The correlation between interim imaging results and disease prognosis of patients with Hodgkin and diffuse large B cell lymphoma: single center experience

Year 2026, Volume: 17 Issue: 57 , 1 - 9 , 16.04.2026

Esra Erpek , Ayşegül Aksu , Hakan Abdullah Özgül , Ahmet Şeyhanlı , Özhan Özdoğan , Mustafa Seçil , Hayri Özsan

https://doi.org/10.17944/interdiscip.1726678

https://izlik.org/JA73CP97ZB

Abstract

Objective: This study aims to explore the relationship between interim imaging outcomes and disease prognosis in patients diagnosed with Hodgkin lymphoma (HL) and diffuse large B-cell lymphoma (DLBCL).
Method: A total of 157 patients were retrospectively analyzed, comprising 90 with DLBCL and 67 with HL, who received follow-up at our institution. Interim and baseline PET/CT scans (I-PET/CT) from 121 patients were independently interpreted by two nuclear medicine specialists, blinded to clinical data. Additionally, 53 patients underwent both initial and interim contrast-enhanced computed tomography (I-CT), which was independently reviewed by two radiologists under blinded conditions.
Results: Interim PET/CT findings were analyzed in relation to post-treatment outcomes to determine the predictive performance of the imaging modality. The positive predictive value (PPV) and negative predictive value (NPV) were calculated separately for HL and DLBCL. In HL cases, I-PET/CT demonstrated a PPV of 36% and an NPV of 95.4%, while in DLBCL, the respective values were 61.9% and 93.1%. Notably, among patients assessed with both PET/CT and I-CT, 2 individuals in the DLBCL group exhibited negative I-CT results despite positive I-PET/CT findings. Conversely, 3 HL patients showed positive I-CT findings despite negative I-PET/CT.
Conclusion: PET/CT provided a substantial advantage in evaluating therapeutic response over conventional CT, reducing the risk of overtreatment in early-stage disease and undertreatment in more advanced stages. Interim PET/CT negativity was found to be a strong indicator of favorable progression-free survival outcomes, potentially guiding clinicians toward more individualized and less intensive treatment strategies. Nevertheless, confirmation of these findings through prospective randomized trials remains essential.

Keywords

lymphoma , interim assesment , PET/CT

Ethical Statement

It was approved by the Non-Interventional Ethics Committee of Dokuz Eylul University Faculty of Medicine with the decision number 2018/11-19 dated 03.05.2018.

