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Annals of Oncology Advance Access published online on September 28, 2005
Annals of Oncology, doi:10.1093/annonc/mdj024
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© 2005 European Society for Medical Oncology
Received July 15, 2005
Revised August 19, 2005
Accepted August 23, 2005

Original article

Is CT scan still necessary for staging in Hodgkin and non-Hodgkin lymphoma patients in the PET/CT era?

P. Raanani 1*, Y. Shasha 2, C. Perry 3, U. Metser 2, E. Naparstek 3, S. Apter 4, A. Nagler 5, A. Polliack 6, I. Ben-Bassat 5, and E. Even-Sapir 2

1 Rabin Medical Center, Department of Hematology, Israel; Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel
2 Tel-Aviv Sourasky Medical Center, Department of Nuclear Medicine, Israel; Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel
3 Department of Hematology, Israel; Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel
4 Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel; Department of Radiology, Ramat-Gan, Israel
5 Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel; The Chaim Sheba Medical Center, Department of Hematology, Israel
6 Department of Hematology, Israel

* To whom correspondence should be addressed.
P. Raanani, E-mail: praanani{at}012.net.il


  Abstract

Background: The clinical impact of fused PET/CT data on staging and patient management of Hodgkin disease (HD) and non-Hodgkin lymphoma (NHL) was assessed.

Patients and methods: A total of 103 consecutive patients with newly diagnosed NHL (n = 68) and HD (n = 35) were assessed retrospectively. Three comparisons were carried out in an attempt to assess the added value of each modality.

Results: For NHL patients, there were significant differences between staging by CT versus PET/CT (P = 0.0001). Disease was upstaged by PET/CT in 31% (mostly in stages I and II) and downstaged in only 1% of patients. In 25% of the patients, the treatment approach was changed according to CT versus PET/CT findings. For HD patients, disease was upstaged by PET/CT in 32% and downstaged by PET/CT in 15% (P = NS). As for NHL, upstaging by PET/CT versus CT was evident mostly for stages I and II. The treatment strategy was altered as determined by CT versus PET/CT in 45% of the patients.

Conclusions: The addition of PET/CT to CT changed the management decisions in approximately a quarter of NHL and a third of HD patients, mostly in early disease stages. Thus, PET/CT performed as the initial staging procedure may well obviate the need for additional diagnostic CT in the majority of patients.

Keywords: PET/CT; Hodgkin disease; non-Hodgkin lymphoma; staging.
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