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Hirano T, Tatetsu H, Ueno S, Shichijo T, Furukawa S, Tsujihashi M, Miyakawa T, Shiraishi S, Higuchi Y, Uchiba M, Yasunaga JI, Nosaka K, Matsuoka M. Significant response of patients with transformed follicular lymphoma with rapid disease progression to CAR-T therapy. J Clin Exp Hematop 2023; 63:266-269. [PMID: 38030235 PMCID: PMC10861368 DOI: 10.3960/jslrt.23033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/30/2023] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
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2
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Brown AK, Carapellucci J, Oshrine B, Gomez A, Meoded A, Asante-Korang A. Diagnostic and management roles of FDG PET/CT imaging in post-transplant lympho-proliferation in pediatric heart transplantation. Clin Transplant 2023; 37:e15015. [PMID: 37237443 DOI: 10.1111/ctr.15015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Post-transplant lymphoproliferative disorder (PTLD) is a serious complication of pediatric heart transplant (PHTx). 18F-FDG PET/CT has been used to differentiate early lympho-proliferation from more advanced PTLD. We report our experience with PET/CT in the management of PTLD following PHTx. METHODS This was a retrospective study of 100 consecutive PHTx recipients at our institution between 2004 and 2018. Patients who underwent PET/CT or conventional CT scans to evaluate for PTLD or high Epstein-Barr viral load were included. RESULTS Males, eight females. Median age at transplant was 3.5 months (IQR = 1.5-27.5). Median age at PTLD diagnosis was 13.3 years (IQR = 9.2-16.1). Median time between transplant and PTLD diagnosis was 9.5 (IQR = 4.5-15) years. Induction agents were used in 12 patients (50%): Thymoglobulin (N = 9), anti-IL2 (N = 2), and Rituximab (N = 1). Eighteen patients (75%) had PET/CT, of whom 14 had 18FDG-avid PTLD. Six had conventional CT. Nineteen patients (79.2%) had diagnostic biopsy confirmation of PTLD, and 5 (20.8%) had excisional biopsies. Two patients had Hodgkin's lymphoma; nine had monomorphic PTLD; eight had polymorphic PTLD; five were classified as other. Nine patients had monomorphic PTLD, including seven with diffuse large cell lymphoma (DLBC) and one with T cell lymphoma. The majority (16/24) had multi-site involvement at PTLD diagnosis, and PET/CT showed that 31.3% (5/16) had easily accessible subcutaneous nodes. Seventeen patients (overall survival 71%) underwent successful treatment without recurrence of PTLD. Of seven deaths (7/24, 29%), five had DLBC lymphoma, one had polymorphic PTLD and one had T-cell lymphoma. CONCLUSION PET-CT allowed simultaneous anatomical and functional assessment of PTLD lesions, while guiding biopsy. In patients with multiple lesions, PET/CT revealed the most prominent and active lesions, improving diagnostic accuracy.
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Affiliation(s)
| | - Jennifer Carapellucci
- Division of Pediatric Cardiology, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
| | - Benjamin Oshrine
- Division of Oncology, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
| | - Anthony Gomez
- Division of Pediatric Cardiology, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
| | - Avner Meoded
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Baylor college of Medicine, Houston, Texas, USA
| | - Alfred Asante-Korang
- Division of Pediatric Cardiology, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
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3
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Al-Ibraheem A, Mottaghy FM, Juweid ME. PET/CT in Hodgkin Lymphoma: An Update. Semin Nucl Med 2023; 53:303-319. [PMID: 36369090 DOI: 10.1053/j.semnuclmed.2022.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
18F-FDG-PET/CT is now an integral part of the workup and management of patients with Hodgkin's lymphoma (HL). PET/CT is currently routinely performed for staging and for response assessment at the end of treatment. Interim PET/CT is typically performed after 1-4 of 6-8 chemo/chemoimmunotherapy cycles ± radiation for prognostication and potential treatment escalation or de-escalation early in the course of therapy, a concept known as response-or risk-adapted treatment. Quantitative PET is an area of growing interest. Metrics such as the standardized uptake value (SUV), metabolic tumor volume, total lesion glycolysis, and their changes with treatment are being investigated as more reproducible and, potentially, more accurate predictors of response and prognosis. Despite the progress made in standardizing the use of PET/CT in lymphoma, challenges remain, particularly with respect to its limited positive predictive value. This review highlights the most relevant applications of PET/CT in HL, its strengths and limitations, as well as recent efforts to implement PET/CT-based metrics as promising tools for precision medicine. Finally, the value of PET/CT for response assessment to immunotherapy is discussed.
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Affiliation(s)
- Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan; Division of Nuclear Medicine/Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital RWTH, Aachen University, Aachen, 52074, Germany, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany and Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Malik E Juweid
- Division of Nuclear Medicine/Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
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4
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Pfaehler E, Euba D, Rinscheid A, Hoekstra OS, Zijlstra J, van Sluis J, Brouwers AH, Lapa C, Boellaard R. Convolutional neural networks for automatic image quality control and EARL compliance of PET images. EJNMMI Phys 2022; 9:53. [PMID: 35943622 PMCID: PMC9363539 DOI: 10.1186/s40658-022-00468-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background Machine learning studies require a large number of images often obtained on different PET scanners. When merging these images, the use of harmonized images following EARL-standards is essential. However, when including retrospective images, EARL accreditation might not have been in place. The aim of this study was to develop a convolutional neural network (CNN) that can identify retrospectively if an image is EARL compliant and if it is meeting older or newer EARL-standards. Materials and methods 96 PET images acquired on three PET/CT systems were included in the study. All images were reconstructed with the locally clinically preferred, EARL1, and EARL2 compliant reconstruction protocols. After image pre-processing, one CNN was trained to separate clinical and EARL compliant reconstructions. A second CNN was optimized to identify EARL1 and EARL2 compliant images. The accuracy of both CNNs was assessed using fivefold cross-validation. The CNNs were validated on 24 images acquired on a PET scanner not included in the training data. To assess the impact of image noise on the CNN decision, the 24 images were reconstructed with different scan durations. Results In the cross-validation, the first CNN classified all images correctly. When identifying EARL1 and EARL2 compliant images, the second CNN identified 100% EARL1 compliant and 85% EARL2 compliant images correctly. The accuracy in the independent dataset was comparable to the cross-validation accuracy. The scan duration had almost no impact on the results. Conclusion The two CNNs trained in this study can be used to retrospectively include images in a multi-center setting by, e.g., adding additional smoothing. This method is especially important for machine learning studies where the harmonization of images from different PET systems is essential.
Supplementary Information The online version contains supplementary material available at 10.1186/s40658-022-00468-w.
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Affiliation(s)
- Elisabeth Pfaehler
- Nuclear Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany.
| | - Daniela Euba
- Nuclear Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Andreas Rinscheid
- Medical Physics and Radiation Protection, University Hospital Augsburg, Augsburg, Germany
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Josee Zijlstra
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Joyce van Sluis
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Constantin Lapa
- Nuclear Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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5
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Naguib MM, Botros SM, Louka AL, Hussein RS. Role of PET/CT in initial evaluation of lymphoma patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021; 52:291. [DOI: https:/doi.org/10.1186/s43055-021-00670-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/22/2021] [Indexed: 08/30/2023] Open
Abstract
Abstract
Background
Accurate radiologic assessment of treatment response in lymphoma patients is important to evaluate the effectiveness of treatment and consequently predict the relapse; the value of PET/CT for post-treatment prognosis prediction has been recently investigated. The aim of this study is to highlight the prognostic value of PET-CT metabolic volumetric parameters in the evaluation of lymphoma patients.
Results
Among the included 40 patients, post-treatment SUV, MTV, and TLG were significantly lower in a responsive group than the non-responsive group. % changes of all quantitative PET/CT parameters were significantly higher in the responsive group than the non-responsive group.
Conclusions
This study suggests that pre-treatment PET/CT quantitative measures (except baseline SUVmax) are not conclusive in the prediction of patient response to treatment; however, the ΔSUVmax, ΔMTV, and ΔTLG% from the baseline to the end of therapy could be used in predicting patient response to treatment, determining patient prognosis, and suggesting the relapse.
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6
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Role of PET/CT in initial evaluation of lymphoma patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00670-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Accurate radiologic assessment of treatment response in lymphoma patients is important to evaluate the effectiveness of treatment and consequently predict the relapse; the value of PET/CT for post-treatment prognosis prediction has been recently investigated. The aim of this study is to highlight the prognostic value of PET-CT metabolic volumetric parameters in the evaluation of lymphoma patients.
Results
Among the included 40 patients, post-treatment SUV, MTV, and TLG were significantly lower in a responsive group than the non-responsive group. % changes of all quantitative PET/CT parameters were significantly higher in the responsive group than the non-responsive group.
Conclusions
This study suggests that pre-treatment PET/CT quantitative measures (except baseline SUVmax) are not conclusive in the prediction of patient response to treatment; however, the ΔSUVmax, ΔMTV, and ΔTLG% from the baseline to the end of therapy could be used in predicting patient response to treatment, determining patient prognosis, and suggesting the relapse.
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7
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Juweid ME, Mueller M, Alhouri A, A-Risheq MZ, Mottaghy FM. Positron emission tomography/computed tomography in the management of Hodgkin and B-cell non-Hodgkin lymphoma: An update. Cancer 2021; 127:3727-3741. [PMID: 34286864 DOI: 10.1002/cncr.33772] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 01/20/2023]
Abstract
18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is now an integral part of lymphoma staging and management. Because of its greater accuracy compared with CT alone, PET/CT is currently routinely performed for staging and for response assessment at the end of treatment in the vast majority of FDG-avid lymphomas and is the cornerstone of response classification for these lymphomas according to the Lugano classification. Interim PET/CT, typically performed after 2 to 4 of 6 to 8 chemotherapy/chemoimmunotherapy cycles with or without radiation, is commonly performed for prognostication and potential treatment escalation or de-escalation early in the course of therapy, a concept known as response-adapted or risk-adapted treatment. Quantitative PET is an area of growing interest. Metrics, such as the standardized uptake value, changes (Δ) in the standardized uptake value, metabolic tumor volume, and total lesion glycolysis, are being investigated as more reproducible and potentially more accurate predictors of response and prognosis. Despite the progress made in standardizing the use of PET/CT in lymphoma, challenges remain, particularly with respect to its limited positive predictive value, emphasizing the need for more specific molecular probes. This review highlights the most relevant applications of PET/CT in Hodgkin and B-cell non-Hodgkin lymphoma, its strengths and limitations, as well as recent efforts at implementing PET/CT-based metrics as promising tools for precision medicine.
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Affiliation(s)
- Malik E Juweid
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Marguerite Mueller
- Department of Nuclear Medicine, University Hospital Rheinish-Westphalian Technical University, Aachen University, Aachen, Germany
| | - Abdullah Alhouri
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - M Ziad A-Risheq
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital Rheinish-Westphalian Technical University, Aachen University, Aachen, Germany.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
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8
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Wijetunga NA, Imber BS, Caravelli JF, Mikhaeel NG, Yahalom J. A picture is worth a thousand words: a history of diagnostic imaging for lymphoma. Br J Radiol 2021; 94:20210285. [PMID: 34111961 DOI: 10.1259/bjr.20210285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The journey from early drawings of Thomas Hodgkin's patients to deep learning with radiomics in lymphoma has taken nearly 200 years, and in many ways, it parallels the journey of medicine. By tracing the history of imaging in clinical lymphoma practice, we can better understand the motivations for current imaging practices. The earliest imaging modalities of the 2D era each had varied, site-dependent sensitivity, and the improved accuracy of imaging studies allowed new diagnostic and therapeutic techniques. First, we review the initial imaging technologies that were applied to understand lymphoma spread and achieve practical guidance for the earliest lymphoma treatments. Next, in the 3D era, we describe how anatomical imaging advances replaced and complemented conventional modalities. Afterward, we discuss how the PET era scans were used to understand response of tumors to treatment and risk stratification. Finally, we discuss the emergence of radiomics as a promising area of research in personalized medicine. We are now able to identify involved lymph nodes and body sites both before and after treatment to offer patients improved treatment outcomes. As imaging methods continue to improve sensitivity, we will be able to use personalized medicine approaches to give targeted and highly focused therapies at even earlier time points, and ideally, we can obtain long-term disease control and cures for lymphomas.
