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Saksena A, Jain A, Pack SD, Kim J, Lee I, Tyagi M, Xi L, Pittaluga S, Raffeld M, Jaffe ES. Follicle Center Lymphoma (FCL) of the Lower Female Genital Tract (LFGT): A Novel Variant of Primary Cutaneous Follicle Center Lymphoma (PCFCL). Am J Surg Pathol 2023; 47:409-419. [PMID: 36461146 PMCID: PMC9974907 DOI: 10.1097/pas.0000000000002003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Primary cutaneous follicle center lymphoma has been distinguished from nodal follicular lymphoma (FL) based on genomic and clinical features. The nature of other extranodal FLs is not well defined. We report 15 cases of follicle center lymphoma involving the lower female genital tract. Cases were evaluated using an immunohistochemical panel for B-cell lymphoma, B-cell clonality, fluorescence in situ hybridization for BCL2 gene rearrangement, and next-generation sequencing. All patients had localized disease with no evidence of bone marrow involvement. Most cases (12/15, 80%) had a follicular pattern, at least focally. Large centrocytes were a prominent feature leading to concern for diffuse large B-cell lymphoma by referring pathologists. Neoplastic cells were positive for CD20 and BCL-6, while BCL-2 was positive in 2/15 (13%) cases. Fluorescence in situ hybridization for BCL2 gene rearrangement was negative in 10/11 (91%) cases. Next-generation sequencing performed in 10 cases revealed TNFRSF14 as the most frequently mutated gene in 6/10 (60%) cases. No case had CREBBP or KMT2D mutations as seen in nodal FL. None of the patients had progressive disease with durable complete remission achieved in 10/12 (83%) cases. The median follow-up period was 7.8 years (range: 0.2 to 20.5 y) with a 5-year overall survival of 100%. We conclude that follicle center lymphoma of the lower female genital tract is a novel variant of primary cutaneous follicle center lymphoma. Despite a frequent component of large cells, it is characterized by localized disease and low risk for dissemination. Awareness and recognition are important to distinguish these lesions from aggressive B-cell lymphomas.
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Affiliation(s)
- Annapurna Saksena
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Ashish Jain
- CCR Collaborative Bioinformatics Resource (CCBR), CCR, NCI, Bethesda, MD
- Advanced Biomedical Computational Science, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Svetlana D. Pack
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Jung Kim
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Ina Lee
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Manoj Tyagi
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Liqiang Xi
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Stefania Pittaluga
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Mark Raffeld
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Elaine S. Jaffe
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
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Di Giuliano F, Picchi E, Pucci N, Minosse S, Ferrazzoli V, Pizzicannella G, Angeloni C, Nasso D, Chiaravalloti A, Garaci F, Floris R. Comparison between diffusion-weighted magnetic resonance and positron-emission tomography in the evaluation of treated lymphomas with mediastinal involvement. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00825-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
The persistence of residual tissue after treatment is frequent in patients with mediastinal lymphomas and it is often characterized by 18F-Flurodeoxyglucose Positron Emission Tomography (18F-FDG PET) uptake. This study aims to investigate the usefulness of diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) sequence in residual tissues of treated mediastinal lymphomas and to compare it with 18F-FDG PET-CT.
Results
We included 21 patients with mediastinal Hodgkin and non-Hodgkin lymphomas who showed residual masses on PET-CT imaging at end of treatment and underwent DWIBS-Magnetic Resonance Imaging (MRI). SUVmax and Apparent Diffusion Coefficient (ADC) values of residual masses were assessed quantitatively, including measurement of mean ADC. 15 patients showed radiotracer uptake at 18F-FDG PET-CT, among them only 3 had positive DWIBS-MRI with low ADC values (median value: 0.90 mm2/s). The mediastinal biopsy in these 3 “double positive” patients confirmed pathological residual tissue. All the patients with positive 18F-FDG PET-CT but negative DWIBS-MRI (n = 18) with high ADC values (median value: 2.05 mm2/s) were confirmed negative by biopsy.
Conclusions
DWIBS-MRI examination combined with ADC measurement allowed to discriminate pathological and non-pathological residual tissue in patients with treated mediastinal lymphoma. These preliminary results seem to pave the way for a leading role of the MRI which could be a useful alternative to the 18F-FDG PET/CT.
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Berger T, Geiger KR, Yeshurun M, Gafter‑Gvili A, Shochat T, Gurion R, Raanani P, Pasvolsky O. Repeat biopsy in relapsed or refractory diffuse large B cell lymphoma: a nationwide survey and retrospective study. Leuk Lymphoma 2022; 63:2461-2468. [DOI: 10.1080/10428194.2022.2081325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tamar Berger
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karyn Revital Geiger
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Yeshurun
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Gafter‑Gvili
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine A, Rabin Medical Center, Petah-Tikva, Israel
| | - Tzippy Shochat
- Bio-Statistical Unit, Rabin Medical Center, Petah Tikva, Israel
| | - Ronit Gurion
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Pasvolsky
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Wang W, Mai B, Ali H, Chen L. Uncommon histiocyte-rich pseudotumor after chemotherapy in peripheral T-cell lymphoma. Leuk Lymphoma 2022; 63:2013-2015. [PMID: 35357259 DOI: 10.1080/10428194.2022.2056176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Wei Wang
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Brenda Mai
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Haval Ali
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lei Chen
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Clinical Characteristics of Sarcoidosis Patients with Self-Reported Lymphoma: A US Nationwide Registry Study. Lung 2021; 199:611-618. [PMID: 34665319 DOI: 10.1007/s00408-021-00485-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Little is known about the association between sarcoidosis and lymphoma. We aim to determine the prevalence of lymphoma in US sarcoidosis patients and compare the clinical characteristics of patients with and without lymphoma. METHODS Using a national registry-based study investigating 3560 respondents to the Foundation for Sarcoidosis Research Sarcoidosis Advanced Registry for Cures Questionnaire (FSR-SARC) completed between June 2014 and August 2019, we identified patients who reported the diagnosis of lymphoma following sarcoidosis and randomly selected a computer-generated control sample of sarcoidosis patients with no reported lymphoma with a 2:1 ratio. RESULTS Among 3560 patients with sarcoidosis, 43 (1.2%) reported developing lymphoma following their sarcoidosis diagnosis. Patients with lymphoma were more likely to be diagnosed with sarcoidosis at a younger age (median, IQR) 40 (27-50) vs 45 (34.8-56, p = 0.017) years, were more likely to be African-Americans OR 95% CI 3.9 (1.6-9.6, p = 0.002), and have low annual income (OR 2.7, 1.1-6.4 p = 0.026). The sarcoidosis-lymphoma group were more likely to have salivary gland (16% vs 5%, p = 0.026) (OR 4; 1.1-14.5) and cutaneous (46% vs 23%, p = 0.023) (OR 2.9; 1.1-7.3) sarcoidosis. They also reported more chronic fatigue (42% vs 23%, p = 0.029), chronic pain (37% vs 13%, p = 0.001), and depression (42% vs 22%, p = 0.019). CONCLUSION The prevalence of lymphoma reported in sarcoidosis patients is higher than the general population which further supports the possible increased risk of lymphoma in sarcoidosis. Diagnosis of sarcoidosis at a younger age, African-American race, cutaneous, and salivary glands sarcoidosis were associated with lymphoma. Sarcoidosis patients who developed lymphoma reported higher disease burden and more non-organ-specific manifestations.
