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Qualitative visual trichotomous assessment improves the value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in predicting the prognosis of diffuse large B-cell lymphoma.

Zhang X, Fan W, Hu YY, Li ZM, Xia ZJ, Lin XP, Zhang YR, Liang PY, Li YH - Chin J Cancer (2015)

Bottom Line: The 3 year overall survival (OS) rate was significantly higher in patients with negative scan results than in those with positive results (91.6% vs. 57.5%, P<0.001).The 3 year OS rate was significantly higher in patients with indeterminate scan results than in those with positive results (91.2% vs. 33.5%, P<0.001) but was similar between patients with negative and indeterminate scan results (91.6% vs. 91.2%, P=0.921).The QVTA criteria are feasible for therapeutic outcome evaluation and can be used to guide risk-adapted therapy.

View Article: PubMed Central - PubMed

Affiliation: Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, P. R. China. zhangx2@sysucc.org.cn.

ABSTRACT

Introduction: Fluorine-18 fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) is a powerful tool for monitoring the response of diffuse large B-cell lymphoma (DLBCL) to therapy, but the criteria to interpret PET/CT results remain under debate. We investigated the value of post-treatment PET/CT in predicting the prognosis of DLBCL patients when interpreted according to qualitative visual trichotomous assessment (QVTA) criteria compared with the Deauville criteria.

Methods: In this retrospective study, final PET/CT scans of DLBCL patients treated with rituximab-based regimens between October 2005 and November 2010 were interpreted using the Deauville and QVTA criteria. Survival curves were estimated using Kaplan-Meier analysis and compared using the log-rank test.

Results: A total of 253 patients were enrolled. The interpretation according to the Deauville criteria revealed that 181 patients had negative PET/CT scan results and 72 had positive results. The 3 year overall survival (OS) rate was significantly higher in patients with negative scan results than in those with positive results (91.6% vs. 57.5%, P<0.001). The 72 patients with positive scan results according to the Deauville criteria were divided into two groups by the interpretation according to the QVTA criteria: 29 had indeterminate results, and 43 had positive results. The 3 year OS rate was significantly higher in patients with indeterminate scan results than in those with positive results (91.2% vs. 33.5%, P<0.001) but was similar between patients with negative and indeterminate scan results (91.6% vs. 91.2%, P=0.921).

Conclusions: Compared with the Deauville criteria, using the QVTA criteria for interpreting post-treatment PET/CT scans of DLBCL patients is likely to reduce the number of false positive results. The QVTA criteria are feasible for therapeutic outcome evaluation and can be used to guide risk-adapted therapy.

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Related in: MedlinePlus

Fluorine-18 fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) scans of diffuse large B-cell lymphoma (DLBCL) with a score of 4. (a), baseline PET/CT; (b), final PET/CT (F-PET/CT). A 26 year-old woman with bulky mediastinal uptake on baseline PET/CT, which was interpreted as indeterminate on F-PET/CT using the qualitative visual trichotomous assessment (QVTA) criteria; the residual foci (red arrow) were diagnosed and scored as 4. However, the Deauville criteria interpreted the scan as positive. The patient was alive and in complete remission 41 months after treatment initiation
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Fig1: Fluorine-18 fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) scans of diffuse large B-cell lymphoma (DLBCL) with a score of 4. (a), baseline PET/CT; (b), final PET/CT (F-PET/CT). A 26 year-old woman with bulky mediastinal uptake on baseline PET/CT, which was interpreted as indeterminate on F-PET/CT using the qualitative visual trichotomous assessment (QVTA) criteria; the residual foci (red arrow) were diagnosed and scored as 4. However, the Deauville criteria interpreted the scan as positive. The patient was alive and in complete remission 41 months after treatment initiation

Mentions: According to the Deauville criteria, 181 patients had negative F-PET/CT scan results and 72 had positive results. According to the QVTA criteria, the 72 positive patients were divided into two groups: indeterminate (n = 29, Fig. 1) and positive (n = 43, Fig. 2).Fig. 1


Qualitative visual trichotomous assessment improves the value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in predicting the prognosis of diffuse large B-cell lymphoma.