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Affiliation(s)
- N Ari Wijetunga
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brandon Stuart Imber
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James F Caravelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - N George Mikhaeel
- Department of Clinical Oncology, Guy's and St. Thomas' Hospital, London, UK
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Lucchini E, Merlo M, Ballerini M, Porcari A, Sinagra G, Pagnan L, Rensi M, Romano A, Bussani R, Ballotta L, Zaja F. Case Report: Cardiac Involvement by Lymphoma: Rare but Heterogeneous Condition With Challenging Behaviors. Front Oncol 2021; 11:665736. [PMID: 33987101 PMCID: PMC8112198 DOI: 10.3389/fonc.2021.665736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/18/2021] [Indexed: 11/24/2022] Open
Abstract
Cardiac lymphomas are rare extranodal lymphomas involving primarily and secondarily the heart and/or pericardium. Here we describe three cases of cardiac involvement from lymphoma with specific peculiarities: two primary cardiac Diffuse Large B-cell Lymphomas and one secondary involvement from Marginal Zone Lymphoma (MZL). The first case highlights the issue of early CNS relapse and the possible role for CNS prophylaxis; the second case demonstrates the difficulties of interpretation and possible mistakes of different radiologic techniques adopted to evaluate cardiac involvement by lymphoma during follow-up; the third is a unique case of MZL with cardiac involvement. Our aim is to share the findings observed in these cases putting them in relation with data from the literature.
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Affiliation(s)
- Elisa Lucchini
- S.C. Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Marco Merlo
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.,Dipartimento di Scienze Mediche e Chirurgiche e della Salute (DSM), Università degli Studi, Trieste, Italy
| | - Mario Ballerini
- S.C. Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Aldostefano Porcari
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Gianfranco Sinagra
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.,Dipartimento di Scienze Mediche e Chirurgiche e della Salute (DSM), Università degli Studi, Trieste, Italy
| | - Lorenzo Pagnan
- S.C. Radiologia diagnostica ed Interventistica, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Marco Rensi
- S.C. Medicina Nucleare, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Andrea Romano
- S.C. (UCO) Anatomia ed Istologia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Rossana Bussani
- Dipartimento di Scienze Mediche e Chirurgiche e della Salute (DSM), Università degli Studi, Trieste, Italy.,S.C. (UCO) Anatomia ed Istologia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Laura Ballotta
- S.C. Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Francesco Zaja
- S.C. Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.,Dipartimento di Scienze Mediche e Chirurgiche e della Salute (DSM), Università degli Studi, Trieste, Italy
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10
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Göçer M, Kurtoğlu E. Comparison of Bone Marrow Involvement with Bone Marrow Biopsy and PET-CT and Evaluation of Any Effects on Survival in Patients Diagnosed with Hodgkin and Non-Hodgkin Lymphoma. Indian J Hematol Blood Transfus 2021; 37:52-59. [PMID: 33707835 PMCID: PMC7900321 DOI: 10.1007/s12288-020-01284-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/23/2020] [Indexed: 01/04/2023] Open
Abstract
We aimed to demonstrate whether PET-CT can replace bone marrow biopsy in detecting bone marrow involvement in subtypes of lymphoma. In addition, we aimed to also reveal whether there is a difference between the mean survival of patients with bone marrow involvement via PET-CT or biopsy. A total of 276 newly diagnosed lymphoma patients who underwent bone marrow biopsy and PET-CT prior to the treatment were scanned retrospectively. Bone marrow biopsy was used as the standard method to investigate the presence of bone marrow involvement in PET-CT. The relationship between bone marrow involvement and mean survival was compared using both methods. Out of the 276 patients, bone marrow involvement was detected with PET-CT and with biopsy, respectively in 56 patients (20.2%) and in 78 patients (28.2%). In terms of PET-CT's accuracy with respect to revealing bone marrow involvement, the highest rates were achieved respectively in diffuse large B cell lymphoma (DLBCL) (87.4%) and Hodgkin lymphoma (HL) (77.7%). In both the PET-CT and bone marrow biopsy methods, Overall Survival (OS) was found to be significantly shorter in patients with involvement than in patients without involvement (P: 0.001). PET-CT may replace bone marrow (BM) biopsy in detecting the bone marrow involvement in aggressive lymphoma subtypes such as DLBCL and HL. The presence of BM involvement at the time of diagnosis in both PET-CT and BM biopsy is associated with poor prognosis, and OS is short in this group.
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Affiliation(s)
- Mesut Göçer
- Division of Hematology, Department of Internal Medicine, Antalya Training and Research Hospital, 07100 Antalya, Turkey
| | - Erdal Kurtoğlu
- Division of Hematology, Department of Internal Medicine, Antalya Training and Research Hospital, 07100 Antalya, Turkey
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11
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Jiang C, Ding C, Xu J, Teng Y, Chen J, Wang Z, Zhou Z. Will Baseline Total Lesion Glycolysis Play a Role in Improving the Prognostic Value of the NCCN-IPI in Primary Gastric Diffuse Large B-Cell Lymphoma Patients Treated With the R-CHOP Regimen? Clin Nucl Med 2021; 46:1-7. [PMID: 33181743 DOI: 10.1097/rlu.0000000000003378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim was to explore whether baseline total lesion glycolysis (TLG) can improve the prognostic value of the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) in primary gastric diffuse large B-cell lymphoma (PG-DLBCL) patients treated with an R-CHOP-like regimen. MATERIALS AND METHODS Ninety-four PG-DLBCL patients who underwent baseline PET/CT between July 2010 and May 2019 were included in this retrospective study. FDG-avid lesions in each patient were segmented to calculate the SUVmax, total metabolic tumor volume (TMTV), and TLG. Progression-free survival (PFS) and overall survival (OS) were used as end points to evaluate prognosis. RESULTS During the follow-up period of 5 to 108 months (35.3 ± 23.5 months), high TLG and a high NCCN-IPI were significantly associated with poor PFS and OS. Total lesion glycolysis and the NCCN-IPI were independent predictors of PFS and OS. Patients were stratified into 3 groups according to the combination of TLG and the NCCN-IPI for PFS (P < 0.001) and OS (P < 0.001): high-risk group (TLG > 1159.1 and NCCN-IPI 4-8) (PFS and OS, 57.7% and 61.5%, respectively, n = 42), intermediate-risk group (TLG > 1159.1 or NCCN-IPI 4-8) (PFS and OS, both 76.9%, n = 26), and low-risk group (TLG ≤ 1159.1 and NCCN-IPI 0-3) (PFS and OS, 97.6% and 100.0%, respectively, n = 26). CONCLUSIONS Both TLG and the NCCN-IPI are independent predictors of PG-DLBCL patient survival. Moreover, the combination of TLG and the NCCN-IPI improved patient risk stratification and might help personalize therapeutic regimens.
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Affiliation(s)
- Chong Jiang
- From the Department of Nuclear Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School
| | - Chongyang Ding
- Department of Nuclear Medicine, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital
| | | | - Yue Teng
- From the Department of Nuclear Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School
| | - Jieyu Chen
- Pathology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School
| | - Zhen Wang
- Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Zhengyang Zhou
- From the Department of Nuclear Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School
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12
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Feng X, Wen X, Li L, Sun Z, Li X, Zhang L, Wu J, Fu X, Wang X, Yu H, Ma X, Zhang X, Xie X, Han X, Zhang M. Baseline Total Metabolic Tumor Volume and Total Lesion Glycolysis Measured on 18F-FDG PET-CT Predict Outcomes in T-Cell Lymphoblastic Lymphoma. Cancer Res Treat 2020; 53:837-846. [PMID: 33285054 PMCID: PMC8291183 DOI: 10.4143/crt.2020.123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE There is no optimal prognostic model for T-cell lymphoblastic lymphoma (T-LBL). Here, we discussed the predictive value of total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) measured on 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) in T-LBL. MATERIALS AND METHODS Thirty-seven treatment naïve T-LBL patients with PET-CT scans were enrolled. TMTV was obtained using the 41% maximum standardized uptake value (SUVmax) threshold method, and TLG was measured as metabolic tumor volume multiplied by the mean SUV. Progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan-Meier curves and compared by the log-rank test. RESULTS The optimal cutoff values for SUVmax, TMTV, and TLG were 12.7, 302 cm3, and 890, respectively. A high SUVmax, TMTV, and TLG indicated a shorten PFS and OS. On multivariable analysis, TMTV ≥ 302 cm3, and central nervous system (CNS) involvement predicted inferior PFS, while high SUVmax, TLG and CNS involvement were associated with worse OS. Subsequently, we generated a risk model comprising high SUVmax, TMTV or TLG and CNS involvement, which stratified the population into three risk groups, which had significantly different median PFS of not reached, 14 months, and 7 months for low-risk group, mediate-risk group, and high-risk group, respectively (p < 0.001). Median OS were not reached, 27 months, and 13 months, respectively (p < 0.001). CONCLUSION Baseline SUVmax, TMTV, and TLG measured on PET-CT are strong predictors of worse outcome in T-LBL. A risk model integrating these three parameters with CNS involvement identifies patients at high risk of disease progression.
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Affiliation(s)
- Xiaoyan Feng
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Wen
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ling Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhenchang Sun
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lei Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingjing Wu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaorui Fu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinhua Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Yu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinran Ma
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xudong Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinli Xie
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xingmin Han
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Abdelmohsen MA, Omar WM. Abdominal extranodal lymphoma detection: positron emission tomography/computed tomography can help. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00243-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Lymphoid neoplasms that present with masses are broadly referred to as lymphomas, and they can be classified to two main groups: Hodgkin’s (HL) and non-Hodgkin’s lymphoma (NHL); they are mainly characterized by enlargement of lymph nodes (nodal disease) although any organ in the body can be involved in different settings of the disease (extranodal disease). Adequate staging, which has a direct impact on prognosis, is essential to properly plan therapy. Stage IV disease with extranodal dissemination should be treated by long-term systemic chemotherapy.
By adding the metabolic changes to the conventional CT morphologic changes, combined positron emission tomography (PET) and computed tomography (CT) may offer clinically useful addition in staging of lymphomas and detection of extranodal lesions.
Results
The study included thirty nine patients, with forty-eight extranodal sites with lymphomatous infiltration, twenty-four males (61.5%), and fifteen females (38.4%). The patients showed forty-eight extranodal abdominal lymphomatous infiltration.
The study included twelve gastric lymphomatous lesions (25%), twelve splenic lymphomatous lesion (25%), three ileo-caecal lymphomatous lesions (6.25%), three patients (6.25%) with skin infiltration, three adrenal lymphomatous lesions (6.25%), three patients with hepatic lymphoma, and twelve bone marrow infiltrations (25%).
The most accurate SUV max cutoff value among studied cases was 3.5, the highest SUV max value noted was 21 in gastric lesions, and the lowest SUV max noted was 4.1 in adrenal lesions.
Confirmation of PET/CT results was done by histopathological assessment and post-management follow-up.
Conclusion
PET/CT study is an effective tool for evaluation of extranodal lymphomas. PET/CT fusion images can affect the clinical management plan by detection of extranodal lymphomas with lymphoma staging modification.