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Gallamini A, Kurlapski M, Zaucha JM. FDG-PET/CT for the Management of Post-Chemotherapy Residual Mass in Hodgkin lymphoma. Cancers (Basel) 2021; 13:cancers13163952. [PMID: 34439108 PMCID: PMC8391562 DOI: 10.3390/cancers13163952] [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: 06/22/2021] [Revised: 07/21/2021] [Accepted: 08/02/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary In the present review the authors report the predictive value of FDG/PET-CT (PET) on treatment outcome of Hodgkin lymphoma patients showing a post-chemotherapy residual mass, based on the published reports of PET-guided consolidation radiotherapy after different-intensity chemotherapy regimens such as ABVD or BEACOPPescalated. A special focus will be dedicated to the role of PET for assessing patients with a residual mass during and after immunotherapy with immune checkpoint inhibitors. Finally, the interpretation criteria of PET will be also reviewed, and the role of alternative imaging techniques discussed. Abstract In the present review, the authors report the published evidence on the use of functional imaging with FDG-PET/CT in assessing the final response to treatment in Hodgkin lymphoma. Despite a very high overall Negative Predictive Value of post-chemotherapy PET on treatment outcome ranging from 94% to 86%, according to different treatment intensity, the Positive Predicting Value proved much lower (40–25%). In the present review the Authors discuss the role of PET to guide consolidation RT over a RM after different chemotherapy regimens, both in early and in advanced-stage disease. A particular emphasis is dedicated to the peculiar issue of the qualitative versus semi-quantitative methods for End-of Therapy PET scan interpretation. A short hint will be given on the role of FDG-PET to assess the treatment outcome after immune checkpoint inhibitors.
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Affiliation(s)
- Andrea Gallamini
- Research and Clinical Innovation Department, Antoine Lacassagne Cancer Centre, 06189 Nice, France
- Correspondence:
| | - Michał Kurlapski
- Haematology and Bone Marrow Transplantation Department, Medical University of Gdansk, 80-214 Gdansk, Poland; (M.K.); (J.M.Z.)
| | - Jan Maciej Zaucha
- Haematology and Bone Marrow Transplantation Department, Medical University of Gdansk, 80-214 Gdansk, Poland; (M.K.); (J.M.Z.)
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Postchemotherapy Histiocyte-rich Pseudotumor Mimicking Residual Lymphoma: A Report of 11 Cases Correlating Clinicopathologic and Radiologic Findings. Am J Surg Pathol 2021; 45:160-168. [PMID: 32769427 DOI: 10.1097/pas.0000000000001547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Postchemotherapy histiocyte-rich pseudotumor is a rare event in lymphoma patients and can cause elevated metabolic activity on positron emission tomography-computed tomography scan mimicking residual tumor. Here, we reported 11 lymphoma cases showing mass-like lesions with increased fluorodeoxyglucose uptake after chemotherapy. These postchemotherapy lesions occurred in various anatomic sites including spleen, mediastinum, lymph node, and other tissue locations, concerning for refractory or residual lymphoma. Their median size was 2.7 cm (range, 1.4 to 7.7 cm) and the median standardized uptake value on positron emission tomography-computed tomography was 10.6 (range, 5.2 to 13.8). Histologic examination of these lesions demonstrated reactive changes mainly composed of histiocyte-rich proliferation without viable lymphoma. Fat necrosis, cholesterol cleft, and calcium deposit were also commonly observed. After biopsies, 3 patients received additional chemotherapy, 2 had stem cell transplant with adjuvant chemotherapy or radiation, 1 had surgical excision, and the remaining 5 patients did not receive any further treatment. Follow-up imaging studies showed the resolved or decreased fluorodeoxyglucose activities in all patients including those without additional treatments, consistent with benign/reactive nature of these pseudotumor lesions. This study illustrates postchemotherapy mass-like lesions with elevated metabolic activity do not always represent residual disease and provides awareness of correlation between radiologic and histologic features of these lesions to avoid misinterpretation and overtreatment of lymphoma patients after chemotherapy.
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Ahn JH, Jang MH. Delayed sarcoidosis onset mimicking mediastinal lymphoma recurrence after complete remission of diffuse large B cell lymphoma: A case report. Thorac Cancer 2021; 12:1231-1233. [PMID: 33615672 PMCID: PMC8046158 DOI: 10.1111/1759-7714.13885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 11/28/2022] Open
Abstract
Sarcoidosis‐lymphoma syndrome describes a pathological state wherein both sarcoidosis and lymphoma are present. Sarcoidosis and lymphoma may occur concurrently, or sarcoidosis may precede lymphoma. There are few reports which have previously described the temporal progression from lymphoma to sarcoidosis. Here, we present a patient with stage II diffuse large B‐cell lymphoma in the right breast. The patient achieved complete remission after chemotherapy. Five years after remission, the patient visited our clinic with newly developed enlarged mediastinal lymph nodes; lymphoma recurrence was suspected. However, mediastinal lymph node biopsy showed numerous noncaseating granulomas with no evidence of malignancy in the mediastinal lymph nodes. Consequently, a diagnosis of sarcoidosis was made. This case report highlights the need for pathological confirmation following biopsy when recurrence of lymphoma is suspected.
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Affiliation(s)
- June Hong Ahn
- Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, South Korea
| | - Min Hye Jang
- Department of Pathology, Yeungnam University College of Medicine, Daegu, South Korea
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Ragheb SR, Louka AL, Sharara SM. Lugano classification: response evaluation criteria for positron emission tomography/computed tomography in lymphoma follow-up. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00303-1] [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
The purpose of this study is to assess the role of 18 fluorodeoxyglucose positron emission tomography/computed tomography (18FDG PET-CT) in the follow-up of patients with lymphoma after finishing therapy.
Results
This study included 42 lymphomas (25 non-Hodgkin’s lymphoma and 17 Hodgkin’s lymphoma); patients ranging in age from 18 to 70 years were examined by 18FDG PET-CT after therapy and analyzed retrospectively. Confirmatory biopsy was mandatory in cases of suspected disease recurrence and follow-up in cases of complete metabolic response. Positron emission tomography/computed tomography in assessment of lymphoma treatment response reveals significant statistical significance (P < 0.05). It shows 100% sensitivity, 92.8% specificity, and 95.2% accuracy in the prediction of response.
Conclusion
Positron emission tomography/computed tomography plays an important role in detection of response to treatment of lymphoma after finishing therapy.
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Farghaly H, Alshareef M, Alqarni A, Sayed M, Nasr H. Dual time point [18F]Flurodeoxyglucose (FDG) Positron Emission Tomography (PET)/Computed Tomography (CT) with water gastric distension in differentiation between malignant and benign gastric lesions. Eur J Radiol Open 2020; 7:100268. [PMID: 32964074 PMCID: PMC7490534 DOI: 10.1016/j.ejro.2020.100268] [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: 05/29/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023] Open
Abstract
Objectives To assess diagnostic accuracy and added value of dual time point 18F-FDG PET/CT after gastric distention using oral water in differentiating malignant from benign gastric lesions. Methods Patients (n = 30, 19 males, mean age 58.6 ± 16.4 years). All patients are known or suspected oncology patients. All patients underwent whole body 18F-FDG PET/CT scan and 2 h delayed PET/CT abdominal images following oral water gastric distension. The best cut off values for early SUVmax (SUVmax1), delayed SUVmax (SUVmax2) and SUVmax2-SUVmax1 (ΔSUVmax) to differentiate benign from malignant lesions were set based on ROC analysis. Data analyzed included in addition; age, sex and 18F-FDG uptake pattern in delayed images. Suspicious gastric lesions were correlated with biopsy in 18 patients (60 %) and with clinical and follow-up imaging (18F-FDG PET/CT, CT or MRI) in 12 patients (40 %). Unpaired t-test was used to compare the mean deference in continuous variables between patients with gastric malignancy and those with benign gastric lesions. Fisher's exact test was used to analyze categorical variables. Logistic regression analysis was performed to identify the most powerful factors to predict malignant lesions. Results Fifteen patients (50 %) had confirmed malignant gastric lesions. Patients with confirmed gastric malignancy were older (65 ± 13 vs 52 ± 17; p = 0.023) and had significantly higher mean ΔSUVmax (1.29 ± 1.76 vs -0.89 ± 1.59; p = 0.003). The mean SUVmax1 (6.99 ± 6.66 vs 5.31 ± 2.53; p = 0.367) and SUVmax2 (8.29 ± 7.41 vs 4.44 ± 3.34; p = 0.077) although both higher in patients with malignant lesions, they did not reach statistical significance. Sensitivity, specificity, PPV, NPV, and accuracy to detect malignant gastric lesions were highest for lesions with localized uptake pattern in delayed images post water oral contrast as well as for lesions with ΔSUVmax>0. Regression analysis revealed both variables as independent predictors for malignant lesions with odd ratios of 22.9 and 9.5 respectively and final model Chi-Square of 19.9 (p < 0.0001). The model correctly identified 12/15 (80 %) malignant lesions and 13/15 (86.7 %) benign lesions with 2 false positives confirmed as chronic active gastritis with helicobacter pylori and 3 false negatives including 1 signet ring gastric cancer and 1 low grade gastrointestinal stromal tumor (GIST), both with poor 18 F-FDG uptake. Conclusion Localized uptake pattern in delayed PET/CT images following gastric distention with oral water contrast as well as ΔSUVmax>0 are powerful independent variables to identify malignant gastric lesions with fairly high sensitivity and reasonable accuracy. Malignancies with inherently low 18F-FDG avidity are the main cause of false negatives while active gastritis is the main cause of false positives.
