3K27me3 mark, and c-MYC was closely correlated. Positive PRC2 expression in bone marrow resident cells was significantly associated with inferior progression-free survival (PFS) and overall survival (OS) and determined to be an independent prognostic factor of inferior PFS and OS. In conclusion, the PRC pathway was frequently activated in bone marrow resident cells of DLBCL patients, and PRC activation was tumor-related and associated with poor clinical outcomes.
Collapse
Affiliation(s)
- Eun Ji Oh
- a Department of Pathology , Yonsei University College of Medicine , Seoul , Korea
| | - Eun Kyung Kim
- a Department of Pathology , Yonsei University College of Medicine , Seoul , Korea
| | - Woo Ick Yang
- a Department of Pathology , Yonsei University College of Medicine , Seoul , Korea
| | - Sun Och Yoon
- a Department of Pathology , Yonsei University College of Medicine , Seoul , Korea
| |
Collapse
|
115
|
El-Galaly TC, Villa D, Alzahrani M, Hansen JW, Sehn LH, Wilson D, de Nully Brown P, Loft A, Iyer V, Johnsen HE, Savage KJ, Connors JM, Hutchings M. Outcome prediction by extranodal involvement, IPI, R-IPI, and NCCN-IPI in the PET/CT and rituximab era: A Danish-Canadian study of 443 patients with diffuse-large B-cell lymphoma. Am J Hematol 2015; 90:1041-6. [PMID: 26260224 DOI: 10.1002/ajh.24169] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 08/01/2015] [Accepted: 08/06/2015] [Indexed: 12/30/2022]
Abstract
18F-fluorodeoxyglucose PET/CT (PET/CT) is the current state-of-the-art in the staging of diffuse large B-cell lymphoma (DLBCL) and has a high sensitivity for extranodal involvement. Therefore, reassessment of extranodal involvement and the current prognostic indices in the PET/CT era is warranted. We screened patients with newly diagnosed DLBCL seen at the academic centers of Aalborg, Copenhagen, and British Columbia for eligibility. Patients that had been staged with PET/CT and treated with R-CHOP(-like) 1(st) line treatment were retrospectively included. In total 443 patients met the inclusion criteria. With a median follow-up of 2.4 years, the 3-year overall (OS) and progression-free survival (PFS) were 73% and 69%, respectively. The Ann Arbor classification had no prognostic impact in itself with the exception of stage IV disease (HR 2.14 for PFS, P<0.01). Extranodal involvement was associated with a worse outcome in general, and in particular for patients with involvement of >2 extranodal sites, including HR 7.81 (P < 0.001) for PFS for >3 sites. Bone/bone marrow involvement was the most commonly involved extranodal site identified by PET/CT (29%) and was associated with an inferior PFS and OS. The IPI, R-IPI, and NCCN-IPI were predictive of PFS and OS, and the two latter could identify a very good prognostic subgroup with 3-year PFS and OS of 100%. PET/CT-ascertained extranodal involvement in DLBCL is common and involvement of >2 extranodal sites is associated with a dismal outcome. The IPI, R-IPI, and NCCN-IPI predict outcome with high accuracy.
Collapse
Affiliation(s)
- Tarec Christoffer El-Galaly
- Department of Hematology; Aalborg University Hospital; Aalborg Denmark
- Clinical Cancer Research Center, Aalborg University Hospital; Aalborg Denmark
| | - Diego Villa
- Division of Medical Oncology; British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia; Vancouver BC Canada
| | - Musa Alzahrani
- Department of Hematology, Faculty of Medicine; University of British Columbia; Vancouver BC Canada
- King Saud University; Riyadh Saudi Arabia
| | - Jakob Werner Hansen
- Department of Hematology; Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - Laurie H. Sehn
- Division of Medical Oncology; British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia; Vancouver BC Canada
| | - Don Wilson
- Department of Functional Imaging; British Columbia Cancer Agency and the University of British Columbia; Vancouver BC Canada
| | - Peter de Nully Brown
- Department of Hematology; Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine & PET; Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - Victor Iyer
- Department of Nuclear Medicine; Aalborg University Hospital; Aalborg Denmark
| | - Hans Erik Johnsen
- Department of Hematology; Aalborg University Hospital; Aalborg Denmark
- Clinical Cancer Research Center, Aalborg University Hospital; Aalborg Denmark
| | - Kerry J. Savage
- Division of Medical Oncology; British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia; Vancouver BC Canada
| | - Joseph M. Connors
- Division of Medical Oncology; British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia; Vancouver BC Canada
| | - Martin Hutchings
- Department of Hematology; Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| |
Collapse
|
116
|
El-Galaly TC, Pedersen MB, Hutchings M, Mylam KJ, Madsen J, Gang AO, Bøgsted M, de Nully Brown P, Loft A, Nielsen AL, Hendel HW, Iyer V, Gormsen LC. Utility of interim and end-of-treatment PET/CT in peripheral T-cell lymphomas: A review of 124 patients. Am J Hematol 2015. [PMID: 26201505 DOI: 10.1002/ajh.24128] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
According to the updated guidelines for imaging in lymphoma, 18F-FDG positron emission tomography/computed tomography (PET/CT) is recommended for staging and evaluation of treatment response in FDG-avid lymphomas. The purpose of the study was to evaluate the utility of PET/CT in nodal peripheral T-cell lymphomas (PTCL). Patients with newly diagnosed nodal PTCL (peripheral T-cell lymphoma NOS, anaplastic large-cell lymphoma, or angioimmunoblastic T-cell lymphoma) seen at five Danish hematology centers during the period 2006 to 2012 were included, if they had been pretherapeutically staged with PET/CT. Medical records were reviewed for baseline clinical and follow-up information. Staging, interim (I-PET), and end-of-treatment PET/CT (E-PET) studies were centrally reviewed, and reported using the Deauville 5-point score (DS). A total of 124 patients fulfilled the inclusion criteria. The median age was 58 years, and 88% received CHOP/CHOP-like therapy. Five years PFS and OS of the study population was 36.8% (95% CI 27.3-46.4) and 49.7% (95% CI 38.9-59.6), respectively. The presence of PET/CT-ascertained lung and/or liver involvement was associated with a worse outcome. The sensitivity of PET/CT for detecting biopsy-defined bone marrow involvement was only 18% (95% CI 4-43). An interim DS >3 was not prognostic for worse OS and PFS among CHOP/CHOP-like treated patients in uni- or multivariate analyses. A DS >3 after treatment predicted a worse prognosis. In conclusion, I-PET was not predictive of outcome in CHOP/CHOP-like treated PTCL patients when using the DS. Prospective studies are needed to determine the optimal use of PET/CT in PTCL including the role of quantitative PET/CT analysis.