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Büyükşimşek M, Kolsuz İ, Yetişir AE, Tohumcuoğlu M, Oğul A, Mirili C, Paydaş S, Güney İB. Performance of Positron Emission Tomography-Computed Tomography and Bone Marrow Biopsy in Detecting Bone Marrow Infiltration in Lymphoma Cases. Turk J Haematol 2020; 37:220-225. [PMID: 32003552 PMCID: PMC7702653 DOI: 10.4274/tjh.galenos.2020.2019.0361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Bone marrow infiltration (BMI) affects the stage diagnosis, and treatment of lymphoma. We aimed to evaluate the performance of bone marrow biopsy (BMB) and positron emission tomography-computed tomography (PET/CT) in detecting BMI in lymphoma patients. Materials and Methods: A total of 269 non-Hodgkin’s lymphoma (NHL) and 110 Hodgkin’s lymphoma (HL) patients were evaluated retrospectively. Sensitivity, negative predictive value (NPV), and accuracy were calculated for PET/CT and BMB in detecting BMI. Results: Sensitivity, NPV, and accuracy for PET/CT in detecting BMI in NHL cases were 65%, 78%, and 84.4%, respectively, while they were 55%, 73.4%, and 79.9% for BMB. PET/CT performance for diffuse large B-cell lymphoma and follicular lymphoma was better than that of BMB, whereas the performance of BMB was better for mantle-cell lymphoma, Burkitt’s lymphoma, and primary mediastinal B-cell lymphoma. Sensitivity, NPV, and accuracy for PET/CT in HL cases were 91.3%, 97.75%, and 98.18%, respectively, while they were 56.52%, 89.69%, and 90.91% for BMB. Due to BMB, 43 (15.9%) patients in the NHL group and 2 (1.8%) patients in the HL group were protected from downstaging. Conclusion: Although their results vary according to NHL subtypes, PET/CT and BMB are complementary methods in determining BMI. In HL, PET/CT is an important diagnostic tool for detecting BMI, and BMB is not necessary in a significant proportion of cases.
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Affiliation(s)
- Mahmut Büyükşimşek
- Çukurova University Faculty of Medicine, Department of Medical Oncology, Adana, Turkey
| | - İrem Kolsuz
- Çukurova University Faculty of Medicine, Department of Internal Medicine, Adana, Turkey
| | | | - Mert Tohumcuoğlu
- Çukurova University Faculty of Medicine, Department of Medical Oncology, Adana, Turkey
| | - Ali Oğul
- Adana Health Practice and Research Center, Department of Medical Oncology, Adana, Turkey
| | - Cem Mirili
- Atatürk University Faculty of Medicine, Department of Medical Oncology, Erzurum, Turkey
| | - Semra Paydaş
- Çukurova University Faculty of Medicine, Department of Medical Oncology, Adana, Turkey
| | - İsa Burak Güney
- Çukurova University Faculty of Medicine, Department of Nuclear Medicine, Adana, Turkey
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15
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Aldin A, Umlauff L, Estcourt LJ, Collins G, Moons KG, Engert A, Kobe C, von Tresckow B, Haque M, Foroutan F, Kreuzberger N, Trivella M, Skoetz N. Interim PET-results for prognosis in adults with Hodgkin lymphoma: a systematic review and meta-analysis of prognostic factor studies. Cochrane Database Syst Rev 2020; 1:CD012643. [PMID: 31930780 PMCID: PMC6984446 DOI: 10.1002/14651858.cd012643.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Hodgkin lymphoma (HL) is one of the most common haematological malignancies in young adults and, with cure rates of 90%, has become curable for the majority of individuals. Positron emission tomography (PET) is an imaging tool used to monitor a tumour's metabolic activity, stage and progression. Interim PET during chemotherapy has been posited as a prognostic factor in individuals with HL to distinguish between those with a poor prognosis and those with a better prognosis. This distinction is important to inform decision-making on the clinical pathway of individuals with HL. OBJECTIVES To determine whether in previously untreated adults with HL receiving first-line therapy, interim PET scan results can distinguish between those with a poor prognosis and those with a better prognosis, and thereby predict survival outcomes in each group. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL and conference proceedings up until April 2019. We also searched one trial registry (ClinicalTrials.gov). SELECTION CRITERIA We included retrospective and prospective studies evaluating interim PET scans in a minimum of 10 individuals with HL (all stages) undergoing first-line therapy. Interim PET was defined as conducted during therapy (after one, two, three or four treatment cycles). The minimum follow-up period was at least 12 months. We excluded studies if the trial design allowed treatment modification based on the interim PET scan results. DATA COLLECTION AND ANALYSIS We developed a data extraction form according to the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). Two teams of two review authors independently screened the studies, extracted data on overall survival (OS), progression-free survival (PFS) and PET-associated adverse events (AEs), assessed risk of bias (per outcome) according to the Quality in Prognosis Studies (QUIPS) tool, and assessed the certainty of the evidence (GRADE). We contacted investigators to obtain missing information and data. MAIN RESULTS Our literature search yielded 11,277 results. In total, we included 23 studies (99 references) with 7335 newly-diagnosed individuals with classic HL (all stages). Participants in 16 studies underwent (interim) PET combined with computed tomography (PET-CT), compared to PET only in the remaining seven studies. The standard chemotherapy regimen included ABVD (16) studies, compared to BEACOPP or other regimens (seven studies). Most studies (N = 21) conducted interim PET scans after two cycles (PET2) of chemotherapy, although PET1, PET3 and PET4 were also reported in some studies. In the meta-analyses, we used PET2 data if available as we wanted to ensure homogeneity between studies. In most studies interim PET scan results were evaluated according to the Deauville 5-point scale (N = 12). Eight studies were not included in meta-analyses due to missing information and/or data; results were reported narratively. For the remaining studies, we pooled the unadjusted hazard ratio (HR). The timing of the outcome measurement was after two or three years (the median follow-up time ranged from 22 to 65 months) in the pooled studies. Eight studies explored the independent prognostic ability of interim PET by adjusting for other established prognostic factors (e.g. disease stage, B symptoms). We did not pool the results because the multivariable analyses adjusted for a different set of factors in each study. Overall survival Twelve (out of 23) studies reported OS. Six of these were assessed as low risk of bias in all of the first four domains of QUIPS (study participation, study attrition, prognostic factor measurement and outcome measurement). The other six studies were assessed as unclear, moderate or high risk of bias in at least one of these four domains. Four studies were assessed as low risk, and eight studies as high risk of bias for the domain other prognostic factors (covariates). Nine studies were assessed as low risk, and three studies as high risk of bias for the domain 'statistical analysis and reporting'. We pooled nine studies with 1802 participants. Participants with HL who have a negative interim PET scan result probably have a large advantage in OS compared to those with a positive interim PET scan result (unadjusted HR 5.09, 95% confidence interval (CI) 2.64 to 9.81, I² = 44%, moderate-certainty evidence). In absolute values, this means that 900 out of 1000 participants with a negative interim PET scan result will probably survive longer than three years compared to 585 (95% CI 356 to 757) out of 1000 participants with a positive result. Adjusted results from two studies also indicate an independent prognostic value of interim PET scan results (moderate-certainty evidence). Progression-free survival Twenty-one studies reported PFS. Eleven out of 21 were assessed as low risk of bias in the first four domains. The remaining were assessed as unclear, moderate or high risk of bias in at least one of the four domains. Eleven studies were assessed as low risk, and ten studies as high risk of bias for the domain other prognostic factors (covariates). Eight studies were assessed as high risk, thirteen as low risk of bias for statistical analysis and reporting. We pooled 14 studies with 2079 participants. Participants who have a negative interim PET scan result may have an advantage in PFS compared to those with a positive interim PET scan result, but the evidence is very uncertain (unadjusted HR 4.90, 95% CI 3.47 to 6.90, I² = 45%, very low-certainty evidence). This means that 850 out of 1000 participants with a negative interim PET scan result may be progression-free longer than three years compared to 451 (95% CI 326 to 569) out of 1000 participants with a positive result. Adjusted results (not pooled) from eight studies also indicate that there may be an independent prognostic value of interim PET scan results (low-certainty evidence). PET-associated adverse events No study measured PET-associated AEs. AUTHORS' CONCLUSIONS This review provides moderate-certainty evidence that interim PET scan results predict OS, and very low-certainty evidence that interim PET scan results predict progression-free survival in treated individuals with HL. This evidence is primarily based on unadjusted data. More studies are needed to test the adjusted prognostic ability of interim PET against established prognostic factors.
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Affiliation(s)
- Angela Aldin
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Kerpener Str. 62, Cologne, Germany, 50937
| | - Lisa Umlauff
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Kerpener Str. 62, Cologne, Germany, 50937
| | - Lise J Estcourt
- NHS Blood and Transplant, Haematology/Transfusion Medicine, Level 2, John Radcliffe Hospital, Headington, Oxford, UK, OX3 9BQ
| | - Gary Collins
- University of Oxford, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Windmill Road, Oxford, UK, OX3 7LD
| | - Karel Gm Moons
- University Medical Center Utrecht, Utrecht University, Julius Center for Health Sciences and Primary Care, PO Box 85500, Utrecht, Netherlands, 3508 GA
| | - Andreas Engert
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Kerpener Str. 62, Cologne, Germany, 50924
| | - Carsten Kobe
- Faculty of Medicine and University Hospital Cologne, Department for Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Bastian von Tresckow
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Kerpener Str. 62, Cologne, Germany, 50924
| | - Madhuri Haque
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Kerpener Str. 62, Cologne, Germany, 50937
| | - Farid Foroutan
- McMaster University, Department of Health Research Methods, Evidence, and Impact, 1280 Main St W, Hamilton, Ontario, Canada, L8S 4L8
| | - Nina Kreuzberger
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Kerpener Str. 62, Cologne, Germany, 50937
| | - Marialena Trivella
- University of Oxford, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Windmill Road, Oxford, UK, OX3 7LD
| | - Nicole Skoetz
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Cochrane Cancer, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Kerpener Str. 62, Cologne, Germany, 50937
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16
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Zhou Y, Hong Z, Zhou M, Sang S, Zhang B, Li J, Li Q, Wu Y, Deng S. Prognostic value of baseline
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F‐FDG PET/CT metabolic parameters in paediatric lymphoma. J Med Imaging Radiat Oncol 2019; 64:87-95. [PMID: 31880103 DOI: 10.1111/1754-9485.12993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/02/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Yeye Zhou
- Department of Nuclear Medicine the First Affiliated Hospital of Soochow University Suzhou China
| | - Zhihui Hong
- Department of Nuclear Medicine the Second Affiliated Hospital of Soochow University Suzhou China
| | - Min Zhou
- Department of Nuclear Medicine Yancheng City No. 1 People's Hospital Yancheng China
| | - Shibiao Sang
- Department of Nuclear Medicine the First Affiliated Hospital of Soochow University Suzhou China
| | - Bin Zhang
- Department of Nuclear Medicine the First Affiliated Hospital of Soochow University Suzhou China
| | - Jihui Li
- Department of Nuclear Medicine the First Affiliated Hospital of Soochow University Suzhou China
| | - Qingru Li
- Department of Nuclear Medicine the First Affiliated Hospital of Soochow University Suzhou China
| | - Yiwei Wu
- Department of Nuclear Medicine the First Affiliated Hospital of Soochow University Suzhou China
| | - Shengming Deng
- Department of Nuclear Medicine the First Affiliated Hospital of Soochow University Suzhou China
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17