References

• Robert Marcus, John W. Sweetenham, Michael E. Williams Lymphoma: Pathology, Diagnosis, and Treatment second edition Published by Cambridge University Press 2014, page:1.
• Sabattini E, Bacci F, Sagramoso C, Pileri SA. WHO classification of tumours of haematopoietic and lymphoid tissues in 2008: an overview. Pathologica. 2010;102(3):83–87.
• Coyle M, Kostakoglu L, Evens AM. The evolving role of response-adapted PET imaging in Hodgkin lymphoma. Ther Adv Hematol. 2016;7(2):108–125. doi:10.1177/2040620715625615.
• Cheson BD, Kostakoglu L. FDG-PET for early response assessment in lymphomas: Part 1—Hodgkin lymphoma. Oncology (Williston Park). 2017;31(1):45–49.
• Kostakoglu L, Goldsmith SJ. Positron emission tomography in lymphoma: comparison with computed tomography and Gallium-67 single photon emission computed tomography. Clin Lymphoma. 2000;1(1):67–74. doi:10.3816/CLM.2000.n.007.
• Eertink JJ, Burggraaff CN, Heymans MW, Dührsen U, Hüttmann A, Schmitz C, et al. Optimal timing and criteria of interim PET in DLBCL: a comparative study of 1692 patients. Blood Adv. 2021;5(9):2375–2384. doi:10.1182/bloodadvances.2021004467.
• Duarte S, Roque A, Saraiva T, Afonso C, Marques BA, Lima CB, et al. Interim FDG18-PET SUVmax variation adds prognostic value to Deauville 5-point scale in the identification of patients with ultra-high-risk diffuse large B cell lymphoma. Clin Lymphoma Myeloma Leuk. 2023;23(2):e107–e116. doi:10.1016/j.clml.2022.11.009.
• Kitajima K, Okada M, Yoshihara K, Tokugawa T, Sawada A, Yoshihara S, et al. Predictive value of interim FDG-PET/CT findings in patients with diffuse large B-cell lymphoma treated with R-CHOP. Oncotarget. 2019;10(52):5403–5411.doi:10.18632/oncotarget.27103.
• Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin’s disease. International Prognostic Factors Project on Advanced Hodgkin’s Disease. N Engl J Med. 1998 Nov 19;339(21):1506-14. doi: 10.1056/NEJM199811193392104. PMID: 9819449.
• Atkins CD. A predictive model for non-Hodgkin’s lymphoma. N Engl J Med. 1994 Feb 24;330(8):574; author reply 574-5. doi: 10.1056/NEJM199402243300815. PMID: 8302331.
• Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67(1):7–30. doi:10.3322/caac.21387.
• Smith A, Howell D, Patmore R, Jack A, Roman E. Incidence of haematological malignancy by sub-type: a report from the Haematological Malignancy Research Network. Br J Cancer. 2011;105(11):1684–1692. doi:10.1038/bjc.2011.450.
• Morton LM, Wang SS, Devesa SS, Hartge P, Weisenburger DD, Linet MS. Lymphoma incidence patterns by WHO subtype in the United States, 1992–2001. Blood. 2006;107(1):265–276. doi:10.1182/blood-2005-06-2508.
• Campo E, Swerdlow SH, Harris NL, Pileri S, Stein H, Jaffe ES. The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. Blood. 2011;117(19):5019–5032. doi:10.1182/blood-2011-01-293050.
• van Leeuwen MT, Turner JJ, Joske DJ, Falster MO, Srasuebkul P, Meagher NS, et al. Lymphoid neoplasm incidence by WHO subtype in Australia 1982–2006. Int J Cancer. 2014;135(9):2146–2156. doi:10.1002/ijc.28849.
• Sant M, Allemani C, Tereanu C, De Angelis R, Capocaccia R, Visser O, et al. Incidence of hematologic malignancies in Europe by morphologic subtype: results of the HAEMACARE project. Blood. 2010;116(19):3724–3734. doi:10.1182/blood-2010-05-282632.
• Feugier P, Van Hoof A, Sebban C, Solal-Céligny P, Bouabdallah R, Fermé C, et al. Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d’Etude des Lymphomes de l’Adulte. J Clin Oncol. 2005;23(18):4117–4126. doi:10.1200/JCO.2005.09.131.
• Cheson BD, Pfistner B, Juweid ME, Gascoyne RD, Specht L, Horning SJ, et al. Revised response criteria for malignant lymphoma. J Clin Oncol. 2007;25(5):579–586. doi:10.1200/JCO.2006.09.2403.
• Hicks RJ, Mac Manus MP, Seymour JF. Initial staging of lymphoma with positron emission tomography and computed tomography. Semin Nucl Med. 2005;35(3):165–175. doi:10.1053/j.semnuclmed.2005.02.003.
• Rodríguez-Vigil B, Gómez-León N, Pinilla I, Hernández-Maraver D, Coya J, Martín-Curto L, et al. PET/CT in lymphoma: prospective study of enhanced full-dose PET/CT versus unenhanced low-dose PET/CT. J Nucl Med. 2006;47(10):1643–1648.
• Moog F, Bangerter M, Diederichs CG, Guhlmann A, Merkle E, Frickhofen N, et al. Extranodal malignant lymphoma: detection with FDG PET versus CT. Radiology. 1998;206(2):475–481. doi:10.1148/radiology.206.2.9457202.
• Gallamini A, Hutchings M, Rigacci L, Specht L, Merli F, Hansen M, et al. Early interim 2-[18F]FDG PET is prognostically superior to international prognostic score in advanced-stage Hodgkin’s lymphoma: an Italian-Danish study. J Clin Oncol. 2007;25(24):3746–3752. doi:10.1200/JCO.2007.11.6525.
• Hutchings M, Mikhaeel NG, Fields PA, Nunan T, Timothy AR. Prognostic value of interim FDG-PET after two or three cycles of chemotherapy in Hodgkin lymphoma. Ann Oncol. 2005;16(7):1160–1168. doi:10.1093/annonc/mdi200.
