Residual SUVmax in FDG-PET/CT Evaluation after First-Line Treatment in Aggressive B-Cell Non-Hodgkin's and Hodgkin's Lymphoma

Year 2019, Volume: 45 Issue: 1, 5 - 11, 01.04.2019

Celal Acar Vildan Özkocaman Ali Tayyar Akpınar Fahir Özkalemkaş

https://doi.org/10.32708/uutfd.464814

Abstract

The
purpose of this study was to assess the sensitivity and specificity of
fluorine-18 fluorodeoxyglucose positron emission tomography/ computed
tomography (FDG-PET/CT) according to the residual SUVmax value in
patients with lymphoma after firstline therapy using clinical follow-up or the biopsy
results, retrospectively. Total 69 patients diagnosed with aggressive B-cell
non-Hodgkin's lymphoma (high grade unclassified B-cell lymphoma, diffuse large
B-cell lymphoma [DLBCL], mantle-cell lymphoma, Burkitt's lymphoma) and
Hodgkin's lymphoma (classic and nodular predominant) who were clinically
followed up between January 2004 - May 2012 and older than 18 were included in
the study. The median follow-up time was 40 months and the mean age was 49.7 ±
15.5 years in patients whose end-of-treatment FDG-PET / CT were assessed. Only
one of the 23 patients with Hodgkin's lymphoma and 10 (21%) of the 46
non-Hodgkin's lymphoma patients were relapsed after the standard therapy in
clinical follow-up. 7 (15%) non-Hodgkin's lymphoma patients were resistant to
the therapy. Median time to relapse of the patients was 20 months. Sensitivity,
specificity, positive predictive value, negative predictive value, and accuracy
rates were calculated as 66.6%, 94.1%, 80%, 88.9%, 87%, respectively when the
residual SUVmax cut-off value > 3.5 was accepted. In conclusion; residual
SUVmax cut-off value > 3,5 has the highest accuracy in the end-of-treatment FDG-PET/CT
similar to the Gallamini criteria. It was thought that SUVmax cut-off value
> 4 which has 96% specificity in ROC analyzes also could be used in
lymphomas which has a suspicious visual assessment.

Keywords

Lymphoma, end-of-treatment FDG-PET/CT, residual SUVmax, response evaluation

Agresif B hücreli Hodgkin Dışı ve Hodgkin Lenfomada İlk Basamak Tedavi Yanıtının FDG-PET/BT ile Değerlendirilmesinde Rezidüel SUVmax

Abstract

Bu çalışmada; lenfomada ilk
basamak tedavi sonrasında Flor-18 fluorodeoksiglukoz pozitron emisyon
tomografisinin (FDG-PET/BT) rezidüel SUVmax değerine göre duyarlılık
ve özgünlüğünün geriye dönük olarak klinik takip veya biyopsi sonuçları
doğrultusunda belirlenmesi amaçlandı. Çalışmaya Ocak 2004-Mayıs 2012 tarihleri
arasında takip edilen, 18 yaş üzeri, agresif B hücreli Hodgkin dışı lenfoma
(Yüksek dereceli sınıflandırılamamış B hücreli lenfoma, diffüz büyük B hücreli
lenfoma [DBBHL], mantle hücreli lenfoma, Burkitt lenfoma) ve Hodgkin lenfoma
(klasik ve nodüler predominant) tanılı 69 hasta dahil edildi. Tedavi sonu
FDG-PET/BT’ leri değerlendirilen hastaların ortanca takip süresi 40 ay olup ortalama
yaş 49,7 ± 15,5  yıl olarak hesaplandı. Klinik
takipte standart tedavi sonrası 23 Hodgkin lenfoma olgusunun sadece birinde, 46
Hodgkin dışı lenfoma olgusunun 10’ unda (%21) relaps gözlendi. Hodgkin dışı
lenfomalı 7 olgu (%15) ise tedaviye dirençli idi. Hastaların ortanca relaps
süresi 20 ay idi. Rezidü SUVmax > 3,5 kabul edildiğinde duyarlılık,
özgüllük, olumlu öngörü, olumsuz öngörü, doğruluk oranları sırası ile %66,6, %94,1,
%80, %88,9, %87 olarak hesaplandı. Sonuç olarak; Gallamini kriterleri ile
benzer şekilde tedavi sonu FDG-PET/BT’ deki en yüksek doğruluğa sahip rezidüel
SUVmax sınır değerinin >3,5 olduğu saptandı. ROC analizlerinde ise
SUVmax >4 değerinin %96 özgüllüğe sahip olduğu ve görsel
değerlendirmenin şüpheli olduğu lenfomalarda bu sınır değerin anlamlı
olabileceği düşünüldü. 

Keywords

Lenfoma, tedavi sonu FDG-PET/BT, rezidüel SUVmax, yanıt değerlendirme

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