Comparison of^ 1^ 8FDG-PET with CT scans in the evaluation of patients with residual and recurrent …
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To our knowledge, this is the first study which compares FDG-PET to CT scanning
in a blind analysis, regarding the viability of residual masses after treatment
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ONCOLOGY REPORTS 8: 1393-1399, 2001
Comparison of 18FDG-PET with CT scans in the evaluation of patients with residual and recurrent Hodgkin's lymphoma
H. DITTMANN1, M. SÖKLER2, C. KOLLMANNSBERGER2, B.M. DOHMEN1, C. BAUMANN2, A. KOPP3, R. BARES1, C.D. CLAUSSEN3, L. KANZ2 and C. BOKEMEYER2 Departments of 1Nuclear Medicine, 2Hematology/Oncology and 3Radiology, University of Tuebingen, Germany Received July 6, 2001; Accepted August 9, 2001
Abstract. The reliable assessment of residual masses after treatment as well as of new lesions suspected for relapse remains a diagnostic problem in patients with Hodgkin's disease (HD). The current study compares the results obtained by CT scan to FDG-PET imaging in a blind analysis with respect to the viability of residual masses and in case of suspected relapse. Between 1/94 and 10/99, 47 comparisons of PET and corresponding CT scans - 26 comparisons in 24 patients with residual tumors and 21 comparisons in 20 patients with suspected relapse of HD - were evaluated by independent reviewers blinded to he results of each other. Patients with primary diagnosis had been treated within trials of the German HD Trial study group. Relapsed patients received intensified salvage chemotherapy regimens. PET was assessed visually and by quantifying glucose uptake (SUV). Changes in size of tumor lesions as well as contrast medium enhancement served as criteria for assessment by CT scans. Results were validated either by histologic examination of a resected mass or biopsy (n=17) or by a clinical follow-up over 6 months following treatment (n=30). In 26 cases with residual lesions FDG-PET showed an increased tracer uptake in 8, 7 of which were true positive (TP) and 1 false positive (FP). Eighteen cases were classified as being negative (no viable HD), 17 true negative (TN) and 1 FN. In the blinded reading of the corresponding CT scans, 10 cases with residual lesions were considered to contain vital lymphoma (2 TP, 8 FP). Sixteen CT scans were classified as negative (10 TP, 6 FN). The resulting sensitivity and specificity of PET were 87.5% and 94.4% in contrast to only 25% and 56% for CT scans. The positive and negative predictive values of PET and CT scans were 87.5% and 94.4% and 20% and 62.5%, respectively. In patients with suspected relapse, sensitivity and positive predictive value for the diagnosis of the relapse
were 100% and 86%, respectively, yielding the same results for both methods. FDG-PET performed in HD patients with residual masses appears to offer important additional information regarding the presence of viable HD in these residual lesions. In patients with suspected relapse of HD, FDG-PET seems not to offer any information over CT scans. Using SUVs is not superior to visual assessment of PET alone. Introduction Today, approximately 70-80% of patients with advanced Hodgkin's disease (HD) are cured with combined modality treatment including chemotherapy and radiotherapy (1). However, the accurate assessment of response to treatment remains a diagnostic challenge, since residual masses after treatment of Hodgkin's disease are a frequent finding which are observed in up to 60% of patients with bulky disease at initial diagnosis (2-5). The significance of these residual masses is unclear and the differentiation between viable residual Hodgkin's lymphoma and scar tissue by non-invasive means is difficult (6-8). Most of these residual lesions consist of scar tissue, but a small number of lesions contain viable tumor cells and thus carry the risk for early relapse (2). These patients may profit from additional treatment e.g. intensified chemotherapy. Thus far, salvage treatment regimens are only applied in case of a clinically evident lymphoma progression or relapse. In contrast, additive radiotherapy of residual lesions may be avoided in patients with completely necrotic masses following chemotherapy. Unfortunately, there are no established radiological criteria, which allow the reliable differentiation between vital lymphoma and necrosis/ scar tissue in residual lesions of Hodgkin's disease. Positron emission tomography (PET) imaging using 2-[18F]fluoro-2deoxy-D-glucose (FDG) is a new diagnostic technique which allows visualization and quantification of regional glucose metabolism within the body (9,10). Since cancer cells are characterized by a higher rate of glucose utilization than normal tissue cells, PET exploits this difference by assessing the rate and quantity of FDG uptake by the tumor. Studies have investigated the role of PET for the evaluation of residual masses in patients with germ cell tumors after chemotherapy suggesting the additional value of PET imaging for the detection of viable carcinoma in residual masses of patients with non-seminomatous germ cell cancer (11-13). PET has
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Correspondence to: Dr C. Bokemeyer, Department of Hematology/ Oncology, University of Tuebingen Medical Center, OtfriedMueller-Str. 10, D-72076 Tuebingen, Germany E-mail: carsten.bokemeyer@uni-tuebingen.de Key words: Hodgkin's disease, residual tumor, recurrent
lymphoma, PET
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