Zhang X, Fan W, Hu YY, Li ZM, Xia ZJ, Lin XP, Zhang YR, Liang PY, Li YH - Chin J Cancer (2015)

Fluorine-18 fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) scans of diffuse large B-cell lymphoma (DLBCL) with a score of 4. (a), baseline PET/CT; (b), final PET/CT (F-PET/CT). A 26 year-old woman with bulky mediastinal uptake on baseline PET/CT, which was interpreted as indeterminate on F-PET/CT using the qualitative visual trichotomous assessment (QVTA) criteria; the residual foci (red arrow) were diagnosed and scored as 4. However, the Deauville criteria interpreted the scan as positive. The patient was alive and in complete remission 41 months after treatment initiation
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4593357&req=5

Fig1: Fluorine-18 fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) scans of diffuse large B-cell lymphoma (DLBCL) with a score of 4. (a), baseline PET/CT; (b), final PET/CT (F-PET/CT). A 26 year-old woman with bulky mediastinal uptake on baseline PET/CT, which was interpreted as indeterminate on F-PET/CT using the qualitative visual trichotomous assessment (QVTA) criteria; the residual foci (red arrow) were diagnosed and scored as 4. However, the Deauville criteria interpreted the scan as positive. The patient was alive and in complete remission 41 months after treatment initiation
Mentions: According to the Deauville criteria, 181 patients had negative F-PET/CT scan results and 72 had positive results. According to the QVTA criteria, the 72 positive patients were divided into two groups: indeterminate (n = 29, Fig. 1) and positive (n = 43, Fig. 2).Fig. 1

Bottom Line: The 3 year overall survival (OS) rate was significantly higher in patients with negative scan results than in those with positive results (91.6% vs. 57.5%, P<0.001).The 3 year OS rate was significantly higher in patients with indeterminate scan results than in those with positive results (91.2% vs. 33.5%, P<0.001) but was similar between patients with negative and indeterminate scan results (91.6% vs. 91.2%, P=0.921).The QVTA criteria are feasible for therapeutic outcome evaluation and can be used to guide risk-adapted therapy.

View Article: PubMed Central - PubMed

Affiliation: Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, P. R. China. zhangx2@sysucc.org.cn.

ABSTRACT

Introduction: Fluorine-18 fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) is a powerful tool for monitoring the response of diffuse large B-cell lymphoma (DLBCL) to therapy, but the criteria to interpret PET/CT results remain under debate. We investigated the value of post-treatment PET/CT in predicting the prognosis of DLBCL patients when interpreted according to qualitative visual trichotomous assessment (QVTA) criteria compared with the Deauville criteria.

Methods: In this retrospective study, final PET/CT scans of DLBCL patients treated with rituximab-based regimens between October 2005 and November 2010 were interpreted using the Deauville and QVTA criteria. Survival curves were estimated using Kaplan-Meier analysis and compared using the log-rank test.

Results: A total of 253 patients were enrolled. The interpretation according to the Deauville criteria revealed that 181 patients had negative PET/CT scan results and 72 had positive results. The 3 year overall survival (OS) rate was significantly higher in patients with negative scan results than in those with positive results (91.6% vs. 57.5%, P<0.001). The 72 patients with positive scan results according to the Deauville criteria were divided into two groups by the interpretation according to the QVTA criteria: 29 had indeterminate results, and 43 had positive results. The 3 year OS rate was significantly higher in patients with indeterminate scan results than in those with positive results (91.2% vs. 33.5%, P<0.001) but was similar between patients with negative and indeterminate scan results (91.6% vs. 91.2%, P=0.921).

Conclusions: Compared with the Deauville criteria, using the QVTA criteria for interpreting post-treatment PET/CT scans of DLBCL patients is likely to reduce the number of false positive results. The QVTA criteria are feasible for therapeutic outcome evaluation and can be used to guide risk-adapted therapy.

Show MeSH
Related in: MedlinePlus