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Annals of Oncology Advance Access originally published online on October 7, 2008
Annals of Oncology 2009 20(2):309-318; doi:10.1093/annonc/mdn629
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© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

hematologic malignancies

High incidence of false-positive PET scans in patients with aggressive non-Hodgkin's lymphoma treated with rituximab-containing regimens

H. S. Han1, M. P. Escalón1, B. Hsiao2, A. Serafini2 and I. S. Lossos1,*

1 Division of Hematology and Oncology, The Sylvester Comprehensive Cancer Center
2 Department of Radiology, University of Miami School of Medicine, Miami, USA

* Correspondence to: Dr I. S. Lossos, Division of Hematology and Oncology, The Sylvester Comprehensive Cancer Center, 1475 NW 12th Avenue, SCCC 3300, Miami, FL 33136, USA. Tel: +1-305-243-4785; Fax: +1-305-243-4787; E-mail: ilossos{at}med.miami.edu

Background: Positron emission tomography (PET) is a powerful predictor of relapse and survival in non-Hodgkin’s lymphomas (NHLs) based on studies carried out in the prerituximab era. Little is known about the predictive power of PET in rituximab-treated patients.

Patients and methods: Patients with aggressive B-cell NHL with baseline and follow-up PET studies were included. Clinical characteristics, PET and computed tomography scans, biopsy results, and outcomes were reviewed. PET was defined as positive if higher than mediastinal or background activity was observed.

Results: In all, 51 patients (diffuse large B cell—38; mantle cell lymphoma—13) treated with rituximab-containing regimens were included. For 13 of 40 patients (32.5%), mid-therapy PET studies were positive and 9 of 48 patients (18.7%) had positive posttherapy PET. The positive predictive value (PPV), negative predictive value (NPV), sensitivity (Se), and specificity (Sp) of the mid-therapy PET for predicting relapse were 33% [95% confidence interval (CI) 19% to 49%], 68% (95% CI 51% to 81%), 33% (95% CI 6% to 76%), and 68% (95% CI 49% to 82%), respectively. For posttherapy PET, the relapse PPV, NPV, Se and Sp were 19% (95% CI 9% to 33%), 81% (95% CI 67% to 91%), 13% (95% CI 0.6% to 53%), and 80%(95% CI 64% to 90%), respectively.

Conclusions: Compared with previous reports in prerituximab era, addition of rituximab resulted in reduced PPV and sensitivity of mid- and posttherapy PET in patients with aggressive B-cell NHL.

Key words: lymphoma, PET scan, rituximab

Received for publication July 21, 2008. Accepted for publication August 7, 2008.


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