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Aldin A, Umlauff L, Estcourt LJ, Collins G, Moons KGM, Engert A, Kobe C, von Tresckow B, Haque M, Foroutan F, Kreuzberger N, Trivella M, Skoetz N. Interim PET-results for prognosis in adults with Hodgkin lymphoma: a systematic review and meta-analysis of prognostic factor studies. Cochrane Database Syst Rev 2019; 9:CD012643. [PMID: 31525824 PMCID: PMC6746624 DOI: 10.1002/14651858.cd012643.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hodgkin lymphoma (HL) is one of the most common haematological malignancies in young adults and, with cure rates of 90%, has become curable for the majority of individuals. Positron emission tomography (PET) is an imaging tool used to monitor a tumour's metabolic activity, stage and progression. Interim PET during chemotherapy has been posited as a prognostic factor in individuals with HL to distinguish between those with a poor prognosis and those with a better prognosis. This distinction is important to inform decision-making on the clinical pathway of individuals with HL. OBJECTIVES To determine whether in previously untreated adults with HL receiving first-line therapy, interim PET scan results can distinguish between those with a poor prognosis and those with a better prognosis, and thereby predict survival outcomes in each group. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL and conference proceedings up until April 2019. We also searched one trial registry (ClinicalTrials.gov). SELECTION CRITERIA We included retrospective and prospective studies evaluating interim PET scans in a minimum of 10 individuals with HL (all stages) undergoing first-line therapy. Interim PET was defined as conducted during therapy (after one, two, three or four treatment cycles). The minimum follow-up period was at least 12 months. We excluded studies if the trial design allowed treatment modification based on the interim PET scan results. DATA COLLECTION AND ANALYSIS We developed a data extraction form according to the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). Two teams of two review authors independently screened the studies, extracted data on overall survival (OS), progression-free survival (PFS) and PET-associated adverse events (AEs), assessed risk of bias (per outcome) according to the Quality in Prognosis Studies (QUIPS) tool, and assessed the certainty of the evidence (GRADE). We contacted investigators to obtain missing information and data. MAIN RESULTS Our literature search yielded 11,277 results. In total, we included 23 studies (99 references) with 7335 newly-diagnosed individuals with classic HL (all stages).Participants in 16 studies underwent (interim) PET combined with computed tomography (PET-CT), compared to PET only in the remaining seven studies. The standard chemotherapy regimen included ABVD (16) studies, compared to BEACOPP or other regimens (seven studies). Most studies (N = 21) conducted interim PET scans after two cycles (PET2) of chemotherapy, although PET1, PET3 and PET4 were also reported in some studies. In the meta-analyses, we used PET2 data if available as we wanted to ensure homogeneity between studies. In most studies interim PET scan results were evaluated according to the Deauville 5-point scale (N = 12).Eight studies were not included in meta-analyses due to missing information and/or data; results were reported narratively. For the remaining studies, we pooled the unadjusted hazard ratio (HR). The timing of the outcome measurement was after two or three years (the median follow-up time ranged from 22 to 65 months) in the pooled studies.Eight studies explored the independent prognostic ability of interim PET by adjusting for other established prognostic factors (e.g. disease stage, B symptoms). We did not pool the results because the multivariable analyses adjusted for a different set of factors in each study.Overall survivalTwelve (out of 23) studies reported OS. Six of these were assessed as low risk of bias in all of the first four domains of QUIPS (study participation, study attrition, prognostic factor measurement and outcome measurement). The other six studies were assessed as unclear, moderate or high risk of bias in at least one of these four domains. Nine studies were assessed as high risk, and three studies as moderate risk of bias for the domain study confounding. Eight studies were assessed as low risk, and four studies as high risk of bias for the domain statistical analysis and reporting.We pooled nine studies with 1802 participants. Participants with HL who have a negative interim PET scan result probably have a large advantage in OS compared to those with a positive interim PET scan result (unadjusted HR 5.09, 95% confidence interval (CI) 2.64 to 9.81, I² = 44%, moderate-certainty evidence). In absolute values, this means that 900 out of 1000 participants with a negative interim PET scan result will probably survive longer than three years compared to 585 (95% CI 356 to 757) out of 1000 participants with a positive result.Adjusted results from two studies also indicate an independent prognostic value of interim PET scan results (moderate-certainty evidence).Progression-free survival Twenty-one studies reported PFS. Eleven out of 21 were assessed as low risk of bias in the first four domains. The remaining were assessed as unclear, moderate or high risk of bias in at least one of the four domains. Eleven studies were assessed as high risk, nine studies as moderate risk and one study as low risk of bias for study confounding. Eight studies were assessed as high risk, three as moderate risk and nine as low risk of bias for statistical analysis and reporting.We pooled 14 studies with 2079 participants. Participants who have a negative interim PET scan result may have an advantage in PFS compared to those with a positive interim PET scan result, but the evidence is very uncertain (unadjusted HR 4.90, 95% CI 3.47 to 6.90, I² = 45%, very low-certainty evidence). This means that 850 out of 1000 participants with a negative interim PET scan result may be progression-free longer than three years compared to 451 (95% CI 326 to 569) out of 1000 participants with a positive result.Adjusted results (not pooled) from eight studies also indicate that there may be an independent prognostic value of interim PET scan results (low-certainty evidence).PET-associated adverse eventsNo study measured PET-associated AEs. AUTHORS' CONCLUSIONS This review provides moderate-certainty evidence that interim PET scan results predict OS, and very low-certainty evidence that interim PET scan results predict progression-free survival in treated individuals with HL. This evidence is primarily based on unadjusted data. More studies are needed to test the adjusted prognostic ability of interim PET against established prognostic factors.
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Affiliation(s)
- Angela Aldin
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Haematological MalignanciesUniversity of CologneKerpener Str. 62CologneGermany50937
| | - Lisa Umlauff
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Haematological MalignanciesUniversity of CologneKerpener Str. 62CologneGermany50937
| | - Lise J Estcourt
- NHS Blood and TransplantHaematology/Transfusion MedicineLevel 2, John Radcliffe HospitalHeadingtonOxfordUKOX3 9BQ
| | - Gary Collins
- University of OxfordCentre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill RoadOxfordUKOX3 7LD
| | - Karel GM Moons
- University Medical Center Utrecht, Utrecht UniversityJulius Center for Health Sciences and Primary CarePO Box 85500UtrechtNetherlands3508 GA
| | - Andreas Engert
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne DuesseldorfUniversity of CologneKerpener Str. 62CologneGermany50924
| | - Carsten Kobe
- Faculty of Medicine and University Hospital Cologne, Department for Nuclear MedicineUniversity of CologneCologneGermany
| | - Bastian von Tresckow
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne DuesseldorfUniversity of CologneKerpener Str. 62CologneGermany50924
| | - Madhuri Haque
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Haematological MalignanciesUniversity of CologneKerpener Str. 62CologneGermany50937
| | - Farid Foroutan
- McMaster UniversityDepartment of Health Research Methods, Evidence, and Impact1280 Main St WHamiltonCanadaL8S 4L8
| | - Nina Kreuzberger
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Haematological MalignanciesUniversity of CologneKerpener Str. 62CologneGermany50937
| | - Marialena Trivella
- University of OxfordCentre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill RoadOxfordUKOX3 7LD
| | - Nicole Skoetz
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane CancerUniversity of CologneKerpener Str. 62CologneGermany50937
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Chang CC, Chen CJ, Hsu WL, Chang SM, Huang YF, Tyan YC. Prognostic Significance of Metabolic Parameters and Textural Features on 18F-FDG PET/CT in Invasive Ductal Carcinoma of Breast. Sci Rep 2019; 9:10946. [PMID: 31358786 PMCID: PMC6662792 DOI: 10.1038/s41598-019-46813-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 06/25/2019] [Indexed: 12/19/2022] Open
Abstract
To investigate the prognostic significance of metabolic parameters and texture analysis on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in patients with breast invasive ductal carcinoma (IDC), from August 2005 to May 2015, IDC patients who had undergone pre-treatment FDG PET/CT were enrolled. The metabolic parameters, including maximal standardized uptake value of breast tumor (SUVbt) and ipsilateral axillary lymph node (SUVln), metabolic tumor volume (MTVbt) and total lesion glycolysis (TLGbt) of breast tumor, whole-body MTV (MTVwb) and whole-body TLG (TLGwb) were recorded. Nine textural features of tumor (four co-occurrence matrices and five SUV-based statistics) were measured. The prognostic significance of above parameters and clinical factors was assessed by univariate and multivariate analyses. Thirty-five patients were enrolled. Patients with low and high MTVwb had 5-year progression-free survival (PFS) of 81.0 and 14.3% (p < 0.0001). The 5-year overall survival for low and high MTVwb was 88.5% and 43.6% (p = 0.0005). Multivariate analyses showed MTVwb was an independent prognostic factor for PFS (HR: 8.29, 95% CI: 2.17–31.64, p = 0.0020). The SUV, TLG and textural features were not independently predictive. Elevated MTVwb was an independent predictor for shorter PFS in patients with breast IDC.
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Affiliation(s)
- Chin-Chuan Chang
- Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chao-Jung Chen
- Departments of Nuclear Medicine, Yuan's General Hospital, Kaohsiung, Taiwan.,Department of Health Business Administration, Meiho University, Pingtung, Taiwan
| | - Wen-Ling Hsu
- Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Min Chang
- Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ying-Fong Huang
- Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Chang Tyan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan. .,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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19
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Shagera QA, Cheon GJ, Koh Y, Yoo MY, Kang KW, Lee DS, Kim EE, Yoon SS, Chung JK. Prognostic value of metabolic tumour volume on baseline 18F-FDG PET/CT in addition to NCCN-IPI in patients with diffuse large B-cell lymphoma: further stratification of the group with a high-risk NCCN-IPI. Eur J Nucl Med Mol Imaging 2019; 46:1417-1427. [PMID: 30941463 DOI: 10.1007/s00259-019-04309-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/07/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this study was to determine the prognostic value of metabolic volumetric parameters as a quantitative index on pre-treatment 18F-FDG PET/CT in addition to the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) in patients with diffuse large B-cell lymphoma (DLBCL). METHODS A total of 103 consecutive patients with DLBCL and baseline FDG PET/CT were retrospectively evaluated. Quantitative metabolic parameters, including total metabolic tumour volume (TMTV) using a standardized uptake value (SUV) of ≥2.5 as the threshold, were estimated. Receiver operating characteristic curve analysis was used to determine the optimal cut-off values for the metabolic parameters. The relationships between study variables and patient survival were tested using Cox regression analysis. Patient survival rates were derived from Kaplan-Meier curves and compared using the log-rank test. RESULTS Median follow-up was 34 months. In patients with a low TMTV (<249 cm3), the 3-year progression free survival (PFS) rate was 83% and the overall survival (OS) rate was 92%, in contrast to 41% and 57%, respectively, in those with a high TMTV (≥249 cm3). In univariate analysis, a high TMTV and NCCN-IPI ≥4 were associated with inferior PFS and OS (P < 0.0001 for all), as was a high total lesion glycolysis (P = 0.004 and P = 0.005, respectively). In multivariate analysis, TMTV and NCCN-IPI were independent predictors of PFS (hazard ratio, HR, 3.11, 95% confidence interval, CI, 1.37-7.07, P = 0.007, and HR 3.42, 95% CI 1.36-8.59, P = 0.009, respectively) and OS (HR 3.41, 95% CI 1.24-9.38, P = 0.017, and HR 5.06, 95% CI 1.46-17.60, P = 0.014, respectively). TMTV was able to separate patients with a high-risk NCCN-IPI of ≥4 (n = 62) into two groups with significantly different outcomes; patients with low TMTV (n = 16) had a 3-year PFS rate of 75% and an OS rate of 88%, while those with a high TMTV had a 3-year PFS rate of 32% and an OS rate of 47% (χ2 = 7.92, P = 0.005, and χ2 = 8.26, P = 0.004, respectively). However, regardless of TMTV, patients with a low-risk NCCN-IPI of <4 (n = 41) had excellent outcomes (3-year PFS and OS rates of 85% and 95%, respectively). CONCLUSION Pretreatment TMTV was an independent predictor of survival in patients with DLBCL. Importantly, TMTV had an additive prognostic value in patients with a high-risk NCCN-IPI. Thus, the combination of baseline TMTV with NCCN-IPI may improve the prognostication and may be helpful guide the decision for intensive therapy and clinical trials, especially in DLBCL patients with a high-risk NCCN-IPI.