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Affiliation(s)
- Hussein Farghaly
- Department of Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohamed Alshareef
- Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alqarni
- Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohamed Sayed
- Department of Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hatem Nasr
- Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.,Department of Oncology and Nuclear Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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Prabhash K, Rajendra A, Noronha V, Bagal B, Niyogi D, Shet T, Purandare N, Tibdewal A. Twin trouble. CANCER RESEARCH, STATISTICS, AND TREATMENT 2020. [DOI: 10.4103/crst.crst_103_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Adams HJA, Kwee TC. Proportion of false-positive follow-up FDG-PET scans in lymphoma: Systematic review and meta-analysis. Crit Rev Oncol Hematol 2019; 141:73-81. [PMID: 31252322 DOI: 10.1016/j.critrevonc.2019.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/20/2019] [Indexed: 01/18/2023] Open
Abstract
This study aimed to assess the false-positive proportion of follow-up 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in lymphoma patients who initially achieved an end-of-treatment complete remission, using biopsy as reference standard. Medline was searched for original studies, studies were methodologically evaluated and results were meta-analytically summarized. Proportion of false-positive results ranged between 9.5%-90.0%, with a weighted summary proportion (random effects) of 42.9% (95% confidence interval [CI]: 29.0%-58.0%). A separate subgroup analysis in symptomatic patients only again revealed a relatively high summary proportion of false-positive follow-up FDG-PET of 37.5% (random effects). In conclusion, the false-positive proportion of follow-up FDG-PET in lymphoma patients who initially achieved an end-of-treatment complete remission is high and remains high when a combination of clinical symptoms and follow-up FDG-PET is used. Therefore, biopsy remains compulsory and follow-up FDG-PET alone may be regarded as unreliable to define progression-free survival.
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Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Zanoni L, Broccoli A, Lambertini A, Pellegrini C, Stefoni V, Lodi F, Fonti C, Nanni C, Zinzani PL, Fanti S. Role of 18F-FLT PET/CT in suspected recurrent or residual lymphoma: final results of a pilot prospective trial. Eur J Nucl Med Mol Imaging 2019; 46:1661-1671. [DOI: 10.1007/s00259-019-04323-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/29/2019] [Indexed: 01/01/2023]
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14
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Broccoli A, Forti Parri SN, Pellegrini C, Casadei B, Bonfanti B, Bertolaccini L, Agostinelli C, Boaron M, Fanti S, Nanni C, Argnani L, Zinzani PL. Histological findings in patients with suspected mediastinal lymphoma relapse according to positive positron emission tomography scan during follow-up: a large retrospective analysis in 96 patients. Leuk Lymphoma 2019; 60:2247-2254. [DOI: 10.1080/10428194.2019.1581931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Alessandro Broccoli
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna, Italy
| | | | - Cinzia Pellegrini
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna, Italy
| | - Beatrice Casadei
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna, Italy
| | - Barbara Bonfanti
- Thoracic Surgery Unit, Maggiore-Bellaria Hospital, Bologna, Italy
| | | | | | - Maurizio Boaron
- Thoracic Surgery Unit, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Lisa Argnani
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna, Italy
| | - Pier Luigi Zinzani
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna, Italy
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Broccoli A, Zinzani PL. The unique biology and treatment of primary mediastinal B-cell lymphoma. Best Pract Res Clin Haematol 2018; 31:241-250. [DOI: 10.1016/j.beha.2018.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/11/2018] [Accepted: 07/02/2018] [Indexed: 01/03/2023]
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16
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Post-therapy lesions in patients with non-Hodgkin's lymphoma characterized by 18F-FDG PET/CT-guided biopsy using automated robotic biopsy arm. Nucl Med Commun 2018; 39:74-82. [PMID: 29189443 DOI: 10.1097/mnm.0000000000000780] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE The aim of this study was to analyse the positive predictive value (PPV) of post-therapy fluorine-18-fluorodeoxyglucose (F-FDG) PET/CT performed for response or recurrence evaluation in patients with non-Hodgkin's lymphoma (NHL) and to appraise the diagnostic utility of F-FDG PET/CT-guided biopsy in this setting. PATIENTS AND METHODS A total of 17 patients with NHL showing F-FDG avid lesions in F-FDG PET/CT performed for response or recurrence assessment underwent F-FDG PET/CT-guided biopsy using automated robotic biopsy arm needle navigation technique. The objectives were analysed in reference to histopathology. RESULTS In all, 15 of the 17 (88.5%) procedures yielded adequate representative tissue samples. Nine out of 15 lesions were positive for residual disease and the remaining revealed benign findings on histopathology. One patient with inconclusive biopsy underwent surgical resection and histopathology confirmed the presence of residual disease. PPV of theF-FDG PET/CT was observed to be 62.5% (10/16). CONCLUSION F-FDG PET/CT for response evaluation in NHL possesses a low PPV and hence warrants histopathological correlation when F-FDG PET/CT findings influence management decision. Diagnostic yield of F-FDG PET/CT-guided biopsy is high and has the potential to reduce sampling errors.
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Whooley PD, Dorer RK, Aboulafia DM. The fear of lymphadenopathy: A cautionary case of sarcoidosis masquerading as recurrent diffuse large b-cell lymphoma (DLBCL). Leuk Res Rep 2018; 9:48-53. [PMID: 29892550 PMCID: PMC5993354 DOI: 10.1016/j.lrr.2018.04.003] [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: 01/23/2018] [Accepted: 04/07/2018] [Indexed: 12/01/2022] Open
Abstract
We describe the cautionary case of a patient with advanced-stage large B-cell lymphoma (DLBCL). After combination chemotherapy, CT-PET revealed a persistent focus of likely DLBCL for which he received radiotherapy. Follow-up CT-PET showed diffuse hypermetabolic adenopathy and recurrent DLBCL was presumed. As part of clinical trial assessment, multiple biopsies showed non-caseating lymphadenitis consistent with sarcoidosis. No treatment for asymptomatic sarcoidosis was required and 18 months later he remains cancer-free. The presentation of sarcoidosis masquerading as recurrent DLBCL highlights the importance of tissue sampling prior to engaging in toxic and potentially life-threatening chemotherapy and the interesting link between DLBCL and sarcoidosis.