Collapse
Affiliation(s)
| | | | - Martin Hutchings
- Department of Hematology; Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - Karen Juul Mylam
- Department of Hematology; Odense University Hospital; Odense Denmark
| | - Jakob Madsen
- Department of Hematology; Aalborg University Hospital; Aalborg Denmark
| | - Anne Ortved Gang
- Department of Hematology; Herlev Hospital, Copenhagen University Hospital; Denmark
| | - Martin Bøgsted
- Department of Hematology; Aalborg University Hospital; Aalborg Denmark
| | - Peter de Nully Brown
- Department of Hematology; Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - Annika Loft
- Department of Clinical Physiology; Nuclear Medicine and PET, Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | | | | | - Victor Iyer
- Department of Nuclear Medicine; Aalborg University Hospital; Aalborg Denmark
| | - Lars Christian Gormsen
- Department of Nuclear Medicine and PET Centre; Aarhus University Hospital; Aarhus Denmark
| |
Collapse
|
117
|
Johnson SA, Kumar A, Matasar MJ, Schöder H, Rademaker J. Imaging for Staging and Response Assessment in Lymphoma. Radiology 2015. [PMID: 26203705 DOI: 10.1148/radiol.2015142088] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Lymphoma comprises a heterogeneous group of diseases; remarkable advances have been made in diagnosis and treatment. Diagnostic imaging provides important information for staging and response assessment in patients with lymphoma. Over the years, staging systems have been refined, and dedicated criteria have been developed for evaluating response to therapy with both computed tomography (CT) and fluorine-18 fluorodeoxyglucose positron emission tomography (PET)/CT. The most recent system proposed for staging and response assessment, known as the Lugano classification, applies to both Hodgkin and non-Hodgkin lymphoma. The use of standardized criteria for staging and response assessment is important for making accurate treatment decisions and for determining the direction of further research. This review provides an overview of the updated CT and PET response criteria to familiarize the radiologist with the most important and clinically relevant aspects of lymphoma imaging. It also provides a short clinical update on lymphoma and the associated spectrum of imaging findings.
Collapse
Affiliation(s)
- Sarah A Johnson
- From the Department of Radiology (S.A.J., J.R.), Department of Medicine (A.K., M.J.M.), and Molecular Imaging and Therapy Service, Department of Radiology (H.S.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Anita Kumar
- From the Department of Radiology (S.A.J., J.R.), Department of Medicine (A.K., M.J.M.), and Molecular Imaging and Therapy Service, Department of Radiology (H.S.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Matthew J Matasar
- From the Department of Radiology (S.A.J., J.R.), Department of Medicine (A.K., M.J.M.), and Molecular Imaging and Therapy Service, Department of Radiology (H.S.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Heiko Schöder
- From the Department of Radiology (S.A.J., J.R.), Department of Medicine (A.K., M.J.M.), and Molecular Imaging and Therapy Service, Department of Radiology (H.S.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Jürgen Rademaker
- From the Department of Radiology (S.A.J., J.R.), Department of Medicine (A.K., M.J.M.), and Molecular Imaging and Therapy Service, Department of Radiology (H.S.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| |
Collapse
|
118
|
Adams HJA, Kwee TC, Fijnheer R, Dubois SV, Nievelstein RAJ, de Klerk JMH. Direct comparison of visual and quantitative bone marrow FDG-PET/CT findings with bone marrow biopsy results in diffuse large B-cell lymphoma: does bone marrow FDG-PET/CT live up to its promise? Acta Radiol 2015; 56:1230-5. [PMID: 25387723 DOI: 10.1177/0284185114554824] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 08/20/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Detection of bone marrow involvement using 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) has been proposed as a non-invasive alternative to standard blind bone marrow biopsy (BMB) of the posterior iliac crest in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). However, studies that directly compare FDG-PET/CT results with histopathology are currently lacking. PURPOSE To directly compare both visual and quantitative bone marrow FDG-PET/CT to BMB at the right posterior iliac crest in patients with newly diagnosed DLBCL. MATERIAL AND METHODS A total of 40 patients with newly diagnosed DLBCL, who had undergone FDG-PET/CT before BMB of the right posterior iliac crest, were retrospectively included. FDG-PET/CT images were visually assessed for bone marrow involvement in the right posterior iliac crest. 3D partial volume corrected mean standardized uptake value (cSUVmean), maximum standardized uptake value (SUVmax), and peak standardized uptake value (SUVpeak) were measured in the right posterior iliac crest, using volume of interest analysis. BMB of the right posterior iliac crest was used as reference standard for bone marrow involvement. RESULTS Sensitivity and specificity of visual FDG-PET/CT analysis for the detection of bone marrow involvement in the right posterior iliac crest were 14.3% (95% confidence interval [CI], 0.5-53.4%) and 100% (95% CI, 87.6-100%), respectively. cSUVmean, SUVmax, and SUVpeak of BMB-negative patients (1.4 ± 0.49, 2.2 ± 0.69, and 1.7 ± 0.59, respectively) considerably overlapped with those of BMB-positive patients (1.8 ± 0.53, 2.7 ± 0.71, and 2.2 ± 0.61, respectively). CONCLUSION In a local, head-to-head comparison with BMB, the diagnostic value of both visual and quantitative FDG-PET/CT for the detection of bone marrow involvement is low in patients with newly diagnosed DLBCL.
