Annals of Oncology Advance Access published online on May 27, 2009
Annals of Oncology, doi:10.1093/annonc/mdp030
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
High SUV uptake on FDG–PET/CT predicts for an aggressive B-cell lymphoma in a prospective study of primary FDG–PET/CT staging in lymphoma
1 Department of Medical Oncology, National Cancer Centre
2 Department of Nuclear Medicine, Singapore General Hospital
3 Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre
4 Department of Hematology, Singapore General Hospital, Singapore
* Correspondence to: Dr S. T. Lim, Department of Medical Oncology, National Cancer Centre, 11 Hospital Drive, Singapore 169610. Tel: +65-64368174; Fax: +65-62272759; E-mail: dmolst{at}nccs.com.sg
Background: Data assessing the role of positron emission tomography (PET)/computed tomography (CT) imaging in lymphoma staging is still being accumulated and current staging is based primarily on CT. This study aims to compare the value of PET/CT over conventional CT and bone marrow biopsy (BMB) in the initial evaluation of patients with lymphoma.
Methods: Data on 122 patients with PET/CT scans as part of their initial staging were prospectively collected and reviewed. All patients had complete staging, including BMB.
Results: Among the 122 patients, 101 had non-Hodgkin’s lymphoma (NHL) and 21 had Hodgkin’s lymphoma (HL). Compared with conventional CT, PET/CT upstaged 21 (17%) cases [B-cell non-Hodgkin’s lymphoma (B-NHL), 12; T-cell non-Hodgkin’s lymphoma (T-NHL), 3; HL, 6]. Of significance, in 13 patients with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG)-avid splenic lesions, four had normal CT findings. A maximum FDG uptake of >10 standardized uptake value (SUV) seems to significantly correlate with an aggressive B-cell lineage (odds ratio 2.47, 95% confidence interval 2.23–2.70). Overall, PET scan was concordant with BMB results in 108 (89%) and discordant in 14 (11%) cases. In HL, our data show that PET scan and marrow results agreed in 19 of the cases (90%), being concordantly negative in 18 cases and concordantly positive in one, giving a negative predictive value (NPV) of 100%, sensitivity of 100% and specificity of 90%. Of note, all 13 with early-stage HL had negative PET/CT scan and BMB. In NHL, all 17 cases of T-NHL had concordant PET and BMB results. In patients with aggressive B-NHL, BMB and PET/CT agreed in 58 patients (92%) and disagreed in five (8%), while the corresponding rates in indolent B-cell lymphoma were 14 (67%) and seven patients (33%), respectively. All seven were falsely negative.
Conclusions: PET/CT upstages 17% of cases and detects occult splenic involvement. This may have potential therapeutic and prognostic implications. SUV >10 may predict for an aggressive histology. Except for indolent B-NHL, our data show that PET scans have a good overall NPV in excluding lymphomatous bone marrow involvement. This is particularly true of early-stage HL, suggesting that BMB may be safely omitted in this group.
lymphoma, positron emission tomography, staging
Received for publication September 22, 2008. Revision received January 18, 2009. Accepted for publication January 26, 2009.