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Affiliation(s)
- Qaid Ahmed Shagera
- Department of Nuclear Medicine, Seoul National University, College of Medicine, Daehangro 101, Jongno-gu, Seoul, 03080, South Korea.,Department of Nuclear Medicine, Althawrah Modern General Hospital, Sana'a, Yemen
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University, College of Medicine, Daehangro 101, Jongno-gu, Seoul, 03080, South Korea. .,Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea. .,Cancer Research Institute and Radiation Medicine Institute, Seoul National University, Seoul, South Korea.
| | - Youngil Koh
- Cancer Research Institute and Radiation Medicine Institute, Seoul National University, Seoul, South Korea.,Division of Hematology/Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Min Young Yoo
- Department of Nuclear Medicine, Seoul National University, College of Medicine, Daehangro 101, Jongno-gu, Seoul, 03080, South Korea.,Department of Nuclear Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - Keon Wook Kang
- Department of Nuclear Medicine, Seoul National University, College of Medicine, Daehangro 101, Jongno-gu, Seoul, 03080, South Korea.,Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea.,Cancer Research Institute and Radiation Medicine Institute, Seoul National University, Seoul, South Korea
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University, College of Medicine, Daehangro 101, Jongno-gu, Seoul, 03080, South Korea.,Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea
| | - E Edmund Kim
- Department of Nuclear Medicine, Seoul National University, College of Medicine, Daehangro 101, Jongno-gu, Seoul, 03080, South Korea.,Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Sung-Soo Yoon
- Cancer Research Institute and Radiation Medicine Institute, Seoul National University, Seoul, South Korea.,Division of Hematology/Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - June-Key Chung
- Department of Nuclear Medicine, Seoul National University, College of Medicine, Daehangro 101, Jongno-gu, Seoul, 03080, South Korea.,Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea.,Cancer Research Institute and Radiation Medicine Institute, Seoul National University, Seoul, South Korea
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20
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Milgrom SA, Elhalawani H, Lee J, Wang Q, Mohamed ASR, Dabaja BS, Pinnix CC, Gunther JR, Court L, Rao A, Fuller CD, Akhtari M, Aristophanous M, Mawlawi O, Chuang HH, Sulman EP, Lee HJ, Hagemeister FB, Oki Y, Fanale M, Smith GL. A PET Radiomics Model to Predict Refractory Mediastinal Hodgkin Lymphoma. Sci Rep 2019; 9:1322. [PMID: 30718585 PMCID: PMC6361903 DOI: 10.1038/s41598-018-37197-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 12/03/2018] [Indexed: 12/14/2022] Open
Abstract
First-order radiomic features, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), are associated with disease progression in early-stage classical Hodgkin lymphoma (HL). We hypothesized that a model incorporating first- and second-order radiomic features would more accurately predict outcome than MTV or TLG alone. We assessed whether radiomic features extracted from baseline PET scans predicted relapsed or refractory disease status in a cohort of 251 patients with stage I-II HL who were managed at a tertiary cancer center. Models were developed and tested using a machine-learning algorithm. Features extracted from mediastinal sites were highly predictive of primary refractory disease. A model incorporating 5 of the most predictive features had an area under the curve (AUC) of 95.2% and total error rate of 1.8%. By comparison, the AUC was 78% for both MTV and TLG and was 65% for maximum standardize uptake value (SUVmax). Furthermore, among the patients with refractory mediastinal disease, our model distinguished those who were successfully salvaged from those who ultimately died of HL. We conclude that our PET radiomic model may improve upfront stratification of early-stage HL patients with mediastinal disease and thus contribute to risk-adapted, individualized management.
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Affiliation(s)
- Sarah A Milgrom
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA.
| | - Hesham Elhalawani
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Joonsang Lee
- Department of Radiation Physics, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Qianghu Wang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Bouthaina S Dabaja
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Chelsea C Pinnix
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jillian R Gunther
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Laurence Court
- Department of Radiation Physics, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Arvind Rao
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA.,Department of Bioinformatics and Computational Biology, Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Mani Akhtari
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Michalis Aristophanous
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Osama Mawlawi
- Department of Imaging Physics, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hubert H Chuang
- Department of Nuclear Medicine, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erik P Sulman
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA.,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Translational Molecular Pathology, Division of Pathology/Lab Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hun J Lee
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Frederick B Hagemeister
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yasuhiro Oki
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle Fanale
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Grace L Smith
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
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21
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Özpolat HT, Yilmaz E, Goksoy HS, Özpolat S, Dogan Ö, Unal SN, Nalcaci M. Detection of bone marrow involvement with FDG PET/CT in patients with newly diagnosed lymphoma. Blood Res 2018; 53:281-287. [PMID: 30588464 PMCID: PMC6300678 DOI: 10.5045/br.2018.53.4.281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/16/2018] [Accepted: 05/27/2018] [Indexed: 11/17/2022] Open
Abstract
Background Bone marrow involvement (BMI) affects the lymphoma stage, survival, and treatment. Bone marrow biopsy (BMB) and fluorodeoxyglucose (FDG) positron emission tomography- computed tomography (PET/CT) are useful techniques to detect BMI. Both have advantages and disadvantages. We aimed to identify factors that could be used to predict BMI with positive and negative results on PET/CT compare them with BMB in newly diagnosed patients with lymphoma. Methods We included 22 non-Hodgkin and 16 Hodgkin lymphoma patients in this single center study. All patients had PET/CT examination and BMB before treatment. BMI in BMB was reported as negative or positive. Bone marrow was classified into 3 types by FDG uptake on PT/CT; diffuse involvement, focal involvement, and normal bone marrow. Results PET/CT and BMB results were concordant (7 positive, 15 negative) in 22 patients (57%). We evaluated concordant and discordant patient characteristics and risk-stratified patients for BMI. Our findings suggest that patients with diffuse FDG uptake on PET/CT, especially patients with advanced age and low platelet and white blood cell counts, are likely to have BMI and could potentially forego BMB. Patients with negative PET/CT findings and no significant laboratory abnormalities are very unlikely to have BMI. Conclusion Our results suggest that BMI should not be decided solely based PET/CT or BMB findings. It is reasonable to use both diagnostic assays along with clinical and laboratory findings. PET/CT result, clinical and laboratory findings could be useful for predicting BMI in patient for whom BMB is contraindicated.
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Affiliation(s)
| | - Ebru Yilmaz
- Department of Nuclear Medicine, Istanbul School of Medicine, Istanbul, Turkey
| | - Hasan Sami Goksoy
- Department of Hematology, Istanbul School of Medicine, Istanbul, Turkey
| | - Sahre Özpolat
- Department of Biostatistics and Epidemiology, Marmara School of Medicine, Istanbul, Turkey
| | - Öner Dogan
- Department of Pathology, Istanbul School of Medicine, Istanbul, Turkey
| | - Seher Nilgun Unal
- Department of Nuclear Medicine, Istanbul School of Medicine, Istanbul, Turkey
| | - Meliha Nalcaci
- Department of Hematology, Istanbul School of Medicine, Istanbul, Turkey
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22
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Elshafey R, Daabes N, Galal S. FDG-PET/CT in re-staging of patients with non Hodgkin lymphoma and monitory response to therapy in Egypt. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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23
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Yap KSK, Mehta OH, Lau WFE, Akhurst T, Warrier S, Heriot A, Hicks RJ. Does addition of a diagnostic contrast-enhanced CT to a contemporaneous PET/CT provide incremental value in patients for restaging of colorectal carcinoma? Eur J Hybrid Imaging 2018. [DOI: 10.1186/s41824-018-0046-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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24
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Zhou M, Chen Y, Huang H, Zhou X, Liu J, Huang G. Prognostic value of total lesion glycolysis of baseline 18F-fluorodeoxyglucose positron emission tomography/computed tomography in diffuse large B-cell lymphoma. Oncotarget 2018; 7:83544-83553. [PMID: 27835875 PMCID: PMC5347787 DOI: 10.18632/oncotarget.13180] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 10/14/2016] [Indexed: 01/15/2023] Open
Abstract
Purpose We evaluated the prognostic value of total lesion glycolysis (TLG) measured in baseline 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in diffuse large B-cell lymphoma (DLBCL) treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Methods A total of 91 patients with newly diagnosed DLBCL underwent 18F-FDG PET/CT scans before R-CHOP therapy. Metabolic tumor volume (MTV) was measured with the marginal threshold of normal liver mean standard uptake value (SUVmean) plus 3 standard deviations (SD). TLG was the sum of the products of MTV and SUVmean in all measured lesions. The predictive value was estimated by Log-rank test and Cox-regression analysis. Results Median follow-up was 30 months (range, 5-124 months). The 5-year estimated progression-free survival (PFS) of the low and high TLG group were 83% and 34%, respectively (p<0.001). The 5-year overall survival (OS) of the same groups were 92% and 67%, respectively (p<0.001). Patients with high TLG level were more likely to relapse than those with low TLG level even though they had got complete or partial remission in R-CHOP therapy (40% versus 9%, p=0.012). Multivariate analysis revealed TLG was the only independent predictor for PFS (Hazard ratio=5.211, 95% confidence interval=2.210-12.288, p<0.001) and OS (Hazard ratio=9.136, 95% confidence interval=1.829-45.644, p=0.002). Other factors including MTV, National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) and Ann Arbor Stage were not independently predictive for survivals. Conclusion Baseline TLG is the only independent predictor for PFS and OS in DLBCL patients treated with R-CHOP therapy.
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Affiliation(s)
- Mingge Zhou
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yumei Chen
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Honghui Huang
- Department of Hematology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiang Zhou
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianjun Liu
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Gang Huang
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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25
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Madan H, Pernuš F, Špiclin Ž. Reference-free error estimation for multiple measurement methods. Stat Methods Med Res 2018; 28:2196-2209. [PMID: 29384043 DOI: 10.1177/0962280217754231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We present a computational framework to select the most accurate and precise method of measurement of a certain quantity, when there is no access to the true value of the measurand. A typical use case is when several image analysis methods are applied to measure the value of a particular quantitative imaging biomarker from the same images. The accuracy of each measurement method is characterized by systematic error (bias), which is modeled as a polynomial in true values of measurand, and the precision as random error modeled with a Gaussian random variable. In contrast to previous works, the random errors are modeled jointly across all methods, thereby enabling the framework to analyze measurement methods based on similar principles, which may have correlated random errors. Furthermore, the posterior distribution of the error model parameters is estimated from samples obtained by Markov chain Monte-Carlo and analyzed to estimate the parameter values and the unknown true values of the measurand. The framework was validated on six synthetic and one clinical dataset containing measurements of total lesion load, a biomarker of neurodegenerative diseases, which was obtained with four automatic methods by analyzing brain magnetic resonance images. The estimates of bias and random error were in a good agreement with the corresponding least squares regression estimates against a reference.
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Affiliation(s)
- Hennadii Madan
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Franjo Pernuš
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Žiga Špiclin
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
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26
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Akhtari M, Milgrom SA, Pinnix CC, Reddy JP, Dong W, Smith GL, Mawlawi O, Abou Yehia Z, Gunther J, Osborne EM, Andraos TY, Wogan CF, Rohren E, Garg N, Chuang H, Khoury JD, Oki Y, Fanale M, Dabaja BS. Reclassifying patients with early-stage Hodgkin lymphoma based on functional radiographic markers at presentation. Blood 2018; 131:84-94. [PMID: 29038339 PMCID: PMC5755043 DOI: 10.1182/blood-2017-04-773838] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/03/2017] [Indexed: 11/20/2022] Open
Abstract
The presence of bulky disease in Hodgkin lymphoma (HL), traditionally defined with a 1-dimensional measurement, can change a patient's risk grouping and thus the treatment approach. We hypothesized that 3-dimensional measurements of disease burden obtained from baseline 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scans, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), would more accurately risk-stratify patients. To test this hypothesis, we reviewed pretreatment PET-CT scans of patients with stage I-II HL treated at our institution between 2003 and 2013. Disease was delineated on prechemotherapy PET-CT scans by 2 methods: (1) manual contouring and (2) subthresholding of these contours to give the tumor volume with standardized uptake value ≥2.5. MTV and TLG were extracted from the threshold volumes (MTVt, TLGt) and from the manually contoured soft-tissue volumes. At a median follow-up of 4.96 years for the 267 patients evaluated, 27 patients were diagnosed with relapsed or refractory disease and 12 died. Both MTVt and TLGt were highly correlated with freedom from progression and were dichotomized with 80th percentile cutoff values of 268 and 1703, respectively. Consideration of MTV and TLG enabled restratification of early unfavorable HL patients as having low- and high-risk disease. We conclude that MTV and TLG provide a potential measure of tumor burden to aid in risk stratification of early unfavorable HL patients.