Collapse
Affiliation(s)
- Hugo JA Adams
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas C Kwee
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rob Fijnheer
- Department of Hematology, Meander Medical Center, Amersfoort, The Netherlands
| | - Stefan V Dubois
- Department of Pathology, Meander Medical Center, Amersfoort, The Netherlands
| | - Rutger AJ Nievelstein
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - John MH de Klerk
- Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands
| |
Collapse
|
119
|
Adams HJ, Kwee TC. Increased bone marrow FDG uptake at PET/CT is not a sufficient proof of bone marrow involvement in diffuse large B-cell lymphoma. Am J Hematol 2015; 90:E182-3. [PMID: 26010072 DOI: 10.1002/ajh.24061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 05/10/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Hugo J.A. Adams
- Department of Radiology and Nuclear Medicine; University Medical Center Utrecht; Utrecht The Netherlands
| | - Thomas C. Kwee
- Department of Radiology and Nuclear Medicine; University Medical Center Utrecht; Utrecht The Netherlands
| |
Collapse
|
120
|
Tilly H, Gomes da Silva M, Vitolo U, Jack A, Meignan M, Lopez-Guillermo A, Walewski J, André M, Johnson PW, Pfreundschuh M, Ladetto M. Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 Suppl 5:v116-25. [PMID: 26314773 DOI: 10.1093/annonc/mdv304] [Citation(s) in RCA: 527] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- H Tilly
- Centre Henri-Becquerel, Université de Rouen, Rouen, France
| | | | - U Vitolo
- A.O. Città della Salute e della Scienza di Torino, Turin, Italy
| | - A Jack
- St James's University Hospital, Leeds, UK
| | - M Meignan
- Henri Mondor University Hospital, Créteil, France
| | | | - J Walewski
- Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland
| | - M André
- CHU Dinant-Godinne, UCL Namur, Yvoir, Belgium
| | - P W Johnson
- Cancer Research UK, University of Southampton, Southampton, UK
| | - M Pfreundschuh
- Innere Medizin I, Universität des Saarlandes, Hamburg, Germany
| | - M Ladetto
- Divisione di Ematologia, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| |
Collapse
|
121
|
Li A, Poon L, Khoo KL, Seet JE, Sinha AK, Lee P. A man with pleural effusion and ascites. Chest 2015; 147:e208-e214. [PMID: 26033134 DOI: 10.1378/chest.14-2237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
A male lifelong nonsmoker aged 58 years with no prior asbestos exposure complained of gradual worsening breathlessness over 3 months. This was associated with abdominal and leg swelling and a 2-kg weight loss. He had no fever, night sweats, hemoptysis, joint pain, rash, abdominal pain, chest pain, or orthopnea. The patient had no recent travel or contact with pulmonary TB. He had stage I left-side testicular seminoma treated with left-sided radical orchidectomy 10 years previous and recently received a diagnosis of Child's B alcoholic liver cirrhosis. His hepatitis B and C screen result was normal.
Collapse
Affiliation(s)
- Andrew Li
- Division of Respiratory and Critical Care Medicine, National University Hospital, Singapore.
| | - Limei Poon
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, Singapore
| | - Kay-Leong Khoo
- Division of Respiratory and Critical Care Medicine, National University Hospital, Singapore
| | - Ju-Ee Seet
- Department of Pathology, National University Hospital, Singapore
| | - Arvind Kumar Sinha
- Department of Diagnostic-Imaging, National University Hospital, Singapore
| | - Pyng Lee
- Division of Respiratory and Critical Care Medicine, National University Hospital, Singapore
| |
Collapse
|
122
|
Chen-Liang TH, Martin-Santos T, Jerez A, Senent L, Orero MT, Remigia MJ, Muiña B, Romera M, Fernandez-Muñoz H, Raya JM, Fernandez-Gonzalez M, Lancharro A, Villegas C, Carlos Herrera J, Frutos L, Luis Navarro J, Uña J, Igua C, Sanchez-Vaño R, Cozar MDP, Contreras J, Sanchez-Blanco JJ, Perez-Ceballos E, Ortuño FJ. The role of bone marrow biopsy and FDG-PET/CT in identifying bone marrow infiltration in the initial diagnosis of high grade non-Hodgkin B-cell lymphoma and Hodgkin lymphoma. Accuracy in a multicenter series of 372 patients. Am J Hematol 2015; 90:686-90. [PMID: 25925613 DOI: 10.1002/ajh.24044] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/24/2015] [Accepted: 04/27/2015] [Indexed: 12/20/2022]
Abstract
Bone marrow infiltration (BMI), categorized as an extra-nodal site, affects stage and is associated with poor prognosis in newly diagnosed lymphoma patients. We have evaluated the accuracy of PET/CT and bone marrow biopsy (BMB) to assess BMI in 372 lymphoma patients [140 Hodgkin Lymphoma (HL) and 232 High Grade B-cell non-Hodgkin Lymphoma (HG B-NHL), among them 155 Diffuse Large B-Cell Lymphoma (DLCL)]. For HL cases, and taking into account PET/CT, sensitivity, negative predictive value (NPV) and accuracy were 96.7, 99.3, and 99.3% while those of BMB were 32.3, 83.8, and 85%, respectively. For HG B-NHL and considering PET/CT, sensitivity, NPV, and accuracy were 52.7, 81.7, and 84.1%, while those of BMB were 77.6, 90.2, and 90.7%, respectively. In the HG B-NHL group, 25 patients would have been under-staged without BMB. These results lead us to recommend PET/CT and the avoidance of BMB to assess BMI in HL. In the case of HG B-NHL, bone marrow status should be assessed firstly by means of PET/CT; only in either focal or diffuse PET/CT with low borderline SUV max values or in negative cases, should BMB be carried out afterwards. In the HG B-NHL setting and at the present moment, both techniques are complementary.
