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18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Management of Aggressive Non-Hodgkin's B-Cell Lymphoma.

Shelly MJ, McDermott S, O'Connor OJ, Blake MA - ISRN Hematol (2012)

Bottom Line: 18-Fluorodeoxyglucose (FDG-PET/CT) is an established imaging modality that has been proven to be of benefit in the management of aggressive B-cell non-Hodgkin's lymphoma, such as diffuse large B-cell lymphoma and advanced stage follicular lymphoma.The combination of anatomic and functional imaging afforded by FDG-PET/CT has led to superior sensitivity and specificity in the primary staging, restaging, and assessment of response to treatment of hematological malignancies when compared to FDG-PET and CT alone.The use of FDG-PET/CT for posttreatment surveillance imaging remains controversial, and further study is needed to ascertain whether this modality is cost effective and appropriate for use in this setting.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.

ABSTRACT
18-Fluorodeoxyglucose (FDG-PET/CT) is an established imaging modality that has been proven to be of benefit in the management of aggressive B-cell non-Hodgkin's lymphoma, such as diffuse large B-cell lymphoma and advanced stage follicular lymphoma. The combination of anatomic and functional imaging afforded by FDG-PET/CT has led to superior sensitivity and specificity in the primary staging, restaging, and assessment of response to treatment of hematological malignancies when compared to FDG-PET and CT alone. The use of FDG-PET/CT for posttreatment surveillance imaging remains controversial, and further study is needed to ascertain whether this modality is cost effective and appropriate for use in this setting.

No MeSH data available.


Related in: MedlinePlus

Coronal fused FDG-PET/CT image (a) of a patient with nodular sclerosis type Hodgkin's lymphoma prechemotherapy demonstrating an FDG-avid lymph node mass in the superior mediastinum (white arrowhead) and hypermetabolic bilateral axillary lymphadenopathy (white arrows). Interim staging coronal fused FDG-PET/CT image (b) in the same patient after 3 cycles of chemotherapy demonstrating a significant interval decrease in both the degree of FDG uptake and the size of the lymph node mass in the superior mediastinum (white arrow) with resolution of the axillary lymphadenopathy.
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fig5: Coronal fused FDG-PET/CT image (a) of a patient with nodular sclerosis type Hodgkin's lymphoma prechemotherapy demonstrating an FDG-avid lymph node mass in the superior mediastinum (white arrowhead) and hypermetabolic bilateral axillary lymphadenopathy (white arrows). Interim staging coronal fused FDG-PET/CT image (b) in the same patient after 3 cycles of chemotherapy demonstrating a significant interval decrease in both the degree of FDG uptake and the size of the lymph node mass in the superior mediastinum (white arrow) with resolution of the axillary lymphadenopathy.

Mentions: Thus, the prognostic power of an interim FDG-PET/CT scan is significant with a number of studies indicating that a negative interim FDG-PET scan in patients with aggressive NHL confers an excellent prognosis while a positive study identifies patients who are likely to experience early relapse and in whom a change in treatment regimen may be beneficial [51, 65, 66]. It must be stressed, however, that interim FDG-PET/CT has a relatively limited PPV when compared to its NPV due to the occurrence of false-positive results due to posttreatment inflammation in RMs. Thus, caution should be exercised when considering changing a patient's treatment regimen based on the findings of FDG-PET/CT imaging alone and it is reasonable to biopsy this patient group if such a change in treatment is being contemplated [69]. Interim FDG-PET/CT scans appear to be very useful in providing a basis for risk-adjusted or “personalized” therapy, whereby the results of interim FDG-PET/CT scans will identify patients who have responded well to initial treatment (i.e., they have a negative interim scan) and therefore will be suitable for a more limited treatment regimen (i.e., reduced numbers of chemotherapy cycles with less treatment-related toxicity) without compromising treatment efficacy or those patients in whom response to initial treatment was poor (i.e., they have a positive interim scan) and therefore an early change of treatment regimen may improve patient outcome [69] (Figure 5).