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Affiliation(s)
- Mani Akhtari
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Radiation Oncology, The University of Texas Medical Branch Hospitals, Galveston, TX
| | - Sarah A Milgrom
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chelsea C Pinnix
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jay P Reddy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Grace L Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Osama Mawlawi
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zeinab Abou Yehia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jillian Gunther
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eleanor M Osborne
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Therese Y Andraos
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christine F Wogan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eric Rohren
- Department of Radiology, Baylor College of Medicine, Houston, TX; and
| | | | | | | | - Yasuhiro Oki
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michelle Fanale
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bouthaina S Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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27
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Ruhlmann V, Poeppel TD, Veit J, Nagarajah J, Umutlu L, Hoffmann TK, Bockisch A, Herrmann K, Sauerwein W. Diagnostic accuracy of 18F-FDG PET/CT and MR imaging in patients with adenoid cystic carcinoma. BMC Cancer 2017; 17:887. [PMID: 29273015 PMCID: PMC5741915 DOI: 10.1186/s12885-017-3890-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 12/08/2017] [Indexed: 11/15/2022] Open
Abstract
Background The aim of this study was to evaluate the value of 18F–FDG PET/CT (PET/CT) and MRI for local and/or whole-body restaging of adenoid cystic carcinoma of the head and neck (ACC). Methods Thirty-six patients with ACC underwent conventional MRI of the head and neck and a whole-body PET/CT and were analysed with regards to detection of a local tumor recurrence, lymph node or distant metastases. A consensus interpretation of all available imaging data was used as reference standard. Sensitivity, specificity, diagnostic accuracy, positive and negative predictive values were calculated for MRI and PET/CT. Results The sensitivity of PET/CT and MRI was 96% (89%), specificity 89% (89%), PPV 96% (96%), NPV 89% (73%) and accuracy 94% (89%) for detection of local tumors. Additionally, PET/CT revealed lymph node metastases in one patient and distant metastases in 9/36 patients. In three patients secondary primaries were found. Conclusions Whole-body PET/CT in addition to MRI of the head and neck improves detection of local tumour and metastastic spread in ACC.
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Affiliation(s)
- Verena Ruhlmann
- Department of Nuclear Medicine, University Duisburg-Essen, Medical Faculty, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Thorsten D Poeppel
- Department of Nuclear Medicine, University Duisburg-Essen, Medical Faculty, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Johannes Veit
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Ulm, Frauensteige 12, 89070, Ulm, Germany
| | - James Nagarajah
- Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Geert Grooteplein 8, 6525, GA, Nijmegen, the Netherlands
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Duisburg-Essen, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Thomas K Hoffmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Ulm, Frauensteige 12, 89070, Ulm, Germany
| | - Andreas Bockisch
- Department of Nuclear Medicine, University Duisburg-Essen, Medical Faculty, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Duisburg-Essen, Medical Faculty, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Wolfgang Sauerwein
- Department of Radiation Oncology, University Duisburg-Essen, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
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28
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Saving costs in cancer patient management through molecular imaging. Eur J Nucl Med Mol Imaging 2017; 44:2153-2157. [PMID: 28808743 PMCID: PMC5680361 DOI: 10.1007/s00259-017-3804-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 11/01/2022]
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29
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Jadvar H, Colletti PM, Delgado-Bolton R, Esposito G, Krause BJ, Iagaru AH, Nadel H, Quinn DI, Rohren E, Subramaniam RM, Zukotynski K, Kauffman J, Ahuja S, Griffeth L. Appropriate Use Criteria for 18F-FDG PET/CT in Restaging and Treatment Response Assessment of Malignant Disease. J Nucl Med 2017; 58:2026-2037. [DOI: 10.2967/jnumed.117.197988] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 06/22/2017] [Indexed: 02/07/2023] Open
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30
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Automatic detection and classification of regions of FDG uptake in whole-body PET-CT lymphoma studies. Comput Med Imaging Graph 2017; 60:3-10. [DOI: 10.1016/j.compmedimag.2016.11.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 11/20/2022]
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31
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Prognostic significance of total metabolic tumor volume on 18F-fluorodeoxyglucose positron emission tomography/ computed tomography in patients with diffuse large B-cell lymphoma receiving rituximab-containing chemotherapy. Oncotarget 2017; 8:99587-99600. [PMID: 29245926 PMCID: PMC5725117 DOI: 10.18632/oncotarget.20447] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/25/2017] [Indexed: 01/16/2023] Open
Abstract
Purpose The purpose of this study was to determine the prognostic significance of metabolic parameters on pre-treatment 18F-fluorodeoxyglucose positron emission tomography/ computed tomography (FDG PET/CT), in patients with diffuse large B-cell lymphoma (DLBCL) receiving rituximab-containing therapy. Materials and Methods From September 2009 to December 2014, DLBCL patients who had received FDG PET/CT scans for staging were enrolled. The maximal standardized uptake value of tumor (SUVt) was recorded. The metabolic tumor volume (MTV) was the volume of lesion with an elevated SUV greater than 2.5. The total lesion glycolysis (TLG) was the sum of the products of MTV and mean SUV in all measured lesions. Univariate and multivariate analyses were used to assess the prognostic significance of maximal SUVt, total MTV, TLG and other clinical parameters. Results There were 118 patients enrolled in this study. The median follow-up time was 28.7 months. The 5-year progression-free survival (PFS) for patients with higher and lower total MTV was 32.3% and 66.0% respectively (p = 0.0001). The 5-year overall survival (OS) for patients with higher and lower total MTV was 34.3% and 69.9% respectively (p < 0.0001). Multivariate analysis revealed, besides IPI, that total MTV was independently predictive for PFS (HR: 2.31, 95% CI: 1.16 - 4.60, p = 0.0180) and OS (HR: 2.38, 95% CI: 1.12 - 5.04, p = 0.024). TLG and maximal SUV of tumor were not independent prognostic factors. Conclusions An elevated total MTV was a predictor for shorter PFS and OS in patients with DLBCL receiving rituximab-containing therapy, independent of IPI.
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Milgrom SA, Pinnix CC, Chuang H, Oki Y, Akhtari M, Mawlawi O, Garg N, Gunther JR, Reddy JP, Smith GL, Rohren E, Hagemeister FB, Lee HJ, Fayad LE, Dong W, Osborne EM, Abou Yehia Z, Fanale M, Dabaja BS. Early-stage Hodgkin lymphoma outcomes after combined modality therapy according to the post-chemotherapy 5-point score: can residual pet-positive disease be cured with radiotherapy alone? Br J Haematol 2017; 179:488-496. [PMID: 28832956 DOI: 10.1111/bjh.14902] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 07/18/2017] [Indexed: 01/02/2023]
Abstract
Early-stage classical Hodgkin lymphoma (HL) patients are evaluated by an end-of-chemotherapy positron emission tomography-computed tomography (eoc-PET-CT) after doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) and before radiation therapy (RT). We determined freedom from progression (FFP) in patients treated with ABVD and RT according to the eoc-PET-CT 5-point score (5PS). Secondarily, we assessed whether patients with a positive eoc-PET-CT (5PS of 4-5) can be cured with RT alone. The cohort comprised 174 patients treated for stage I-II HL with ABVD and RT alone. ABVD was given with a median of four cycles and RT with a median dose of 30·6 Gy. Five-year FFP was 97%. Five-year FFP was 100% (0 relapses/98 patients) for patients with a 5PS of 1-2, 97% (2/65) for a 5PS of 3, 83% (1/8) for a 5PS of 4, and 67% (1/3) for a 5PS of 5 (P < 0·001). Patients with positive eoc-PET-CT scans who were selected for salvage RT alone had experienced a very good partial response to ABVD. Risk factors for recurrence in this subgroup included a small reduction in tumour size and a 'bounce' in ≥1 PET-CT parameter (reduction then rise from interim to final scan). Thus, a positive eoc-PET-CT is associated with inferior FFP; however, appropriately selected patients can be cured with RT alone.
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Affiliation(s)
- Sarah A Milgrom
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Chelsea C Pinnix
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Hubert Chuang
- Department of Nuclear Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Yasuhiro Oki
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Mani Akhtari
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Osama Mawlawi
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Naveen Garg
- Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jillian R Gunther
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jay P Reddy
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Grace L Smith
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Eric Rohren
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | | | - Hun J Lee
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Luis E Fayad
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Wenli Dong
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX, USA
| | - Eleanor M Osborne
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Zeinab Abou Yehia
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle Fanale
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Bouthaina S Dabaja
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
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Abstract
Lymphoma of the heart and pericardium may develop in up to 25% of patients with disseminated nodal disease, but primary cardiac lymphoma is rare. The majority are diffuse large B-cell lymphomas, which arise in immunocompetent older individuals, men twice as often as women. Subsets are found in immunocompromised patients, including those with HIV-AIDS or allograft recipients. Cardiac lymphomas tend to arise in the wall of the right heart, especially right atrium, with contiguous infiltration of epicardium and pericardium. Pericardial implants and effusions are common. The disease is often multifocal in the heart, but cardiac valves are usually spared.
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Affiliation(s)
- Jean Jeudy
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Allen P Burke
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Aletta Ann Frazier
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA; American Institute for Radiologic Pathology, 1010 Wayne Avenue, Silver Spring, MD, USA.
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Wada R, Kamiya T, Fujino K, Ueda J, Isohashi K, Tatsumi M, Hatazawa J. [Creation and Evaluation of Educational Programs for Additional Delayed Scan of FDG-PET/CT]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2017; 73:1119-1124. [PMID: 29151544 DOI: 10.6009/jjrt.2017_jsrt_73.11.1119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Generally, FDG-PET/CT image is acquired at the 60th minute after tracer administration. Depending on the clinical case, additional delayed scans may be useful. However, it is difficult to judge whether additional delayed scan is useful or not. The purposes of this study were creation and evaluation of educational programs to help radiological technologists to decide the usefulness of additional delayed scan of FDG-PET/CT. METHODS Educational programs consisted of the instructional materials and the judgment test of clinical cases. The instructional materials provided the valuable findings for differentiation between uptake in the wall of the colon and colon content, distinction between uptake in the lymph node and urinary tract, and evaluation of malignancy. The judgment test of clinical cases consisted of 10 cases selected by a nuclear medicine physician (for 5 of that cases additional delayed scan was decided to be useful). Five experienced technologists and five inexperienced technologists scored the volubility of additional delayed scan pre- and post-training using the instructional materials (the full marks of score is 5). RESULTS After the educational programs using the instructional materials, the score was improved with the significant difference in both experienced (pre: 3.6±1.4, post: 4.0±1.2) and inexperienced (pre: 2.8±1.5, post: 3.7±1.5) groups (p<0.05). CONCLUSION According to the educational programs, technologist might be able to decide whether the additional delayed scan is useful or not. The successful results of this study may improve the interpretation or reduce the total exposure dose of the PET/CT scan.