Collapse
Affiliation(s)
- Tzu-Hua Chen-Liang
- S. de Hematología Y Oncología Médica. H.J.M. Morales Meseguer; Murcia Spain
| | | | - Andres Jerez
- S. de Hematología Y Oncología Médica. H.J.M. Morales Meseguer; Murcia Spain
| | | | | | | | - Begoña Muiña
- S. de Hematología. H. R. Méndez; Lorca Murcia Spain
| | | | | | - Jose M. Raya
- S. de Hematología. H, Universitario de Canarias; La Laguna Tenerife Spain
| | | | | | | | | | - Laura Frutos
- S. de Medicina Nuclear. H, Virgen de La Arrixaca; Murcia Spain
| | | | - Jon Uña
- S. de Medicina Nuclear H, Universitario N.S. de La Candelaria; Tenerife Spain
| | | | | | | | - Jose Contreras
- S. de Medcina Nuclear. H, Sta Lucia; Cartagena Murcia Spain
| | | | | | | |
Collapse
|
123
|
|
124
|
Meignan M, Hutchings M, Schwartz LH. Imaging in Lymphoma: The Key Role of Fluorodeoxyglucose-Positron Emission Tomography. Oncologist 2015; 20:890-5. [PMID: 26173837 DOI: 10.1634/theoncologist.2015-0036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 03/20/2015] [Indexed: 01/14/2023] Open
Affiliation(s)
- Michel Meignan
- Centre Universitaire Hospitalier Henri Mondor, Lymphoma Study Association Imaging, Créteil, France; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Columbia University Medical Center, New York, New York, USA
| | - Martin Hutchings
- Centre Universitaire Hospitalier Henri Mondor, Lymphoma Study Association Imaging, Créteil, France; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Columbia University Medical Center, New York, New York, USA
| | - Lawrence H Schwartz
- Centre Universitaire Hospitalier Henri Mondor, Lymphoma Study Association Imaging, Créteil, France; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Columbia University Medical Center, New York, New York, USA
| |
Collapse
|
125
|
Dayton VJ, Linden MA, McKenna RW, Yohe S, Fink J, Park K, Kubic V. In Reply. Arch Pathol Lab Med 2015; 139:846-7. [PMID: 26125422 DOI: 10.5858/arpa.2014-0509-le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Vanessa J Dayton
- Department of Hematopathology, Laboratory Medicine and ;Pathology, University of Minnesota Medical Center, Minneapolis, MN 55455-0385
| | - Michael A Linden
- Department of Hematopathology, Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN 55455-0385
| | - Robert W McKenna
- Department of Hematopathology, Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN 55455-0385
| | - Sophia Yohe
- Department of Hematopathology, Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN 55455-0385
| | - James Fink
- Department of Hematopathology, Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN 55455-0385
| | - Katherine Park
- Department of Hematopathology, Laboratory Medicine and Pathology, Hennepin County Medical Center, Minneapolis, MN 5540
| | - Virginia Kubic
- Department of Hematopathology, Laboratory Medicine and Pathology, Hennepin County Medical Center, Minneapolis, MN 5540
| |
Collapse
|
126
|
Kim HK, Cheung DY. Once in a blue moon, the bone marrow aspiration and biopsy has clinical impact for gastric mucosa-associated lymphoid tissue lymphoma. Gut Liver 2015; 8:577-9. [PMID: 25368742 PMCID: PMC4215440 DOI: 10.5009/gnl14367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Hye Kang Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Dae Young Cheung
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| |
Collapse
|
127
|
Yang YQ, Ding CY, Xu J, Fan L, Wang L, Tian T, Li TN, Li JY, Xu W. Exploring the role of bone marrow increased FDG uptake on PET/CT in patients with lymphoma-associated hemophagocytic lymphohistiocytosis: a reflection of bone marrow involvement or cytokine storm? Leuk Lymphoma 2015; 57:291-298. [DOI: 10.3109/10428194.2015.1048442] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
128
|
Meignan M, Gallamini A, Haioun C, Barrington S, Itti E, Luminari S, Polliack A. Report on the 5th International Workshop on Positron Emission Tomography in Lymphoma held in Menton, France, 19–20 September 2014. Leuk Lymphoma 2015; 56:1229-32. [DOI: 10.3109/10428194.2015.1029748] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
129
|
Adams HJA, Nievelstein RAJ, Kwee TC. Opportunities and limitations of bone marrow biopsy and bone marrow FDG-PET in lymphoma. Blood Rev 2015; 29:417-25. [PMID: 26113144 DOI: 10.1016/j.blre.2015.06.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 06/10/2015] [Accepted: 06/12/2015] [Indexed: 12/17/2022]
Abstract
Bone marrow involvement in lymphoma may have prognostic and therapeutic consequences. Bone marrow biopsy (BMB) is the established method for the evaluation of the bone marrow. (18)F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) plays an important role in lymphoma staging, but its value in the assessment of the bone marrow and whether it can replace BMB is still a topic of debate and investigation. The purpose of this scientific communication is to provide an evidence-based overview about the opportunities and limitations of BMB and FDG-PET in the evaluation of the bone marrow in patients with lymphoma. This article first reviews the basic properties, opportunities and limitations of BMB and bone marrow FDG-PET, and then focuses on the clinical utility of BMB and bone marrow FDG-PET in three major lymphoma subtypes including Hodgkin lymphoma, diffuse large B-cell lymphoma, and follicular lymphoma.