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Affiliation(s)
- Peter D Whooley
- Division of General Internal Medicine, Virginia Mason Medical Center, Seattle, WA, United States
| | - Russell K Dorer
- Section of Pathology, Virginia Mason Medical Center, Seattle, WA, United States
| | - David M Aboulafia
- Floyd & Delores Jones Cancer Institute at Virginia Mason Medical Center, Seattle, WA, United States.,Division of Hematology, University of Washington, United States
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18 F-FDG PET/TC con contraste intravenoso en el seguimiento estandarizado de pacientes con linfoma. Rev Esp Med Nucl Imagen Mol 2018; 37:151-155. [DOI: 10.1016/j.remn.2017.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/31/2017] [Accepted: 09/08/2017] [Indexed: 11/24/2022]
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García Vicente A, Talavera Rubio M, Dominguez Ferreras E, Calle Primo C, Amo-Salas M, Tello Galán M, Jimèc)nez Londoño G, Jimèc)nez Aragón F, Hernández Ruiz B, Soriano Castrejón Á. 18 F-FDG PET/contrast enhanced CT in the standard follow-up of patients with lymphoma. Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2017.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Adams HJA, Kwee TC. Debate on the value of end-of-treatment FDG-PET response evaluation in follicular lymphoma. Acta Oncol 2017; 56:1789-1791. [PMID: 28712315 DOI: 10.1080/0284186x.2017.1349927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Hugo J. A. Adams
- Department of Radiology and Nuclear Imaging, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas C. Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
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Adams HJA, Kwee TC. Prevention of large-scale implementation of unnecessary and expensive predictive tests in Hodgkin's lymphoma. LANCET HAEMATOLOGY 2017; 4:e63-e64. [PMID: 28159190 DOI: 10.1016/s2352-3026(16)30190-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 11/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht 3584, The Netherlands.
| | - Thomas C Kwee
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht 3584, The Netherlands
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Huang J, Tan Y, Zhen Z, Lu S, Sun F, Zhu J, Wang J, Liao R, Sun X. Role of post-chemotherapy radiation in the management of children and adolescents with primary advanced malignant mediastinal germ cell tumors. PLoS One 2017; 12:e0183219. [PMID: 28813488 PMCID: PMC5558937 DOI: 10.1371/journal.pone.0183219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 08/01/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Primary malignant mediastinal germ cell tumors (MMGCTs) are rare in children and adolescents and have a poorer prognosis than their gonadal counterparts. We report a single institutional experience of a 10-year period of primary advanced MMGCTs treated with chemotherapy, followed by radiotherapy in those who had residual mass. METHODS Children and adolescents with primary advanced MMGCTs between 2005 and 2014 were identified from the Cancer Center, Sun Yat-Sen University. Medical records were reviewed for clinicopathological characteristics, treatments, and outcomes. RESULTS Twenty-four children and adolescents with either stage III or IV primary advanced MMGCTs met the inclusion criteria. There were 23 males and one female with a median age of 16 (range 10-18). Seven cases were seminomas (29.2%); four (16.7%) yolk sac tumors (YST); three (12.5%) choriocarcinomas; and ten (41.6%) nonteratomatous combined germ cell tumors (CGCTs). All patients were treated with first-line cisplatin-based chemotherapy regimens (PEB: 19, VIP: 5). Thirteen (54.2%) and Twelve (50%) patients received surgery and radiotherapy, respectively. With a median follow-up of 46.2 months (range 9.6-124.8 months), a total of five (20%) patients died of disease progression; the five-year overall survival (OS) and disease-free survival (DFS) rates were 82.3% and 64.9%, respectively.-Seven patients with seminoma GCTs received post-chemotherapy irradiation were alive with sustained CR (5-year OS and DFS, 100%, respectively). Five patients with NSGCTs were administered irradiation and one relapsed 35 months later and died of metastasis (5-year OS, 100%; 5-year DFS 66.7%). Univariate analysis identified histology and stage were prognostic factors. CONCLUSION Multimodality treatment approach of chemotherapy followed by radiation consolidation ensured long-term survival in primary advanced MMGCTs. Further research is warranted to improve the prognosis of children with primary advanced MMGCTs.
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Affiliation(s)
- Junting Huang
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Yuting Tan
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Zijun Zhen
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Suying Lu
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Feifei Sun
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Jia Zhu
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Juan Wang
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Ru Liao
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Xiaofei Sun
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
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Lazarovici J, Terroir M, Arfi-Rouche J, Michot JM, Mussot S, Florea V, Ghigna MR, Dartigues P, Petrovanu C, Danu A, Fermé C, Ribrag V, Ghez D. Poor predictive value of positive interim FDG-PET/CT in primary mediastinal large B-cell lymphoma. Eur J Nucl Med Mol Imaging 2017. [DOI: 10.1007/s00259-017-3758-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Zinzani PL, Broccoli A. Optimizing Outcomes in Primary Mediastinal B-cell Lymphoma. Hematol Oncol Clin North Am 2017; 30:1261-1275. [PMID: 27888880 DOI: 10.1016/j.hoc.2016.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Primary mediastinal B-cell lymphoma is characterized by a high chance of cure, and cured patients have a long disease-free life-expectancy; however, prognosis is severe in the case of relapsed or refractory disease. The initial use of the most effective chemoimmunotherapy regimen is therefore crucial. Understanding who will benefit from postinduction radiotherapy is also of paramount importance; positron emission tomography may be a reliable guide for physicians in determining which patients will require consolidation. New drugs with mechanisms of action including the most relevant biologic features of the tumor may allow better disease control.
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Affiliation(s)
- Pier Luigi Zinzani
- Institute of Hematology L. e A. Seràgnoli, University of Bologna, Via Massarenti, 9, Bologna 40138, Italy.
| | - Alessandro Broccoli
- Institute of Hematology L. e A. Seràgnoli, University of Bologna, Via Massarenti, 9, Bologna 40138, Italy
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Martelli M, Ferreri A, Di Rocco A, Ansuinelli M, Johnson PW. Primary mediastinal large B-cell lymphoma. Crit Rev Oncol Hematol 2017; 113:318-327. [DOI: 10.1016/j.critrevonc.2017.01.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/10/2017] [Accepted: 01/14/2017] [Indexed: 12/16/2022] Open
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Adams HJA, Kwee TC. Reply: Interim PET in Hodgkin Lymphoma: Is It So Useless? J Nucl Med 2017; 58:1180-1182. [PMID: 28280222 DOI: 10.2967/jnumed.117.192294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Hugo J A Adams
- Deventer Ziekenhuis Nico Bolkesteinlaan 75 7416 SE Deventer, The Netherlands E-mail:
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Adams HJA, Kwee TC. Predictive Value of Interim [ 18F]Fluorodeoxyglucose-Positron Emission Tomography in Advanced-Stage Hodgkin Lymphoma Is Not Well Established. J Clin Oncol 2016; 35:370-371. [PMID: 28095276 DOI: 10.1200/jco.2016.68.1494] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Hugo J A Adams
- Hugo J.A. Adams, University Medical Center Utrecht, Utrecht, the Netherlands; and Thomas C. Kwee, University Medical Center Groningen, Groningen, the Netherlands
| | - Thomas C Kwee
- Hugo J.A. Adams, University Medical Center Utrecht, Utrecht, the Netherlands; and Thomas C. Kwee, University Medical Center Groningen, Groningen, the Netherlands
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Adams HJA, Kwee TC. Critical considerations on the predictive value of end-of-treatment FDG-PET in lymphoma. Eur J Nucl Med Mol Imaging 2016; 44:342-343. [PMID: 27783106 DOI: 10.1007/s00259-016-3553-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
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Adams HJA, Kwee TC. No convincing evidence to support postinduction FDG-PET in follicular lymphoma. Ann Hematol 2016; 95:2085-2086. [DOI: 10.1007/s00277-016-2808-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
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An YS, Yoon JK, Lee SJ, Jeong SH, Lee HW. Clinical significance of post-treatment 18F-fluorodeoxyglucose uptake in cervical lymph nodes in patients with diffuse large B-cell lymphoma. Eur Radiol 2016; 26:4632-4639. [PMID: 27193777 DOI: 10.1007/s00330-016-4365-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/15/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We assessed the clinical significance of FDG uptake in cervical lymph nodes after treatment of patients with DLBCL. METHODS In total, 87 patients with DLBCL were enrolled. All patients had newly appeared FDG uptake in cervical lymph nodes on PET/CT during follow-up after cessation of therapy. Cervical lymph nodes were finally diagnosed as benign or malignant according to histopathological findings or follow-up PET. Clinical characteristics and PET findings were compared between groups and factors associated with malignant lesions were evaluated. RESULTS Only 8 (9.2 %) patients with cervical lymph nodes with FDG uptake ultimately had malignancy. FDG uptake lymph nodes appeared significantly earlier in the malignant group than in patients with benign FDG uptake (p = 0.013). Primary nodal lymphoma was more frequent in patients with cancer spread than in those with benign FDG uptake in lymph nodes (p < 0.001). CONCLUSION Most cervical lymph nodes with FDG uptake (about 91 %) appearing after treatment of malignant DLBCL were ultimately benign. The elapsed time between the end of therapy and the appearance of cervical lymph nodes with FDG uptake and the primary sites of lymphomas are helpful clues in determining which cases are malignant. KEY POINTS • About 91 % appearing after treatment of DLBCL were benign. • Elapsed time between therapy and FDG uptake was associated with malignancy. • Primary sites of lymphoma are helpful clues to determine malignancy.
