¹⁸F-FDG PET and conventional imaging for assessment of Hodgkin’s disease and non Hodgkin’s lymphoma

Summary

The aim of this study was to assess the diagnostic value of FDG-PET and conventional imaging (CI) in a large series of patient with Hodgkin’s disease (HD) or non-Hodgkin’s lymphoma (NHL) at three time points during their course of disease. Patients, methods: 169 consecutive lymphoma patients (69 HD; 100 NHL) were included. 193 FDG-PET studies were performed for staging at baseline in 42 cases, for post-therapeutic monitoring in 103, and for diagnosis of recurrence in 48 cases. Performance indices of sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and accuracy of metabolic FDG-PET and morphological CI were calculated. Differences in staging and diagnosis of residual or recurrent lymphoma were compared. Results: FDG-PET changed staging in 36% of cases for staging at baseline, in 52% of cases for monitoring response to treatment, and in 29% for diagnosis of recurrence. FDG-PET staging results were confirmed in 80% for staging at baseline, in 74% for monitoring response to treatment, and in 50% for diagnosis of recurrence. FDGPET and CI differed significantly at monitoring response to treatment for sensitivity (0.91 versus 0.69; p<0.02), specificity (0.90 versus 0.38; p<0.00001), PPV (0.77 versus 0.42; p<0.001), and accuracy (0.83 versus 0.55; p<0.02). Conclusion: FDG-PET should be considered as the diagnostic modality of choice for post-therapeutic assessment of lymphoma patients and may be a reliable alternative to CI for staging at baseline and diagnosis of recurrence.

Zusammenfassung

Ziel: Die Studie untersucht den diagnostischen Wert von FDG-PET und konventioneller Bildgebung (CI) in einer großen Patientenserie mit Morbus Hodgkin (HD) oder Non- Hodgkin Lymphom (NHL) zu drei Zeitpunkten während des Krankheitsverlaufs. Patienten, Methoden: 169 Lymphom- Patienten (69 HD; 100 NHL) wurden in die Studie eingeschlossen. 193 FDG-PET Untersuchungen wurden zu drei verschiedenen Zeitpunkten durchgeführt: 42 Untersuchungen zum Primärstaging, 103 zum posttherapeutischen Staging, und 48 zum Rezidivstaging. Die diagnostische Wertigkeit von FDG-PET und CI wurde anhand von Sensitivität, Spezifität, positiv (PPV) und negativ prädiktivem Wert (NPV) sowie der Treffsicherheit berechnet. Unterschiede beim Staging sowie bei der Diagnose von residuellen oder rezidivierenden Lymphomen wurden miteinander verglichen. Ergebnisse: FDG-PET führte zu Änderung des Stagings in 36% der Fälle beim Primärstaging, in 52% der Fälle beim posttherapeutischen Staging und in 29% beim Rezidivstaging. Ergebnisse des Stagings durch die FDG-PET wurden in 80% beim Primärstaging, in 74% beim posttherapeutischen Staging und in 50% beim Rezidivstaging bestätigt. Signifikante Differenzen zwischen FDG-PET und CI zeigten sich beim posttherapeutischen Staging hinsichtlich der Sensitivität (0,91 versus 0,69; p <0,02), der Spezifität (0,90 versus 0,38; p <0,00001), des PPV (0,77 versus 0,42; p <0,001) und der Treffsicherheit (0,83 versus 0,55; p <0,02). Schlussfolgerung: FDG-PET sollte als Methode der Wahl beim posttherapeutischen Staging von Lymphom-Patienten erwogen werden. Darüber hinaus erscheint die FDG-PET eine sinnvolle Alternative zur konventionellen Bildgebung beim Primär- und Rezidivstaging zu sein. Correspondence to: Jan Bucerius, MD Department of Nuclear Medicine University Hospital of Bonn Sigmund-Freud-Straße 25 53105 Bonn, Germany Tel. [phone], Fax –90 96 E-mail: [e-mail]

Keywords

Hodgkin’s disease - non-Hodgkin’s lymphoma - positron emission tomography - computed tomography - magnetic resonance imaging

Schlüsselwörter

Morbus Hodgkin - Non-Hodgkin-Lymphom - Computertomographie - Positronenemissionstomographie - Magnetresonanztomographie

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