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Affiliation(s)
- Ryota Wada
- Division of Radiology, Department of Medical Technology, Osaka University Hospital
| | - Takashi Kamiya
- Division of Radiology, Department of Medical Technology, Osaka University Hospital
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine
| | - Kouichi Fujino
- Division of Radiology, Department of Medical Technology, Osaka University Hospital
| | - Junpei Ueda
- Division of Radiology, Department of Medical Technology, Osaka University Hospital
| | - Kayako Isohashi
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine
| | - Mitsuaki Tatsumi
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
- Department of Radiology, Osaka University Hospital
| | - Jun Hatazawa
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine
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Abstract
OBJECTIVE The purpose of this article is to examine the role of different imaging biomarkers, focusing in particular on the use of updated CT and PET response criteria for the assessment of oncologic treatment effectiveness in patients with lymphoma but also discussing other potential functional imaging methods and their limitations. CONCLUSION Lymph nodes are commonly involved by metastatic solid tumors as well as by lymphoma. Evolving changes in cancer therapy for lymphoma and metastases have led to improved clinical outcomes. Imaging is a recognized surrogate endpoint that uses established criteria based on changes in tumor bulk to monitor the effects of treatment. With the introduction of targeted therapies and novel antiangiogenic drugs, the oncologic expectations from imaging assessment are changing to move beyond simple morphologic methods. Molecular and functional imaging methods (e.g., PET, perfusion, DWI, and dual-energy CT) are therefore being investigated as imaging biomarkers of response and prognosis. The role of these advanced imaging biomarkers extends beyond measuring tumor burden and therefore might offer insight into early predictors of therapeutic response. Despite the potential benefits of these exciting imaging biomarkers, several challenges currently exist.
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Fat-Containing Hypermetabolic Masses on FDG PET/CT: A Spectrum of Benign and Malignant Conditions. AJR Am J Roentgenol 2016; 207:1095-1104. [PMID: 27490138 DOI: 10.2214/ajr.16.16066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This article focuses on identifying the imaging appearances of hypermetabolic fatty masses and masslike lesions on PET/CT and understanding the diagnostic challenges radiologists may face while interpreting findings of these lesions on PET/CT. This article provides an approach to aid in the diagnosis of these lesions and the appropriate management of patients. CONCLUSION Both malignant and benign fat-containing masses and masslike lesions can show hypermetabolic activity on PET/CT. Although the differential diagnosis is broad, clinical history, anatomic location, and knowledge of anatomic variants and imaging features can help radiologists avoid misinterpretation of benign fatty lesions as malignancy.
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Milgrom SA, Dong W, Akhtari M, Smith GL, Pinnix CC, Mawlawi O, Rohren E, Garg N, Chuang H, Yehia ZA, Reddy JP, Gunther JR, Khoury JD, Suki T, Osborne EM, Oki Y, Fanale M, Dabaja BS. Chemotherapy Response Assessment by FDG-PET-CT in Early-stage Classical Hodgkin Lymphoma: Moving Beyond the Five-Point Deauville Score. Int J Radiat Oncol Biol Phys 2016; 97:333-338. [PMID: 28068241 DOI: 10.1016/j.ijrobp.2016.10.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/05/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE In early-stage classical Hodgkin lymphoma, fluorodeoxyglucose positron emission tomography (PET)-computed tomography (CT) scans are performed routinely after chemotherapy, and the 5-point Deauville score is used to report the disease response. We hypothesized that other PET-CT parameters, considered in combination with Deauville score, would improve risk stratification. METHODS AND MATERIALS Patients treated for stage I to II Hodgkin lymphoma from 2003 to 2013, who were aged ≥18 years and had analyzable PET-CT scans performed before and after chemotherapy, were eligible. The soft tissue volume (STV), maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis were recorded from the PET-CT scans before and after chemotherapy. Reductions were defined as 1 - (final PET-CT value)/(corresponding initial PET-CT value). The primary endpoint was freedom from progression (FFP). RESULTS For 202 patients treated with chemotherapy with or without radiation therapy, the 5-year FFP was 89% (95% confidence interval 85%-93%). All PET-CT parameters were strongly associated with the Deauville score (P<.001) and FFP (P<.0001) on univariate analysis. The Deauville score was highly predictive of FFP (C-index 0.89) but was less discriminating in the Deauville 1 to 4 subset (C-index 0.67). Therefore, we aimed to identify PET-CT parameters that would improve risk stratification for this subgroup (n=187). STV reduction was predictive of outcome (C-index 0.71) and was dichotomized with an optimal cutoff of 0.65 (65% reduction in STV). A model incorporating the Deauville score and STV reduction predicted FFP more accurately than either measurement alone in the Deauville 1 to 4 subset (C-index 0.83). The improvement in predictive accuracy of this composite measure compared with the Deauville score alone met statistical significance (P=.045). CONCLUSIONS The relative reduction in tumor size is an independent predictor of outcome. Combined with the Deauville score, it might improve risk stratification and contribute to response-adapted individualization of therapy.
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Affiliation(s)
- Sarah A Milgrom
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
| | - Wenli Dong
- Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas
| | - Mani Akhtari
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Grace L Smith
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Chelsea C Pinnix
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Osama Mawlawi
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, Texas
| | - Eric Rohren
- Department of Radiology, Baylor College of Medicine, Houston, Texas
| | - Naveen Garg
- Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Hubert Chuang
- Department of Nuclear Medicine, MD Anderson Cancer Center, Houston, Texas
| | - Zeinab Abou Yehia
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Jay P Reddy
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Jillian R Gunther
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Joseph D Khoury
- Department of Hematopathology, MD Anderson Cancer Center, Houston, Texas
| | - Tina Suki
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Eleanor M Osborne
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Yasuhiro Oki
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, Texas
| | - Michelle Fanale
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, Texas
| | - Bouthaina S Dabaja
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
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Intra-patient Variability of FDG Standardized Uptake Values in Mediastinal Blood Pool, Liver, and Myocardium during R-CHOP Chemotherapy in Patients with Diffuse Large B-cell Lymphoma. Nucl Med Mol Imaging 2016; 50:300-307. [PMID: 27994685 DOI: 10.1007/s13139-016-0432-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/09/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE 18F-fluorodeoxyglucose (FDG) PET/CT is useful for staging and evaluating treatment response in patients with diffuse large B-cell lymphoma (DLBCL). A five-point scale model using the mediastinal blood pool (MBP) and liver as references is a recommended method for interpreting treatment response. We evaluated the variability in standardized uptake values (SUVs) of the MBP, liver, and myocardium during chemotherapy in patients with DLBCL. METHODS We analyzed 60 patients with DLBCL who received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) treatment and underwent baseline, interim, and final FDG PET/CT scans. The FDG uptakes of lymphoma lesions, MBP, liver, and myocardium were assessed, and changes in the MBP and liver SUV and possible associated factors were evaluated. RESULTS The SUV of the liver did not change significantly during the chemotherapy. However, the SUVmean of MBP showed a significant change though the difference was small (p = 0.019). SUVmean of MBP and liver at baseline and interim scans was significantly lower in patients with advanced Ann Arbor stage on diagnosis. The SUVmean of the MBP and liver was negatively correlated with the volumetric index of lymphoma lesions in baseline scans (r = -0.547, p < 0.001; r = -0.502, p < 0.001). Positive myocardial FDG uptake was more frequently observed in interim and final scans than in the baseline scan, but there was no significant association between the MBP and liver uptake and myocardial uptake. CONCLUSIONS The SUV of the liver was not significantly changed during R-CHOP chemotherapy in patients with DLBCL, whereas the MBP SUV of the interim scan decreased slightly. However, the SUV of the reference organs may be affected by tumor burden, and this should be considered when assessing follow-up scans. Although myocardial FDG uptake was more frequently observed after R-CHOP chemotherapy, it did not affect the SUV of the MBP and liver.
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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.
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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.
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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.
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Abdel Rahman H, Sedky M, Hamoda A, Raafat T, Youssef A, Omar W, Hassanein O, Moussa E. Role of FDG-PET scan in the management of pediatric mature B cell non-Hodgkin's lymphoma. CCHE experience. J Egypt Natl Canc Inst 2016; 28:95-9. [PMID: 27133974 DOI: 10.1016/j.jnci.2016.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/26/2016] [Accepted: 03/30/2016] [Indexed: 10/21/2022] Open
Abstract
AIM OF WORK To evaluate the sensitivity (Se), specificity (Sp), and predictive values (PV) of PET scan during management of pediatric mature B cell non-Hodgkin's lymphoma (NHL) in comparison with conventional computed tomography (CT) scan. PATIENTS AND METHODS A retrospective study enrolled on pediatric NHL patients at Children Cancer Hospital Egypt (CCHE) during the period from July 2007 to the end of June 2013. RESULTS For 115 pediatric patients diagnosed with mature B cell NHL, 152 PET and 152 CT scans were done simultaneously. Median age was 5.7years. They were 85 males (74%) and 30 females (26%). One hundred twenty six scans (82.9%) were done for 100 (87%) Burkitt lymphoma (BL) patients, while 26 scans (17.1%) were done for 15 (13.0%) patients with diffuse large B cell NHL (DLBC). Nineteen examination (12.5%) were done before starting chemotherapy (group 1), 107 (70.3%) at time of evaluation (group 2), and 26 (17.1%) during follow up (group C). Overall sensitivity was 91.6% for PET and 70.0% for conventional CT (p=0.02). Specificity was 84.1% for PET and 58.9% for CT (p<0.001). Positive predictive value (PPV) for PET was 50%, while was 22% for CT scan (p<0.001). Negative predictive value (NPV) for PET was 98%, and 92% for CT (p=0.01). CONCLUSION PET scan is significantly more sensitive than conventional CT in the management of aggressive pediatric mature B cell NHL. PET negativity is an excellent indicator of tumor response.
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Affiliation(s)
- Hany Abdel Rahman
- Department of Pediatric Oncology, National Cancer Institute and Children Cancer Hospital, Egypt.
| | - Mohamed Sedky
- Department of Pediatrics, National Research Centre and Children Cancer Hospital, Egypt
| | - Asmaa Hamoda
- Department of Pediatric Oncology, National Cancer Institute and Children Cancer Hospital, Egypt
| | - Tarek Raafat
- Department of Radiodiagnosis, National Cancer Institute and Children Cancer Hospital, Egypt
| | - Ayda Youssef
- Department of Radiodiagnosis, National Cancer Institute and Children Cancer Hospital, Egypt
| | - Walid Omar
- Department of Nuclear Medicine, National Cancer Institute and Children Cancer Hospital, Egypt
| | - Omneya Hassanein
- Department of Clinical Research, Children Cancer Hospital, Egypt
| | - Emad Moussa
- Department of Medical Oncology, Menoufiah University and Children Cancer Hospital, Egypt
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Assessment of Sequential PET/MRI in Comparison With PET/CT of Pediatric Lymphoma: A Prospective Study. AJR Am J Roentgenol 2016; 206:623-31. [DOI: 10.2214/ajr.15.15083] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Song MK, Yang DH, Lee GW, Lim SN, Shin S, Pak KJ, Kwon SY, Shim HK, Choi BH, Kim IS, Shin DH, Kim SG, Oh SY. High total metabolic tumor volume in PET/CT predicts worse prognosis in diffuse large B cell lymphoma patients with bone marrow involvement in rituximab era. Leuk Res 2016; 42:1-6. [PMID: 26851438 DOI: 10.1016/j.leukres.2016.01.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 11/17/2015] [Accepted: 01/21/2016] [Indexed: 01/06/2023]
Abstract
Bone marrow involvement (BMI) in diffuse large B cell lymphoma (DLBCL) was naively regarded as an adverse clinical factor. However, it has been unknown which factor would separate clinical outcomes in DLBCL patients with BMI. Recently, metabolic tumor volume (MTV) on positron emission tomography/computed tomography (PET/CT) was suggested to predict prognosis in several lymphoma types. Therefore, we investigated whether MTV would separate the outcomes in DLBCL patients with BMI. MTV on PET/CT was defined as an initial tumor burden as target lesion ≥ standard uptake value, 2.5 in 107 patients with BMI. Intramedullary (IM) MTV was defined as extent of BMI and total MTV was as whole tumor burden. 260.5 cm(3) and 601.2 cm(3) were ideal cut-off values for dividing high and low MTV status in the IM and total lymphoma lesions in Receiver Operating Curve analysis. High risk NCCN-IPI (p<0.001, p<0.001), bulky disease (p=0.011, p=0.005), concordant subtype (p=0.025, p=0.029), high IM MTV status (p<0.001, p<0.001), high total MTV status (p<0.001, p<0.001), and ≥ 2CAs in BM (p=0.037, p=0.033) were significantly associated with progression-free survival (PFS) and overall survival (OS) than other groups. In multivariate analysis, high risk NCCN-IPI (PFS, p=0.006; OS, p=0.013), concordant subtype (PFS, p=0.005; OS, p=0.007), and high total MTV status (PFS, p<0.001; OS, p<0.001) had independent clinical impacts. MTV had prognostic significances for survivals in DLBCL with BMI.