18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Management of Aggressive Non-Hodgkin's B-Cell Lymphoma.

Shelly MJ, McDermott S, O'Connor OJ, Blake MA - ISRN Hematol (2012)

Coronal fused FDG-PET/CT image (a) of a patient with nodular sclerosis type Hodgkin's lymphoma prechemotherapy demonstrating an FDG-avid lymph node mass in the superior mediastinum (white arrowhead) and hypermetabolic bilateral axillary lymphadenopathy (white arrows). Interim staging coronal fused FDG-PET/CT image (b) in the same patient after 3 cycles of chemotherapy demonstrating a significant interval decrease in both the degree of FDG uptake and the size of the lymph node mass in the superior mediastinum (white arrow) with resolution of the axillary lymphadenopathy.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3313577&req=5

fig5: Coronal fused FDG-PET/CT image (a) of a patient with nodular sclerosis type Hodgkin's lymphoma prechemotherapy demonstrating an FDG-avid lymph node mass in the superior mediastinum (white arrowhead) and hypermetabolic bilateral axillary lymphadenopathy (white arrows). Interim staging coronal fused FDG-PET/CT image (b) in the same patient after 3 cycles of chemotherapy demonstrating a significant interval decrease in both the degree of FDG uptake and the size of the lymph node mass in the superior mediastinum (white arrow) with resolution of the axillary lymphadenopathy.
Mentions: Thus, the prognostic power of an interim FDG-PET/CT scan is significant with a number of studies indicating that a negative interim FDG-PET scan in patients with aggressive NHL confers an excellent prognosis while a positive study identifies patients who are likely to experience early relapse and in whom a change in treatment regimen may be beneficial [51, 65, 66]. It must be stressed, however, that interim FDG-PET/CT has a relatively limited PPV when compared to its NPV due to the occurrence of false-positive results due to posttreatment inflammation in RMs. Thus, caution should be exercised when considering changing a patient's treatment regimen based on the findings of FDG-PET/CT imaging alone and it is reasonable to biopsy this patient group if such a change in treatment is being contemplated [69]. Interim FDG-PET/CT scans appear to be very useful in providing a basis for risk-adjusted or “personalized” therapy, whereby the results of interim FDG-PET/CT scans will identify patients who have responded well to initial treatment (i.e., they have a negative interim scan) and therefore will be suitable for a more limited treatment regimen (i.e., reduced numbers of chemotherapy cycles with less treatment-related toxicity) without compromising treatment efficacy or those patients in whom response to initial treatment was poor (i.e., they have a positive interim scan) and therefore an early change of treatment regimen may improve patient outcome [69] (Figure 5).

Bottom Line: 18-Fluorodeoxyglucose (FDG-PET/CT) is an established imaging modality that has been proven to be of benefit in the management of aggressive B-cell non-Hodgkin's lymphoma, such as diffuse large B-cell lymphoma and advanced stage follicular lymphoma.The combination of anatomic and functional imaging afforded by FDG-PET/CT has led to superior sensitivity and specificity in the primary staging, restaging, and assessment of response to treatment of hematological malignancies when compared to FDG-PET and CT alone.The use of FDG-PET/CT for posttreatment surveillance imaging remains controversial, and further study is needed to ascertain whether this modality is cost effective and appropriate for use in this setting.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.

ABSTRACT
18-Fluorodeoxyglucose (FDG-PET/CT) is an established imaging modality that has been proven to be of benefit in the management of aggressive B-cell non-Hodgkin's lymphoma, such as diffuse large B-cell lymphoma and advanced stage follicular lymphoma. The combination of anatomic and functional imaging afforded by FDG-PET/CT has led to superior sensitivity and specificity in the primary staging, restaging, and assessment of response to treatment of hematological malignancies when compared to FDG-PET and CT alone. The use of FDG-PET/CT for posttreatment surveillance imaging remains controversial, and further study is needed to ascertain whether this modality is cost effective and appropriate for use in this setting.

No MeSH data available.


Related in: MedlinePlus