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Affiliation(s)
- Young-Sil An
- Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Woncheon-dong, Yeongtong-gu, Gyeonggi-do, Suwon-si, Korea, 443-749.
| | - Joon-Kee Yoon
- Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Woncheon-dong, Yeongtong-gu, Gyeonggi-do, Suwon-si, Korea, 443-749
| | - Su Jin Lee
- Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Woncheon-dong, Yeongtong-gu, Gyeonggi-do, Suwon-si, Korea, 443-749
| | - Seong Hyun Jeong
- Department of Hematology-Oncology, Ajou University School of Medicine, Woncheon-dong, Yeongtong-gu, Gyeonggi-do, Suwon, Korea
| | - Hyun Woo Lee
- Department of Hematology-Oncology, Ajou University School of Medicine, Woncheon-dong, Yeongtong-gu, Gyeonggi-do, Suwon, Korea
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Cavalli F, Ceriani L, Zucca E. Functional Imaging Using 18-Fluorodeoxyglucose PET in the Management of Primary Mediastinal Large B-Cell Lymphoma: The Contributions of the International Extranodal Lymphoma Study Group. Am Soc Clin Oncol Educ Book 2016; 35:e368-75. [PMID: 27249743 DOI: 10.1200/edbk_159037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Primary mediastinal large B-cell lymphoma (PMLBCL) is recognized as a distinct disease entity. Treatment outcomes appear better than in other diffuse large B-cell lymphoma (DLBCL) types, partly because of their earlier stage at presentation and the younger age of most patients. If initial treatment fails, however, the results of salvage chemotherapy and myeloablative treatment are poor. The need to avoid relapses after initial therapy has led to controversy over the extent of front-line therapy, particularly whether consolidation radiotherapy to the mediastinum is always required and whether the 18-fluorodeoxyglucose ((18)F-FDG) uptake detected by PET-CT scan can be used to determine its requirements. Functional imaging using PET-CT generally allows distinguishing of residual mediastinal masses containing active lymphoma from those with only sclerotic material remaining. The International Extranodal Lymphoma Study Group (IELSG) conducted the prospective IELSG-26 study, which showed that a five-point visual scale can be used to define metabolic response after immunochemotherapy and that a cut point based on liver uptake discriminates effectively between high or low risk of failure, with 5-year progression-free survival (PFS) of 99% versus 68% and 5-year overall survival (OS) of 100% versus 83%. This study also showed that a baseline quantitative PET parameter, namely the total lesion glycolysis describing the metabolic tumor burden, can be a powerful predictor of PMLBCL outcomes and warrants further validation as a biomarker. The ongoing IELSG-37 randomized study addresses the need for consolidation mediastinal radiotherapy in patients in whom a complete metabolic response (CMR) can be seen on PET scans after standard immunochemotherapy.
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Affiliation(s)
- Franco Cavalli
- From the Oncology Institute of Southern Switzerland, Lymphoma Unit-Ospedale San Giovanni, Bellinzona, Switzerland
| | - Luca Ceriani
- From the Oncology Institute of Southern Switzerland, Lymphoma Unit-Ospedale San Giovanni, Bellinzona, Switzerland
| | - Emanuele Zucca
- From the Oncology Institute of Southern Switzerland, Lymphoma Unit-Ospedale San Giovanni, Bellinzona, Switzerland
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de Charry F, Sadoune K, Sebban C, Rey P, de Parisot A, Nicolas-Virelizier E, Belhabri A, Ghesquières H, Ninet J, Faurie P. [Association of lymphoma and granulomatosis: A case series]. Rev Med Interne 2015; 37:453-9. [PMID: 26611429 DOI: 10.1016/j.revmed.2015.10.344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/24/2015] [Accepted: 10/23/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE The sarcoidosis-lymphoma syndrome is a recognised entity. However, the presence of granulomas in patients with a haematological disease should not lead too easily to a diagnosis of sarcoidosis. The presence of granulomatous lesions during the follow-up of these patients raises diagnostic and therapeutic issues. METHODS We included 25 patients followed by the department of haematology in a French hospital (Centre Léon-Bérard). These patients presented with granulomatous lesions. Patients with a history of sarcoidosis were excluded. We report the type of haematological disease, the time of onset of the granulomatous disease compared to that of lymphoma, associated symptoms, aetiology and outcome. Patients were divided into three groups according to the time of onset of the granulomatous lesions. RESULTS Granulomatous lesions appeared before the haematological disease in 4 cases, was concomitant in 8 cases and appeared later in 13 remaining cases. The two main subtypes of lymphoma encountered were: diffuse large cell lymphoma (36%) and Hodgkin's lymphoma (28%). Granulomatous lesions were related to the progression of the hematological disease in 11 cases, to sarcoidosis in 4 cases, to infection in 3 cases, to drug allergy in one case, to inflammatory bowel disease in one case, to granuloma annulare in one case and was isolated in 4 cases (no identified etiology). In the group where granulomas appeared after the haematological disease, mean SUV was 11 for the haematological disease versus 6.4 for granulomas. CONCLUSION Granulomatous diseases in lymphomas can be due to various aetiologies: infection, reaction to the haematological disease, or systemic sarcoidosis. It is an important challenge for clinicians, who can miss the diagnosis of lymphoma and or conclude to a treatment failure or a relapse. Computed tomography scan (CT-scan) or (18)F-deoxyglucose-positron emission tomography scan can help establish a diagnosis but do not replace biopsy.
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Affiliation(s)
- F de Charry
- Service de médecine interne, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France; Service d'hématologie, centre Léon-Bérard, 28, rue Laënnec, 69003 Lyon, France; Service de médecine interne, hôpital d'Instruction des Armées Desgenettes, 108, boulevard Pinel, 69003 Lyon, France.