Collapse
Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Rutger A J Nievelstein
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas C Kwee
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
130
|
Role of FDG-PET/CT in staging and first-line treatment of Hodgkin and aggressive B-cell lymphomas. MEMO-MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2015. [DOI: 10.1007/s12254-015-0215-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
131
|
Fernández-Tejada A, Cañada FJ, Jiménez-Barbero J. Recent Developments in Synthetic Carbohydrate-Based Diagnostics, Vaccines, and Therapeutics. Chemistry 2015; 21:10616-28. [PMID: 26095198 DOI: 10.1002/chem.201500831] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Glycans are everywhere in biological systems, being involved in many cellular events with important implications for medical purposes. Building upon a detailed understanding of the functional roles of carbohydrates in molecular recognition processes and disease states, glycans are increasingly being considered as key players in pharmacological research. On the basis of the important progress recently made in glycochemistry, glycobiology, and glycomedicine, we provide a complete overview of successful applications and future perspectives of carbohydrates in the biopharmaceutical and medical fields. This review highlights the development of carbohydrate-based diagnostics, exemplified by glycan imaging techniques and microarray platforms, synthetic oligosaccharide vaccines against infectious diseases (e.g., HIV) and cancer, and finally carbohydrate-derived therapeutics, including glycomimetic drugs and glycoproteins.
Collapse
Affiliation(s)
| | - F Javier Cañada
- Chemical and Physical Biology, CIB-CSIC, Ramiro de Maeztu 9, 28040 Madrid (Spain)
| | - Jesús Jiménez-Barbero
- Infectious Disease Programme, Center for Cooperative Research in Biosciences, CIC-bioGUNE, Bizkaia Technology Park, 48160 Derio (Spain). .,Ikerbasque, Basque Foundation for Science, María López de Haro 13, 48009 Bilbao (Spain).
| |
Collapse
|
132
|
Bai J, Zhang Y, Duan M, Li J, Cao X, Cai H, Zhuang J, Chen M, Zhou D, Zhu Z, Zhang W. [Diagnostic value of three evaluation methods of ¹⁸F-FDG PET/CT in detecting bone marrow infiltration in patients with newly diagnosed diffuse large B-cell lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2015; 36:489-92. [PMID: 26134014 PMCID: PMC7343072 DOI: 10.3760/cma.j.issn.0253-2727.2015.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate three methods of ¹⁸F-FDG PET/CT in detecting bone marrow infiltration in patients with newly diagnosed diffuse large B-cell lymphoma. METHODS Seventy-seven patients with newly diagnosed diffuse large B-cell lymphoma from July 2012 to June 2014 were retrospectively analyzed. All patients received both ¹⁸F-FDG PET/CT scan and bone marrow biopsy in the region of the posterior iliac crests. There were three evaluation methods of ¹⁸F-FDG PET/CT to detect bone marrow infiltration, including visual comparison (the FDG uptake in bone marrow of iliac crests was higher than the normal liver tissue), the maximal standardized uptake values (SUV(max)) in bone marrow of iliac crests (more than or equal to 2.5), the ratio of maximal standardized uptake values of iliac crests bone marrow to liver parenchyma intensity (more than 1). All results were compared with the bone marrow biopsy. RESULTS Visual comparison of ¹⁸F-FDG PET/CT could be used to diagnose bone marrow infiltration, with the sensitivity of 100.00%, specificity of 80.00%, positive predictive value of 48.00%, and negative predictive value of 100.00%. When the SUV(max) of iliac crests was used as the diagnostic threshold, the sensitivity was 75.00%, with 92.31% specificity, 64.29% positive predictive value, and 95.24% negative predictive value. The ratio of SUV(max) had the best diagnostic efficiency, with sensitivity of 100.00%, specificity of 90.77%, positive predictive value of 66.67%, and negative predictive value of 100.00%. CONCLUSION The ratio of SUV(max) is a valuable diagnostic method in detecting diffuse large B-cell lymphoatic bone marrow involvement.
Collapse
Affiliation(s)
- Jiefei Bai
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yingqiang Zhang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Minghui Duan
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jian Li
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xinxin Cao
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Huacong Cai
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Junling Zhuang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Miao Chen
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Daobin Zhou
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhaohui Zhu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wei Zhang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| |
Collapse
|
133
|
Adams HJA, de Klerk JMH, Fijnheer R, Heggelman BGF, Dubois SV, Nievelstein RAJ, Kwee TC. Does the presence of tumor-induced cortical bone destruction at CT have any prognostic value in newly diagnosed diffuse large B-cell lymphoma? Skeletal Radiol 2015; 44:687-94. [PMID: 25662178 PMCID: PMC4363520 DOI: 10.1007/s00256-015-2102-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 10/30/2014] [Accepted: 01/09/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the prognostic value of tumor-induced cortical bone destruction at computed tomography (CT) in newly diagnosed diffuse large B-cell lymphoma (DLBCL). MATERIALS AND METHODS This retrospective study included 105 patients with newly diagnosed DLBCL who had undergone CT and bone marrow biopsy (BMB) before R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, Oncovin, and prednisolone) chemo-immunotherapy. Cox regression analyses were used to determine the associations of cortical bone status at CT (absence vs. presence of tumor-induced cortical bone destruction), BMB findings (negative vs. positive for lymphomatous involvement), and dichotomized National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) strata (low risk vs. high risk) with progression-free survival (PFS) and overall survival (OS). RESULTS Univariate Cox regression analysis indicated that cortical bone status at CT was no significant predictor of either PFS or OS (p = 0.358 and p = 0.560, respectively), whereas BMB findings (p = 0.002 and p = 0.013, respectively) and dichotomized NCCN-IPI risk strata (p = 0.002 and p = 0.003, respectively) were significant predictors of both PFS and OS. In the multivariate Cox proportional hazards model, only the dichotomized NCCN-IPI score was an independent predictive factor of PFS and OS (p = 0.004 and p = 0.003, respectively). CONCLUSIONS The presence of tumor-induced cortical bone destruction at CT was not found to have any prognostic implications in newly diagnosed DLBCL.