• Terasawa T, Lau J, Bardet S, Couturier O, Hotta T, Hutchings M, et al. Fluorine-18-FDG PET for interim response assessment of advanced-stage Hodgkin’s lymphoma and DLBCL: a systematic review. J Clin Oncol. 2009;27(11):1906–1914. doi:10.1200/JCO.2008.16.0861.
• Cerci JJ, Pracchia LF, Linardi CCG, Pitella FA, Delbeke D, Izaki M, et al. 18F-FDG PET after 2 cycles of ABVD predicts event-free survival in Hodgkin lymphoma. J Nucl Med. 2010;51(9):1337–1343. doi:10.2967/jnumed.109.073197.
• Gallamini A, Rigacci L, Merli F, Nassi L, Bosi A, Capodanno I, et al. The predictive value of PET after two courses of therapy in advanced-stage Hodgkin’s disease. Haematologica. 2006;91(4):475–481. doi:10.3324/haematol.10417.
• Hutchings M, Loft A, Hansen M, Pedersen LM, Buhl T, Jurlander J, et al. FDG-PET after two cycles of chemotherapy predicts treatment failure and PFS in Hodgkin lymphoma. Blood. 2006;107(1):52–59. doi:10.1182/blood-2005-06-2252.
• Mikhaeel NG, Hutchings M, Fields PA, O’Doherty MJ, Timothy AR. FDG-PET after two to three cycles of chemotherapy predicts survival in high-grade NHL. Ann Oncol. 2005;16(9):1514–1523. doi:10.1093/annonc/mdi272.
• Zhu D, Zhang Y, Shi M, Tang Y, Liu P. Prognostic value of interim 18F-FDG PET in DLBCL: a meta-analysis. Int J Clin Exp Med. 2015;8(9):15340–15350.
• Yang DH, Ahn JS, Byun BH, Min JJ, Kweon SS, Chae YS, et al. Interim PET/CT-based prognostic model in DLBCL in the post-rituximab era. Ann Hematol. 2013;92(4):471–479. doi:10.1007/s00277-012-1640-x.
• Safar V, Dupuis J, Itti E, Jardin F, Fruchart C, Bardet S, et al. Interim FDG-PET in DLBCL treated with chemo + rituximab. J Clin Oncol. 2012;30(2):184–190. doi:10.1200/JCO.2011.38.2648.
• Pregno P, Chiappella A, Bellò M, Botto B, Ferrero S, Franceschetti S, et al. Interim PET/CT failed to predict outcome in DLBCL treated with R-CHOP. Blood. 2012;119(9):2066–2073. doi:10.1182/blood-2011-06-359943.
• González-Barca E, Canales M, Cortés M, Vidal MJ, Salar A, Oriol A, et al. Predictive value of interim PET/CT for EFS in DLBCL patients in a phase II trial. Nucl Med Commun. 2013;34(10):946–952. doi:10.1097/MNM.0b013e328363c695.
• Cox MC, Ambrogi V, Lanni V, Cavalieri E, Pelliccia S, Scopinaro F, et al. Interim FDG-PET is not justified in DLBCL during first-line immunochemotherapy. Leuk Lymphoma. 2012;53(2):263–269. doi:10.3109/10428194.2011.614704.
• Mamot C, Klingbiel D, Hitz F, Renner C, Pabst T, Driessen C, et al. Predictive value of interim PET in DLBCL treated with R-CHOP-14 (SAKK 38/07). J Clin Oncol. 2015;33(23):2523–2529. doi:10.1200/JCO.2014.58.9846.
• Itti E, Lin C, Dupuis J, Paone G, Capacchione D, Rahmouni A, Haioun C, Meignan M. Prognostic value of interim 18F-FDG PET in patients with diffuse large B-Cell lymphoma: SUV-based assessment at 4 cycles of chemotherapy. J Nucl Med. 2009 Apr;50(4):527-33. doi: 10.2967/jnumed.108.057703.
• Lin C, Itti E, Haioun C, Petegnief Y, Luciani A, Dupuis J, et al. Early PET for prognosis in DLBCL: SUV vs visual analysis. J Nucl Med. 2007;48(10):1626–1632. doi:10.2967/jnumed.107.042093.
• Casasnovas RO, Meignan M, Berriolo-Riedinger A, Bardet S, Julian A, Thieblemont C, et al. SUVmax reduction improves prognosis in interim PET in DLBCL. Blood. 2011;118(1):37–43. doi:10.1182/blood-2010-12-327767.
• Itti E, Meignan M, Berriolo-Riedinger A, Biggi A, Cashen AF, Véra P, et al. International confirmatory study of early PET/CT in DLBCL: Deauville vs ΔSUVmax. Eur J Nucl Med Mol Imaging. 2013;40(9):1312–1320. doi:10.1007/s00259-013-2435-6.
• Zhao W, Wu X, Huang S, Wang H, Fu H. Evaluation of therapeutic effect and prognostic value of PET/CT in DLBCL. EJNMMI Res. 2024;14(1):20. doi:10.1186/s13550-024-01074-w.
• Ferrari C, Pisani AR, Masi T, Santo G, Mammucci P, Rubini D, et al. Lesion-to-liver SUVmax ratio in end-of-treatment PET/CT in DLBCL. J Clin Med. 2022;11(19):5541. doi:10.3390/jcm11195541.
• Li YH, Zhao YM, Jiang YL, Tang S, Chen MT, Xiao ZZ, et al. End-of-treatment PET/CT in DLBCL: Deauville vs SUVmax ratio. Eur J Nucl Med Mol Imaging. 2022;49(4):1311–1321. doi:10.1007/s00259-021-05581-z.
• Gao J, Liu S, Zhao M, Zhang H, Jing H. Prognostic role of interim PET-CT with partial response in DLBCL. Ann Hematol. 2025. doi:10.1007/s00277-025-06368-0.
• Cottereau AS, Meignan M, Nioche C, Capobianco N, Clerc J, Chartier L, et al. Risk stratification in DLBCL using PET/CT metabolic burden and dissemination. Ann Oncol. 2021;32(3):404–411. doi:10.1016/j.annonc.2020.11.019.
• Capobianco N, Meignan M, Cottereau AS, Vercellino L, Sibille L, Spottiswoode B, et al. Deep-learning FDG uptake classification for tumor volume estimation in DLBCL. J Nucl Med. 2021;62(1):30–36. doi:10.2967/jnumed.120.242412.
• Veziroglu EM, Farhadi F, Hasani N, Nikpanah M, Roschewski M, Summers RM, et al. Role of artificial intelligence in PET/CT imaging for lymphoma management. Semin Nucl Med. 2023;53(3):426–448. doi: 10.1053/j.semnuclmed.2022.11.003