| | - K Sadoune
- Service de médecine nucléaire, centre Léon-Bérard, 28, rue Laënnec, 69003 Lyon, France
| | - C Sebban
- Service d'hématologie, centre Léon-Bérard, 28, rue Laënnec, 69003 Lyon, France
| | - P Rey
- Service d'hématologie, centre Léon-Bérard, 28, rue Laënnec, 69003 Lyon, France
| | - A de Parisot
- Service d'hématologie, centre Léon-Bérard, 28, rue Laënnec, 69003 Lyon, France
| | | | - A Belhabri
- Service d'hématologie, centre Léon-Bérard, 28, rue Laënnec, 69003 Lyon, France
| | - H Ghesquières
- Service d'hématologie, centre Léon-Bérard, 28, rue Laënnec, 69003 Lyon, France
| | - J Ninet
- Service de médecine interne, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - P Faurie
- Service de médecine interne, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
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Saleh Farghaly HR, Mohamed Sayed MH, Nasr HA, Abdelaziz Maklad AM. Dual time point fluorodeoxyglucose positron emission tomography/computed tomography in differentiation between malignant and benign lesions in cancer patients. Does it always work? Indian J Nucl Med 2015; 30:314-9. [PMID: 26430314 PMCID: PMC4579615 DOI: 10.4103/0972-3919.159693] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Assess the added value of dual time point F-18-fluorodeoxyglucose positron emission tomography/computed tomography (DTP F-18-FDG-PET/CT) in the differentiation of malignant from a benign lesion in cancer patients. MATERIALS AND METHODS Totally, 140 F-18-FDG PET/CT scans of 60 cancer patients who underwent DTP protocol (early whole body PET/CT [E] at 60 min [range, 45-76 min] and delayed limited PET/CT [D] on areas of interest at 120 min [range, 108-153 min] after the tracer injection) were retrospectively reviewed. Visual and semi-quantitative analysis was performed on both early and delayed images. All findings were confirmed by histopathology and/or at least 3 months follow-up (F-18-FDG PET/CT, CT, or magnetic resonance imaging). The result was considered true positive (TP) if delayed standardized uptake value (SUV) of suspicious lesions increased and confirmed to be malignant, false positive (FP) if delayed SUV increased and confirmed to be benign, true negative (TN) if delayed SUV unchanged or decreased and confirmed to be benign, and false negative (FN) if delayed SUV unchanged or decreased and confirmed to be malignant. RESULTS A total of 164 suspicious lesions were detected (20 presacral lesions, 18 lung nodules, 18 Hodgkin's disease (HD) lesions, 16 rectal lesions, 16 head and neck (H and N) lesions, 14 hepatic lesions, 14 non-Hodgkin's lymphoma (NHL) lesions, 12 mediastinal lymph nodes (LNs), 10 focal gastric uptake, 10 soft tissue lesions, 8 breast lesions, 4 peritoneal nodule, and 4 others). Sixty-four lesions were pathologically confirmed, and 100 lesions were confirmed based on 3-6 months follow-up. There were 62 TP lesions, 44 FP, 58 TN and no FN results. The overall sensitivity was 100% of DTP F-18-FDG PET/CT in detecting suspicious lesions. The specificity was 57% in differentiating malignant from benign lesions, and the accuracy was 73%. Positive predictive value was 59%, negative predictive value (NPV) 100%. All hepatic lesions were TP. Accuracy in metastatic hepatic lesions HD, presacral soft tissue, lung nodules, H, and N cancer, breast cancer, NHL and mediastinal LN was100%, 88.8%, 80%, 78%, 75%, 75%, 71%, and 33.3%, respectively. CONCLUSIONS DTP F-18-FDG-PET/CT protocol does not always work in differentiation between benign and malignant lesions. However; it has high NPV, and promising results was noted in hepatic lesions, lymphoma, and recurrent rectal cancer.
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Affiliation(s)
- Hussein Rabie Saleh Farghaly
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt, Saudi Arabia ; Department of Radiology, Division of Nuclear Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohamed Hosny Mohamed Sayed
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt, Saudi Arabia
| | - Hatem Ahmed Nasr
- Department of Oncology and Nuclear Medicine, Nuclear Medicine Unit, Kasr Al-Aini - Cairo University Hospital, Cairo, Egypt
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Pinnix CC, Dabaja B, Ahmed MA, Chuang HH, Costelloe C, Wogan CF, Reed V, Romaguera JE, Neelapu S, Oki Y, Rodriguez MA, Fayad L, Hagemeister FB, Nastoupil L, Turturro F, Fowler N, Fanale MA, Nieto Y, Khouri IF, Ahmed S, Medeiros LJ, Davis RE, Westin J. Single-institution experience in the treatment of primary mediastinal B cell lymphoma treated with immunochemotherapy in the setting of response assessment by 18fluorodeoxyglucose positron emission tomography. Int J Radiat Oncol Biol Phys 2015; 92:113-21. [PMID: 25863759 DOI: 10.1016/j.ijrobp.2015.02.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 12/28/2022]
Abstract
PURPOSE Excellent outcomes obtained after infusional dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and rituximab (R-EPOCH) alone have led some to question the role of consolidative radiation therapy (RT) in the treatment of primary mediastinal B cell lymphoma (PMBL). We reviewed the outcomes in patients treated with 1 of 3 rituximab-containing regimens (cyclophosphamide, doxorubicin, vincristine, prednisone [R-CHOP]; hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone [R-HCVAD], or R-EPOCH) with or without RT. We also evaluated the ability of positron emission tomography-computed tomography (PET-CT) to identify patients at risk of relapse. METHODS AND MATERIALS We retrospectively identified 97 patients with diagnoses of stage I/II PMBCL treated at our institution between 2001 and 2013. The clinical characteristics, treatment outcomes, and toxicity were assessed. We analyzed whether postchemotherapy PET-CT could identify patients at risk for progressive disease according to a 5 point scale (5PS) Deauville score assigned. RESULTS Among 97 patients (median follow-up time, 57 months), the 5-year overall survival rate was 99%. Of patients treated with R-CHOP, 99% received RT; R-HCVAD, 82%; and R-EPOCH, 36%. Of 68 patients with evaluable end-of-chemotherapy PET-CT scans, 62% had a positive scan (avidity above that of the mediastinal blood pool [Deauville 5PS = 3]), but only 9 patients experienced relapse (n=1) or progressive disease (n=8), all with a 5PS of 4 to 5. Of the 25 patients who received R-EPOCH, 4 experienced progression, all with 5PS of 4 to 5; salvage therapy (RT and autologous stem cell transplantation) was successful in all cases. CONCLUSION Combined modality immunochemotherapy and RT is well tolerated and effective for treatment of PMBCL. A postchemotherapy 5PS of 4 to 5, rather than 3 to 5, can identify patients at high risk of progression who should be considered for therapy beyond chemotherapy alone after R-EPOCH.
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Affiliation(s)
- Chelsea C Pinnix
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bouthaina Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Mohamed Amin Ahmed
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hubert H Chuang
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Colleen Costelloe
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christine F Wogan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Valerie Reed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jorge E Romaguera
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sattva Neelapu
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yasuhiro Oki
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - M Alma Rodriguez
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas; Office of Medical Affairs, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Luis Fayad
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Frederick B Hagemeister
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Loretta Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Francesco Turturro
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nathan Fowler
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle A Fanale
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yago Nieto
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Issa F Khouri
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sairah Ahmed
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard Eric Davis
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Westin
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Luminari S, Ceriani L, Dührsen U. FDG-PET(CT)-adapted trials in non-Hodgkin lymphoma. Clin Transl Imaging 2015. [DOI: 10.1007/s40336-015-0125-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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London J, Grados A, Fermé C, Charmillon A, Maurier F, Deau B, Crickx E, Brice P, Chapelon-Abric C, Haioun C, Burroni B, Alifano M, Le Jeunne C, Guillevin L, Costedoat-Chalumeau N, Schleinitz N, Mouthon L, Terrier B. Sarcoidosis occurring after lymphoma: report of 14 patients and review of the literature. Medicine (Baltimore) 2014; 93:e121. [PMID: 25380084 PMCID: PMC4616278 DOI: 10.1097/md.0000000000000121] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Sarcoidosis is a granulomatous disease that most frequently affects the lungs with pulmonary infiltrates and/or bilateral hilar and mediastinal lymphadenopathy. An association of sarcoidosis and lymphoproliferative disease has previously been reported as the sarcoidosis-lymphoma syndrome. Although this syndrome is characterized by sarcoidosis preceding lymphoma, very few cases of sarcoidosis following lymphoma have been reported. We describe the clinical, biological, and radiological characteristics and outcome of 39 patients presenting with sarcoidosis following lymphoproliferative disease, including 14 previously unreported cases and 25 additional patients, after performing a literature review. Hodgkin lymphoma and non-Hodgkin lymphoma were equally represented. The median delay between lymphoma and sarcoidosis was 18 months. Only 16 patients (41%) required treatment. Sarcoidosis was of mild intensity or self-healing in most cases, and overall clinical response to sarcoidosis was excellent with complete clinical response in 91% of patients. Sarcoidosis was identified after a follow-up computerized tomography scan (CT-scan) or fluorodeoxyglucose-positron emission tomography/computerized tomography (FDG-PET/CT) evaluation in 18/34 patients (53%). Sarcoidosis is therefore a differential diagnosis to consider when lymphoma relapse is suspected on a CT-scan or FDG-PET/CT, emphasizing the necessity to rely on histological confirmation of lymphoma relapse.