Collapse
Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands,
| | | | | | | | | | | | | |
Collapse
|
134
|
Painter D, Smith A, de Tute R, Crouch S, Roman E, Jack A. The clinical impact of staging bone marrow examination on treatment decisions and prognostic assessment of lymphoma patients. Br J Haematol 2015; 170:175-8. [DOI: 10.1111/bjh.13412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 02/16/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Dan Painter
- Epidemiology and Cancer Statistics Group; University of York; York UK
| | - Alexandra Smith
- Epidemiology and Cancer Statistics Group; University of York; York UK
| | - Ruth de Tute
- Haematological Malignancy Diagnostic Service; Leeds Cancer Centre Leeds; Leeds UK
| | - Simon Crouch
- Epidemiology and Cancer Statistics Group; University of York; York UK
| | - Eve Roman
- Epidemiology and Cancer Statistics Group; University of York; York UK
| | - Andrew Jack
- Haematological Malignancy Diagnostic Service; Leeds Cancer Centre Leeds; Leeds UK
| |
Collapse
|
135
|
El-Galaly TC, Hutchings M. Imaging of non-Hodgkin lymphomas: diagnosis and response-adapted strategies. Cancer Treat Res 2015; 165:125-46. [PMID: 25655608 DOI: 10.1007/978-3-319-13150-4_5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Optimal lymphoma management requires accurate pretreatment staging and reliable assessment of response, both during and after therapy. Positron emission tomography with computerized tomography (PET/CT) combines functional and anatomical imaging and provides the most sensitive and accurate methods for lymphoma imaging. New guidelines for lymphoma imaging and recently revised criteria for lymphoma staging and response assessment recommend PET/CT staging, treatment monitoring, and response evaluation in all FDG-avid lymphomas, while CT remains the method of choice for non-FDG-avid histologies. Since interim PET imaging has high prognostic value in lymphoma, a number of trials investigate PET-based, response-adapted therapy for non-Hodgkin lymphomas (NHL). PET response is the main determinant of response according to the new response criteria, but PET/CT has little or no role in routine surveillance imaging, the value which is itself questionable. This review presents from a clinical point of view the evidence for the use of imaging and primarily PET/CT in NHL before, during, and after therapy. The reader is given an overview of the current PET-based interventional NHL trials and an insight into possible future developments in the field, including new PET tracers.
Collapse
|
136
|
Moskowitz CH, Schöder H. Current Status of the Role of PET Imaging in Diffuse Large B-Cell Lymphoma. Semin Hematol 2015; 52:138-42. [DOI: 10.1053/j.seminhematol.2015.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
137
|
Adams HJ, Kwee TC. Do Not Abandon the Bone Marrow Biopsy Yet in Diffuse Large B-Cell Lymphoma. J Clin Oncol 2015; 33:1217-1217. [DOI: 10.1200/jco.2014.58.7360] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
| | - Thomas C. Kwee
- University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
138
|
Barrington SF, Mikhaeel NG, Kostakoglu L, Meignan M, Hutchings M, Müeller S, Schwartz LH, Zucca E, Fisher RI, Trotman J, Hoekstra OS, Hicks RJ, O'Doherty MJ, Hustinx R, Biggi A, Cavalli F, Lister TA, Cheson BD. Reply to B. Bennani-Baiti et al, H.J.A. Adams et al, E. Laffon et al, and E.A. Hawkes et al. J Clin Oncol 2015; 33:1221-3. [PMID: 25691678 DOI: 10.1200/jco.2014.59.9373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - N George Mikhaeel
- Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | | | - Michel Meignan
- Centre Universitaire Hospitalier Henri Mondor, Creteil, Paris, France
| | - Martin Hutchings
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | | | - Judith Trotman
- Concord Hospital, and University of Sydney, Sydney, New South Wales, Australia
| | | | - Rodney J Hicks
- Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | - Franco Cavalli
- Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | | | - Bruce D Cheson
- Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC
| |
Collapse
|
139
|
Abstracts from the 5th International Workshop on Positron Emission Tomography in Lymphoma held in Menton, France, 19–20 September 2014. Leuk Lymphoma 2015. [DOI: 10.3109/10428194.2015.1034707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
140
|
Cho SF, Chang CC, Liu YC, Chang CS, Hsiao HH, Liu TC, Huang CT, Lin SF. Utilization of 18F-FDG PET/CT as a staging tool in patients with newly diagnosed lymphoma. Kaohsiung J Med Sci 2015; 31:130-7. [DOI: 10.1016/j.kjms.2014.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 11/19/2014] [Accepted: 11/04/2014] [Indexed: 11/30/2022] Open
|
141
|
Barrington SF, Mikhaeel NG, Kostakoglu L, Meignan M, Hutchings M, Müeller SP, Schwartz LH, Zucca E, Fisher RI, Trotman J, Hoekstra OS, Hicks RJ, O'Doherty MJ, Hustinx R, Biggi A, Cheson BD. Role of imaging in the staging and response assessment of lymphoma: consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J Clin Oncol 2015; 32:3048-58. [PMID: 25113771 DOI: 10.1200/jco.2013.53.5229] [Citation(s) in RCA: 1075] [Impact Index Per Article: 119.