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Affiliation(s)
- Moo-Kon Song
- Department of Hematology-Oncology, Pusan National University Yangsan Hospital Medical Research Institute, Yangsan, Republic of Korea
| | - Deok-Hwan Yang
- Department of Hematology, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea.
| | - Gyeong-Won Lee
- Department of Hematology, Gyeong-Sang National University Hospital, school of medicine, Gyeong-Sang National University Jinju, Republic of Korea
| | - Sung-Nam Lim
- Department of Hematology, Busan Haeundae Paik Hospital, Busan, Republic of Korea
| | - Seunghyeon Shin
- Department of Nuclear medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Kyoung June Pak
- Department of Nuclear medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Seong Young Kwon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Hye Kyung Shim
- Department of Nuclear Medicine, Busan Haeundae Paik Hospital, Busan, Republic of Korea
| | - Bong-Hoi Choi
- Department of Nuclear Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - In-Suk Kim
- Department of Laboratory medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Dong-Hoon Shin
- Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Seong-Geun Kim
- Department of Hematology-Oncology, Pusan National University Yangsan Hospital Medical Research Institute, Yangsan, Republic of Korea
| | - So-Yeon Oh
- Department of Hematology-Oncology, Pusan National University Yangsan Hospital Medical Research Institute, Yangsan, Republic of Korea
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Park SH, Lee JJ, Kim HO, Lee DY, Suh C, Jung HY, Choi KD, Kim DH, Huh J, Ryu JS. 18F-Fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography in mucosa-associated lymphoid tissue lymphoma: variation in 18F-FDG avidity according to site involvement. Leuk Lymphoma 2015; 56:3288-94. [PMID: 25804932 DOI: 10.3109/10428194.2015.1030640] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to determine the 18F-FDG avidity of MALT lymphoma and the additional utility of 18F-FDG PET/CT in MALT lymphoma staging. Pretreatment 18F-FDG PET/CT scans of 222 patients with 227 MALT lymphoma lesions were retrospectively analyzed. 18F-FDG avidity of lesions was noted in 28%. The proportion was lower for gastric MALT lymphomas than for non-gastric lesions (9% vs. 60%, p<0.0001) and higher for mass-forming lesions than for superficial lesions (82% vs. 2%, p<0.0001). 18F-FDG PET/CT showed the presence of additional lesions in 23 patients: four of six true-positive lesions had 18F-FDG avid primary lesions, and 15 of 17 false-positive lesions had 18F-FDG-non avid lesions. 18F-FDG avidity differed according to the location and gross morphologic characteristics of the MALT lymphoma. Most gastric MALT lymphomas were superficial and had low 18F-FDG avidity. For staging, 18F-FDG PET/CT can be helpful mainly for 18F-FDG avid primary MALT lymphomas.
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Affiliation(s)
- Seol Hoon Park
- a Department of Nuclear Medicine , Ulsan University Hospital , Seoul , Republic of Korea
| | - Jong Jin Lee
- b Department of Nuclear Medicine , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Hye Ok Kim
- b Department of Nuclear Medicine , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Dong Yun Lee
- b Department of Nuclear Medicine , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Cheolwon Suh
- c Department of Internal Medicine and Oncology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Hwoon-Yong Jung
- d Department of Internal Medicine and Gastroenterology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Kee Don Choi
- d Department of Internal Medicine and Gastroenterology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Do Hoon Kim
- d Department of Internal Medicine and Gastroenterology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Jooryung Huh
- e Department of Pathology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Jin-Sook Ryu
- b Department of Nuclear Medicine , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
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Utility of baseline 18FDG-PET/CT functional parameters in defining prognosis of primary mediastinal (thymic) large B-cell lymphoma. Blood 2015; 126:950-6. [DOI: 10.1182/blood-2014-12-616474] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 05/24/2015] [Indexed: 12/11/2022] Open
Abstract
Key Points
18FDG PET/CT is a very important staging tool for patients with PMBCL. Metabolic activity defined by TLG on the baseline PET scan is a powerful predictor of PMBCL outcome.
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Whole-body diffusion-weighted MRI and (18)F-FDG PET/CT can discriminate between different lymphoma subtypes. Clin Radiol 2015. [PMID: 26208992 DOI: 10.1016/j.crad.2015.06.087] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM To determine whether combined 2-[(18)F]-fluoro-2-deoxy-d-glucose ((18)F-FDG) positron-emission tomography (PET)/computed tomography (CT) and diffusion-weighted imaging (DWI) can be used for characterisation of different lymphoma subtypes, i.e., indolent versus aggressive lymphoma, and also to assess the prognostic value of different quantitative parameters of whole-body (WB) DWI and (18)F-FDG PET/CT. MATERIALS AND METHODS Pre-therapeutic WB magnetic resonance imaging (MRI) including DWI and (18)F-FDG PET/CT were performed in lymphoma patients. Different quantitative DWI and (18)F-FDG PET/CT parameters were evaluated for characterisation of different lymphoma subtypes. These parameters were also correlated, both separately and in combination, against overall survival (OS) and progression-free survival (PFS). A lesion-by-lesion analysis was performed for correlation analysis between maximum standardised uptake value (SUVmax), mean standardised uptake value (SUVmean) and mean apparent diffusion coefficient (ADC). RESULTS Fifty patients were included in the study and divided into three groups: Hodgkin's lymphoma (HL), n=12; aggressive non-Hodgkin's lymphoma (NHL), n=29 (including 20 patients with diffuse large B-cell lymphoma, DLBCL); and indolent NHL, n=9. Indolent NHL showed significantly lower mean ADC values than the other two lymphoma groups (p=0.013). Aggressive NHL had a higher SUVmax than HL. The OS analysis of all patients showed a relationship (p=0.006) between increased mean ADC and longer OS. A model with both SUVmean and mean ADC, strengthened the possibility to predict PFS; however, a separate analysis of the DLBCL patients showed that none of the quantitative parameters could predict OS or PFS. CONCLUSION ADC can discriminate between indolent and aggressive NHL. This finding can be useful in assessing possible transformation from indolent to aggressive NHL. ADC, ADC/SUV, and SUV cannot predict OS/PFS independent of lymphoma subtype.
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Feng DD, Fulham M. Classification of thresholded regions based on selective use of PET, CT and PET-CT image features. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:1913-6. [PMID: 25570353 DOI: 10.1109/embc.2014.6943985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Fluorodeoxyglucose positron emission tomography - computed tomography (FDG PET-CT) is the preferred image modality for lymphoma diagnosis. Sites of disease generally appear as foci of increased FDG uptake. Thresholding methods are often applied to robustly separate these regions. However, its main limitation is that it also includes sites of FDG excretion and physiological FDG uptake regions, which we define as FEPU - sites of FEPU include the bladder, renal, papillae, ureters, brain, heart and brown fat. FEPU can make image interpretation problematic. The ability to identify and label FEPU sites and separate them from abnormal regions is an important process that could improve image interpretation. We propose a new method to automatically separate and label FEPU sites from the thresholded PET images. Our method is based on the selective use of features extracted from data types comprising of PET, CT and PET-CT. Our FEPU classification of 43 clinical lymphoma patient studies revealed higher accuracy when compared to non-selective image features.
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Platzek I, Beuthien-Baumann B, Ordemann R, Maus J, Schramm G, Kitzler HH, Laniado M, Kotzerke J, van den Hoff J. FDG PET/MR for the assessment of lymph node involvement in lymphoma: initial results and role of diffusion-weighted MR. Acad Radiol 2014; 21:1314-9. [PMID: 25086953 DOI: 10.1016/j.acra.2014.05.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/12/2014] [Accepted: 05/13/2014] [Indexed: 12/24/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to evaluate the sensitivity and specificity of positron emission tomography/magnetic resonance imaging (PET/MR) with 18F-fluorodeoxyglucose (FDG) for nodal involvement in malignant lymphoma. MATERIALS AND METHODS Twenty-seven patients with malignant lymphoma (16 men and 11 women; mean age, 45 years) were included in this retrospective study. The patients underwent FDG PET/MR after intravenous injection of FDG (176-357 MBq FDG, 282 MBq on average). Follow-up imaging and histology served as the standard of reference. RESULTS One-hundred and twenty-seven (18.1%) of 702 lymph node stations were rated as having lymphoma involvement based on the standard of reference. One-hundred and twenty-four (17.7%) of 702 lymph node stations were rated as positive by FDG PET/MR. The sensitivity and specificity of FDG PET/MR for lymph node station involvement were 93.8% and 99.4%. CONCLUSIONS FDG PET/MR is feasible for lymphoma staging and has a high sensitivity and specificity for nodal involvement in lymphoma. Comparison with PET/CT is necessary to determine whether FDG PET/MR can replace PET/CT for lymphoma staging.
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Affiliation(s)
- Ivan Platzek
- Department of Radiology, Dresden University Hospital, Fetscherstr. 74, 01307 Dresden, Germany.
| | | | - Rainer Ordemann
- Department of Internal Medicine, Dresden University Hospital, Dresden, Germany
| | - Jens Maus
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Georg Schramm
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Hagen H Kitzler
- Department of Neuroradiology, Dresden University Hospital, Dresden, Germany
| | - Michael Laniado
- Department of Radiology, Dresden University Hospital, Fetscherstr. 74, 01307 Dresden, Germany
| | - Jörg Kotzerke
- Department of Nuclear Medicine, Dresden University Hospital, Dresden, Germany
| | - Jörg van den Hoff
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
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Evaluation of regional cerebral glucose metabolism in patients with malignant lymphoma of the body using statistical image analysis. Ann Nucl Med 2014; 28:950-60. [PMID: 25113148 PMCID: PMC4244549 DOI: 10.1007/s12149-014-0890-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 07/19/2014] [Indexed: 11/14/2022]
Abstract
Objectives The aim of this study was to clarify the characteristics of regional cerebral glucose metabolic abnormalities in patients with malignant lymphoma of the body using statistical image analyses. Post-therapeutic changes in cerebral glucose metabolism were also evaluated. Methods The subjects consisted of 30 patients, including 16 patients with diffuse large B-cell lymphoma and 14 patients with other types of lymphoma. Patients with primary cerebral lymphoma were excluded from this study. All patients underwent CT and whole-body FDG-PET scans, including 4-min brain scans using a dedicated PET/CT scanner during both the pre- and post-treatment periods. The whole-body scans started 60 min after the administration of 185 MBq of FDG, after which the brain data were extracted from whole-body data. The degree of regional cerebral glucose metabolism was evaluated on a voxel-by-voxel basis using statistical parametric mapping (SPM). The total tumor glycolytic volume of the body was measured using a separate workstation. The normal control subjects were 12 persons who underwent medical check with FDG-PET/CT and had no lesions suggesting malignant tumor. Results The level of regional cerebral glucose metabolism decreased in association with an increase in the total glycolytic volume in the bilateral frontal and parietal cortices. After chemotherapy, the statistical image analysis demonstrated an interval recovery of the cerebral glucose metabolism of the bilateral parietal and occipital cortices in the good responders, whereas there were no significant differences observed in regional cerebral glucose metabolism between the pre- and post-treatment images in the poor responders. Comparison between normal control subjects and patients with pre-treatment lymphoma also showed that the regional cerebral glucose metabolism decreased in the parieto-occipital cortices in patients with lymphoma compared to normal control subjects. Conclusions We demonstrated that patients with malignant lymphoma of the body exhibited abnormal regional cerebral glucose metabolism, which improves after chemotherapy. Although the mechanism underlying the reduction of cerebral glucose metabolism remains unclear, our findings indicate the functional alternation and/or subclinical damage of the brain in patients with malignant lymphoma.
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