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Affiliation(s)
- Jonathan London
- Department of Internal Medicine (JL, CLL, LG, NC-C, LM, BT), National Referral Center for Rare Systemic and Autoimmune Diseases; Department of Hematology (BD), Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes; Department of Hematology (EC); Department of Internal Medicine (CC-A), Pitié-Salpêtrière Hospital, AP-HP; Department of Onco-Hematology (PB), Saint-Louis Hospital, AP-HP; Department of Pathology (BB), Hôtel-Dieu Hospital, AP-HP; Department of Thoracic Surgery (MA), Cochin Hospital, AP-HP, Paris; Department of Internal Medicine (AC, FM), Belle Isle Hospital, Metz; Department of Internal Medicine (AG, NS), CHU Conception, Assistance Publique-Hôpitaux de Marseille, Marseille; Department of Medicine (CF), Gustave Roussy, Villejuif; and Lymphoid Malignancies Unit (CH), Henri Mondor Hospital, AP-HP, Créteil, France
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38
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Picardi M, Pugliese N, Cirillo M, Zeppa P, Cozzolino I, Ciancia G, Pettinato G, Salvatore C, Quintarelli C, Pane F. Advanced-stage Hodgkin Lymphoma: US/Chest Radiography for Detection of Relapse in Patients in First Complete Remission—A Randomized Trial of Routine Surveillance Imaging Procedures. Radiology 2014; 272:262-74. [DOI: 10.1148/radiol.14132154] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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39
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Martelli M, Ceriani L, Zucca E, Zinzani PL, Ferreri AJM, Vitolo U, Stelitano C, Brusamolino E, Cabras MG, Rigacci L, Balzarotti M, Salvi F, Montoto S, Lopez-Guillermo A, Finolezzi E, Pileri SA, Davies A, Cavalli F, Giovanella L, Johnson PWM. [18F]fluorodeoxyglucose positron emission tomography predicts survival after chemoimmunotherapy for primary mediastinal large B-cell lymphoma: results of the International Extranodal Lymphoma Study Group IELSG-26 Study. J Clin Oncol 2014; 32:1769-75. [PMID: 24799481 DOI: 10.1200/jco.2013.51.7524] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To assess the role of [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) after rituximab and anthracycline-containing chemoimmunotherapy in patients with primary mediastinal large B-cell lymphoma (PMLBCL). PATIENTS AND METHODS Among 125 patients prospectively enrolled, 115 were eligible for central review of PET/CT scans at the completion of standard chemoimmunotherapy, by using a five-point scale. Consolidation radiotherapy (RT) was permitted and given to 102 patients. RESULTS Fifty-four patients (47%) achieved a complete metabolic response (CMR), defined as a completely negative scan or with residual [18F]FDG activity below the mediastinal blood pool (MBP) uptake. In the remaining 61 patients (53%), the residual uptake was higher than MBP uptake but below the liver uptake in 27 (23%), slightly higher than the liver uptake in 24 (21%), and markedly higher in 10 (9%). CMR after chemoimmunotherapy predicted higher 5-year progression-free survival (PFS; 98% v 82%; P=.0044) and overall survival (OS; 100% v 91%; P=.0298). Patients with residual uptake higher than MBP uptake but below liver uptake had equally good outcomes without any recurrence. Using the liver uptake as cutoff for PET positivity (boundary of score, 3 to 4) discriminated most effectively between high or low risk of failure, with 5-year PFS of 99% versus 68% (P<.001) and 5-year OS of 100% versus 83% (P<.001). CONCLUSION More than 90% of patients are projected to be alive and progression-free at 5 years, despite a low CMR rate (47%) after chemoimmunotherapy. This study provides a basis for using PET/CT to define the role of RT in PMLBCL.
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Affiliation(s)
- Maurizio Martelli
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain
| | - Luca Ceriani
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain
| | - Emanuele Zucca
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain.
| | - Pier Luigi Zinzani
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain
| | - Andrés J M Ferreri
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain
| | - Umberto Vitolo
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain
| | - Caterina Stelitano
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain
| | - Ercole Brusamolino
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain
| | - Maria Giuseppina Cabras
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain
| | - Luigi Rigacci
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain
| | - Monica Balzarotti
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain
| | - Flavia Salvi
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain
| | - Silvia Montoto
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain
| | - Armando Lopez-Guillermo
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain
| | - Erica Finolezzi
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain
| | - Stefano A Pileri
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain
| | - Andrew Davies
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain
| | - Franco Cavalli
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain
| | - Luca Giovanella
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain
| | - Peter W M Johnson
- Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain
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García Molina M, Chicaiza-Becerra L, Moreno-Calderón A, Prieto Martínez V, Sarmiento Urbina I, Linares Ballesteros A. Costo-efectividad de 18FDG-PET/CT vs CT al final del tratamiento en pacientes pediátricos con Linfoma Hodgkin. Rev Salud Publica (Bogota) 2014. [DOI: 10.15446/rsap.v16n2.37326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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41
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Behairy NHELD, Rafaat TA, Nayal ASELDE, Bassiouny MI. PET/CT in initial staging and therapy response assessment of early mediastinal lymphoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2013.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Schnipper LE, Lyman GH, Blayney DW, Hoverman JR, Raghavan D, Wollins DS, Schilsky RL. American Society of Clinical Oncology 2013 Top Five List in Oncology. J Clin Oncol 2013; 31:4362-70. [DOI: 10.1200/jco.2013.53.3943] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Lowell E. Schnipper
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
| | - Gary H. Lyman
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
| | - Douglas W. Blayney
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
| | - J. Russell Hoverman
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
| | - Derek Raghavan
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
| | - Dana S. Wollins
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
| | - Richard L. Schilsky
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
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Unmanipulated haploidentical BMT following non-myeloablative conditioning and post-transplantation CY for advanced Hodgkin's lymphoma. Bone Marrow Transplant 2013; 49:190-4. [PMID: 24185585 DOI: 10.1038/bmt.2013.166] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 05/22/2013] [Accepted: 06/26/2013] [Indexed: 11/08/2022]
Abstract
Twenty-six patients with advanced Hodgkin's disease received a related HLA haploidentical unmanipulated BMT, following a non-myeloablative conditioning with low-dose TBI, proposed by the Baltimore group; GvHD prophylaxis consisted of high-dose post-transplantation CY (PT-CY), mycophenolate and a calcineurin inhibitor. All patients had received a previous autograft, and 65% had active disease at the time of BMT. Sustained engraftment of donor cells occurred in 25 patients (96%), with a median time to neutrophil recovery (>0.5 × 10(9)/L) and platelet recovery (>20 × 10(9)/L) of +18 and +23 days from BMT. The incidence of grade II-IV acute GVHD and of chronic GVHD was 24% and 8%, respectively. With a median follow-up of 24 months (range 18-44) 21 patients are alive, 20 disease free. The cumulative incidence of TRM and relapse was 4% and 31%, respectively. The actuarial 3-year survival is 77%, the actuarial 3-year PFS is 63%. In conclusion, we confirm that high-dose PT-CY is effective as prophylaxis of GVHD after HLA haploidentical BMT, can prevent rejection and does not appear to eliminate the allogeneic graft versus lymphoma effect.
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Barrington SF, Mikhaeel NG. When should FDG-PET be used in the modern management of lymphoma? Br J Haematol 2013; 164:315-28. [PMID: 24131306 DOI: 10.1111/bjh.12601] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 09/04/2013] [Indexed: 12/01/2022]
Abstract
Positron Emission Tomography (PET) is a functional imaging technique that, combined with computerized tomography (PET-CT), is increasingly used in lymphoma. Most subtypes accumulate fluorodeoxyglucose (FDG) and the increased sensitivity of PET-CT, especially for extranodal disease, compared to CT, makes PET-CT an attractive staging tool. The availability of a staging PET-CT scan also improves the accuracy of subsequent response assessment. 'Interim' PET-CT can be used to assess early response and end-of-treatment PET-CT assesses remission. Clinical trials are currently seeking to establish whether the predictive value of PET-CT can be successfully used to guide individual treatment to reduce toxicity and/or to improve outcomes. Standardized methods for performing and reporting PET have been developed in the context of trials. The role of PET in transplantation selection is currently evolving, as it appears to be more accurate and prognostic than CT. The role of FDG PET-CT throughout the management course in patients with lymphoma is explored in this review, with areas discussed that may limit the use of PET-CT imaging which clinicians should be familiar with to inform practice.