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Recent advances in imaging, use of prognostic indices, and molecular profiling techniques have the potential to improve disease characterization and outcomes in lymphoma. International trials are under way to test image-based response–adapted treatment guided by early interim positron emission tomography (PET)–computed tomography (CT). Progress in imaging is influencing trial design and affecting clinical practice. In particular, a five-point scale to grade response using PET-CT, which can be adapted to suit requirements for early- and late-response assessment with good interobserver agreement, is becoming widely used both in practice- and response-adapted trials. A workshop held at the 11th International Conference on Malignant Lymphomas (ICML) in 2011 concluded that revision to current staging and response criteria was timely. METHODS An imaging working group composed of representatives from major international cooperative groups was asked to review the literature, share knowledge about research in progress, and identify key areas for research pertaining to imaging and lymphoma. RESULTS A working paper was circulated for comment and presented at the Fourth International Workshop on PET in Lymphoma in Menton, France, and the 12th ICML in Lugano, Switzerland, to update the International Harmonisation Project guidance regarding PET. Recommendations were made to optimize the use of PET-CT in staging and response assessment of lymphoma, including qualitative and quantitative methods. CONCLUSION This article comprises the consensus reached to update guidance on the use of PET-CT for staging and response assessment for [18F]fluorodeoxyglucose-avid lymphomas in clinical practice and late-phase trials.
Collapse
|
142
|
Adams HJ, Kwee TC, Fijnheer R, Dubois SV, Nievelstein RA, de Klerk JM. Diffusely increased bone marrow FDG uptake in recently untreated lymphoma: incidence and relevance. Eur J Haematol 2015; 95:83-9. [DOI: 10.1111/ejh.12483] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Hugo J.A. Adams
- Department of Radiology and Nuclear Medicine; University Medical Center Utrecht; Utrecht The Netherlands
| | - Thomas C. Kwee
- Department of Radiology and Nuclear Medicine; University Medical Center Utrecht; Utrecht The Netherlands
| | - Rob Fijnheer
- Department of Hematology; Meander Medical Center; Amersfoort The Netherlands
| | - Stefan V. Dubois
- Department of Pathology; Meander Medical Center; Amersfoort The Netherlands
| | - Rutger A.J. Nievelstein
- Department of Radiology and Nuclear Medicine; University Medical Center Utrecht; Utrecht The Netherlands
| | - John M.H. de Klerk
- Department of Nuclear Medicine; Meander Medical Center; Amersfoort The Netherlands
| |
Collapse
|
143
|
Chen B, Han D, Ge BH, Li C, Ma D, Yang J. RETRACTED ARTICLE: The diagnostic performance of 18F-FDG PET in detecting bone marrow infiltration in Hodgkin's lymphoma and diffuse large B-cell lymphoma: a meta-analysis. Skeletal Radiol 2015; 44:311. [PMID: 25194939 DOI: 10.1007/s00256-014-1995-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 05/18/2014] [Accepted: 08/19/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Budong Chen
- Radiology Department, Beijing Friendship Hospital of Capital Medical University, Beijing, 100050, China
| | | | | | | | | | | |
Collapse
|
144
|
Karunanithi S, Kumar G, Sharma P, Bal C, Kumar R. Potential role of (18)F-2-fluoro-2-deoxy-glucose positron emission tomography/computed tomography imaging in patients presenting with generalized lymphadenopathy. Indian J Nucl Med 2015; 30:31-8. [PMID: 25589803 PMCID: PMC4290063 DOI: 10.4103/0972-3919.147532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Generalized lymphadenopathy is a common and often vexing clinical problem caused by various inflammatory, infective and malignant diseases. We aimed to review briefly and highlight the potential role of 18F-2-fluoro-2-deoxy-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in such patients. 18F-FDG PET/CT can play an important role in the management of generalized lymphadenopathy. It can help in making an etiological diagnosis; can detect extranodal sites of involvement and employed for monitoring response to therapy.
Collapse
Affiliation(s)
- Sellam Karunanithi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ganesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Punit Sharma
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
145
|
Adams HJA, de Klerk JMH, Fijnheer R, Heggelman BGF, Dubois SV, Nievelstein RAJ, Kwee TC. Bone marrow biopsy in diffuse large B-cell lymphoma: useful or redundant test? Acta Oncol 2015; 54:67-72. [PMID: 25263078 DOI: 10.3109/0284186x.2014.958531] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine the additional value of bone marrow biopsy (BMB) in the standard staging work-up of patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL), in terms of risk assessment and treatment planning. MATERIAL AND METHODS A total of 113 consecutive patients with newly diagnosed DLBCL who had undergone standard pretreatment evaluation, including serum lactate dehydrogenase measurement, Eastern Cooperative Oncology Group performance status assessment, computed tomography or (18)F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography, and BMB, were retrospectively included. National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) score and treatment strategy were determined in each patient, once without and once with taking into account BMB results. Numbers and percentages of BMB-induced changes on NCCN-IPI-based risk stratification (i.e. formation of low, low-intermediate, high-intermediate, and high risk groups) and choice of treatment were calculated, along with 95% confidence intervals (CIs). RESULTS BMB was positive in 18 of 113 patients (15.9%, 95% CI 10.2-23.9 %). BMB-induced changes on NCCI-IPI-based risk stratification occurred in 9 of 113 patients (8.0%, 95% CI 4.1-14.6%). Five patients were upstaged from low-intermediate to high-intermediate risk, and four patients were upstaged from high-intermediate to high risk. BMB findings changed treatment planning in none of the 113 patients (0.0%, 95% CI 0.0-4.0%). CONCLUSION Although BMB results upstaged the NCCN-IPI-based risk stratification in a small number of cases, this did not have any therapeutic implications in our patient series. These findings support the omission of BMB from routine staging of newly diagnosed DLBCL in the current risk stratification and treatment era.
Collapse
Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht , Utrecht , The Netherlands
| | | | | | | | | | | | | |
Collapse
|
146
|
Zhou Z, Chen C, Li X, Li Z, Zhang X, Chang Y, Lu L, Cui Y, Ma Y, Zhang M. Evaluation of bone marrow involvement in extranodal NK/T cell lymphoma by FDG-PET/CT. Ann Hematol 2014; 94:963-7. [DOI: 10.1007/s00277-014-2289-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 12/18/2014] [Indexed: 11/29/2022]
|
147
|
Cerci JJ, Fanti S, Redondo F, Györke T, Carr R. Reply: Critical Views on the Prognostic Potential and Interpretation of Bone Marrow 18F-FDG PET in Diffuse Large B-Cell Lymphoma. J Nucl Med 2014; 56:164. [DOI: 10.2967/jnumed.114.150086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
148
|
Coughlan M, Elstrom R. The use of FDG-PET in diffuse large B cell lymphoma (DLBCL): predicting outcome following first line therapy. Cancer Imaging 2014; 14:34. [PMID: 25608713 PMCID: PMC4264252 DOI: 10.1186/s40644-014-0034-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/12/2014] [Indexed: 11/10/2022] Open
Abstract
Positron emission tomography (PET) using 18fluoro-2-deoxyglucose (FDG) has become a standard clinical tool for staging and response assessment in aggressive lymphomas. The use of PET scans in clinical trials is still under exploration, however. In this review, we examine current data regarding PET in DLBCL, and its potential applicability to development of a surrogate endpoint to expedite clinical trial conduct. Interim PET scanning in DLBCL shows mixed results, with qualitative assessment variably associated with outcome. Addition of quantitative assessment might improve predictive power of interim scans. Data from multiple retrospective studies support that PET-defined response at end of treatment correlates with outcome in DLBCL. Optimal technical criteria for standardization of acquisition and criteria for interpretation of scans require further study. Prospective studies to define the correlation of PET-defined response and time-dependent outcomes such as progression free survival (PFS) and overall survival (OS), critical for development of PET as a surrogate endpoint for clinical trials, are ongoing. In conclusion, evolving data regarding utility of PET in predictcing outcome of patients with DLBCL show promise to support the use of PET as a surrogate endpoint in clinical trials of DLBCL in the future.
Collapse
|
149
|
Kim HY, Kim JS, Choi DR, Kim HS, Kwon JH, Jang GD, Kim JH, Jung JY, Song HH, Lee YK, Min SK, Hwang HS, Kim HJ, Zang DY, Kim HJ. The Clinical Utility of FDG PET-CT in Evaluation of Bone Marrow Involvement by Lymphoma. Cancer Res Treat 2014; 47:458-64. [PMID: 25648095 PMCID: PMC4506116 DOI: 10.4143/crt.2014.091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/12/2014] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Bone marrow biopsy is a standard method for the evaluation of bone marrow infiltration by lymphoma; however, it is an invasive and painful procedure. Fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) is a noninvasive imaging technique with the potential to detect bone marrow involvement by lymphoma. MATERIALS AND METHODS We retrospectively reviewed medical records of lymphoma patients. All patients were examined by FDG PET-CT and iliac crest bone marrow biopsy for initial staging work-up. RESULTS The study population comprised 94 patients (median age, 60 years; 56 males) with Hodgkin's lymphoma (n=8) or non-Hodgkin's lymphoma (n=86). Maximum standardized uptake values on the iliac crest of patients with lymphoma infiltrated bone marrow were significantly higher than those of patients with intact bone marrow (2.2±1.2 g/mL vs. 1.3±0.4 g/mL; p=0.001). The calculated values for FDG PET-CT during evaluation of bone marrow involvement were as follows: sensitivity 50%, specificity 96%, positive predictive value 80%, negative predictive value 85%, and positive likelihood ratio (LR+) 11.7. The value of LR+ was 16.0 in patients with aggressive subtypes of non-Hodgkin's lymphoma (NHL). CONCLUSION FDG PET-CT could not replace bone marrow biopsy due to the low sensitivity of FDG PET-CT for detection of bone marrow infiltration in lymphoma patients. Conversely, FDG PET-CT had high specificity and LR+; therefore, it could be a useful tool for image-guided biopsy for lymphoma staging, especially for aggressive subtypes of NHL. In addition, unilateral bone marrow biopsy could be substituted for bilateral bone marrow biopsy in lymphoma patients with increased FDG uptake on any iliac crest.
Collapse
Affiliation(s)
- Ho Young Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Ju-Seok Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Dae Ro Choi
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hyeong Su Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Geun-Doo Jang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jung Han Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Joo Young Jung
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hun Ho Song
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Young Kyung Lee
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Soo Kee Min
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hee Sung Hwang
- Department of Nuclear Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hwa Jung Kim
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Young Zang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hyo Jung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| |
Collapse
|
150
|
Al-Hamadani M, Go RS. Stage redistribution and survival among Medicare beneficiaries before and after the approval of positron emission tomography scan for non-Hodgkin lymphoma. Leuk Lymphoma 2014; 56:1544-6. [DOI: 10.3109/10428194.2014.966709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|