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Affiliation(s)
- Sally Fiona Barrington
- Division of Imaging and Biomechanical Engineering, PET Imaging Centre at St Thomas' Hospital, King's College, London, UK
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Gobbi PG, Ferreri AJ, Ponzoni M, Levis A. Hodgkin lymphoma. Crit Rev Oncol Hematol 2013; 85:216-37. [DOI: 10.1016/j.critrevonc.2012.07.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 03/02/2012] [Accepted: 07/03/2012] [Indexed: 10/28/2022] Open
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Xu LM, Fang H, Wang WH, Jin J, Wang SL, Liu YP, Song YW, Ren H, Zhou LQ, Li YX. Prognostic significance of rituximab and radiotherapy for patients with primary mediastinal large B-cell lymphoma receiving doxorubicin-containing chemotherapy. Leuk Lymphoma 2012; 54:1684-90. [PMID: 23137070 DOI: 10.3109/10428194.2012.746684] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract The aim of this study was to evaluate the prognostic importance of rituximab and radiotherapy in patients with primary mediastinal large B-cell lymphoma (PMBCL) receiving doxorubicin-containing chemotherapy. Seventy-nine patients with PMBCL received CHOP chemotherapy with (n = 39) or without rituximab (n = 40), and 60 patients received additional radiotherapy. Patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) had significantly superior survival rates. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 83.7% and 76.7% for R-CHOP, compared with 48.3% (p = 0.011) and 44.2% (p = 0.012) for CHOP, respectively. Similarly, the 5-year OS and PFS rates for early stage patients were 93.8% and 84.6% with R-CHOP, and 52.0% (p = 0.002) and 46.6% (p = 0.003) with CHOP, respectively. Patients treated with chemotherapy and radiotherapy had better survival and local control (LC) rates compared with chemotherapy alone. The 5-year OS, PFS and LC rates for early stage patients were 73.6%, 69.9% and 92.6% for chemotherapy and radiotherapy, and 50.8% (p = 0.076), 36.9% (p = 0.008) and 56.4% (p < 0.001) for chemotherapy alone, respectively. Early stage patients treated with R-CHOP and radiotherapy had 5-year OS, PFS and LC rates of 96.4%, 85.9% and 93.1%. R-CHOP plus consolidation radiotherapy was associated with excellent survival and LC rates.
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Affiliation(s)
- Li-Ming Xu
- Department of Radiation Oncology, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, P R China
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Nakayama M, Okizaki A, Ishitoya S, Sakaguchi M, Sato J, Aburano T. Dual-time-point F-18 FDG PET/CT imaging for differentiating the lymph nodes between malignant lymphoma and benign lesions. Ann Nucl Med 2012. [PMID: 23188388 PMCID: PMC3575551 DOI: 10.1007/s12149-012-0669-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose The purpose of the present study is to evaluate the clinical value of dual-time-point F-18 FDG PET/CT imaging to differentiate malignant lymphoma (ML) from benign lymph node (BLN). Materials and methods The subjects were 310 lymph nodes in 84 patients (195 ML lesions in 30 patients and 115 BLN in 54 patients associated with various etiologies.). F-18 FDG PET/CT scan was performed at 50 min (early scan) and at 100 min (delayed scan) after the injection. First, the maximum standardized uptake value (SUVmax) of each lesion at early and delayed scans was calculated. Second, we estimated the difference between early and delayed SUVmax (D-SUVmax) and the retention index (RI-SUVmax) to evaluate the change of tracers in the lesions. Furthermore, proper cut-off values of them were evaluated using receiver operating characteristic analysis. The efficacy of each parameter was analyzed with ANOVA. Results Delayed SUVmax and D-SUVmax in ML were significantly higher than those in BLN. Proper cut-off value in delayed SUVmax was 4.0 and in D-SUVmax was 1.0. When the proper cut-off value in D-SUVmax was applied, the D-SUVmax yielded the role of diagnosis with sensitivity of 82.6 %, specificity of 65.2 %, positive predictive value of 80.1 % and negative predictive value of 68.8 %, respectively. Conclusions The delayed SUVmax and D-SUVmax were useful indices to differentiate ML from BLN, regardless of histologic subtype. Dual-time-point F-18 FDG PET/CT imaging may help to consider whether there is any need to proceed to more invasive tests, such as biopsy, in individual patients.
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Affiliation(s)
- Michihiro Nakayama
- Department of Radiology, Asahikawa Medical University, 2-1-1-1 Midorigaoka-higashi, Asahikawa, 078-8510, Japan.
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Abstract
Management of Hodgkin's lymphoma continues to develop. Outcomes for patients with favourable-risk, early-stage disease are excellent, and serial reductions in intensity of treatment have been made to retain the excellent prognosis while reducing the late effects of treatment. Prognosis is also very good in advanced-stage disease but the rate of relapse is higher than in early-stage disease, and the optimum first-line treatment is unclear. Workers are investigating the role of functional imaging to assess whether treatment can be tailored according to response, with the most intensive therapies reserved for patients predicted to have poor outcomes. In this Seminar we critically appraise the management of Hodgkin's lymphoma in early-stage disease, advanced-stage disease, and at relapse, with a focus on late effects of treatment.
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Affiliation(s)
- William Townsend
- Department of Haematology, University College London Medical School, Cancer Institute, UK
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Abstract
CLINICAL/METHODICAL ISSUE Staging or re-staging of lymphomas using conventional imaging modalities is based on morphological changes, usually on the diameter of lesions. However, vitality of tumors cannot be evaluated. STANDARD RADIOLOGICAL METHODS In this context computed tomography (CT) has been used as a standard modality. METHODICAL INNOVATIONS Since the introduction of positron emission tomography (PET), evaluation of tumor vitality has become possible. Moreover PET/CT hybrid scanners were brought onto the market one decade ago. PERFORMANCE The fluorodeoxyglucose (FDG) PET/CT technique is now accepted as one of the most accurate modalities in the diagnosis of aggressive lymphomas due to a high FDG uptake (overall accuracy > 90%, sensitivity >90%). However, indolent lymphomas suffer from lower FDG uptake due to a moderate metabolic activity. After the introduction of PET/CT hybrid imaging the specificity of this diagnostic technique increased significantly compared to PET alone (from > 80% to > 90%). With the utilization of PET approximately 20% more lesions are detected when comparing to CT alone and in up to 15% of the patients this also results in a change of the therapeutic regime. As post-chemotherapy scar tissue usually persists for months, evaluation of vitality within residual bulks using FDG-PET can predict therapy response much earlier than CT, enabling therapy stratification. Other PET tracers apart from FDG have low impact in imaging of lymphomas and only the thymidine analogue fluorothymidine (FLT) is used in some cases for non-invasive measurement of proliferation. ACHIEVEMENTS Despite the capability of FDG-PET/CT there is no evidence that the improvement in diagnostics is translated into a better patient outcome and therefore warrants the high costs. False positive findings in PET can result in unnecessary treatment escalation with subsequent higher therapy-associated toxicity and costs. PRACTICAL RECOMMENDATIONS Some pitfalls can be avoided by scheduling PET scans carefully. As treatment-induced inflammation early after therapy can be misinterpreted as vital tumor tissue, it is recommended to wait at least 3 weeks between the last treatment cycle and the subsequent FDG-PET follow-up. Until the results of the prospective multicenter trials "PETAL" and "HD-18" become available, in Germany FDG-PET is only recommended generally for restaging Hodgkin's disease with a known rest bulk of > 2.5 cm in justifiable individual cases or in clinical trials.
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García Vicente A, Bellón Guardia M, Soriano Castrejón A, Calle Primo C, Cordero García J, Palomar Muñoz A, Pilkington Woll J, Talavera Rubio M, Hernández Ruiz B. 18F-FDG-PET/CT in the surveillance of patients with lymphoma: Detection of asymptomatic recurrences. Rev Esp Med Nucl Imagen Mol 2012. [DOI: 10.1016/j.remngl.2011.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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