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Semiquantitative  18 F-fluoro-2-deoxy-D-glucose positron emission tomography ( 18 F-FDG PET) parameters have been proposed as prognostic markers in classical Hodgkin lymphoma (cHL). In non-Hodgkin lymphoma necrosis as assessed by  18 F-FDG PET or computed tomography (CT) (necrosis visual ) correlates with an adverse prognosis. We investigated whether semiquantitative  18 F-FDG PET metrics correlate with necrosis visual , determined the incidence of necrosis visual  and explored the prognostic impact of these factors in cHL. From 87 cHL cases treated with ABVD, (escalated) BEACOPP or CHOP chemotherapy between 2010 and 2017, 71 had both a NEDPAS/EARL accredited  18 F-FDG PET and a contrast enhanced CT scan. Semiquantitative  18 F-FDG PET parameters were determined using Hermes Hybrid 3D software. Necrosis visual , defined by photopenic tumor areas on  18 F-FDG PET and attenuation values between 10 and 30 Hounsfield units (HUs) on CT, was assessed blinded to outcome. Univariate Cox regression survival analyses of progression free survival (PFS) were performed. Necrosis visual  was observed in 18.3% of cHL patients. Bulky disease (tumor mass >10 cm in any direction) ( P  = 0.002) and TLG ( P  = 0.041) but no other semiquantitative parameters were significantly associated with necrosis visual . In exploratory univariate survival analysis for PFS the covariates IPS, bulky disease, MTV and TLG were prognostic, while necrosis visual  was not.

Relationship between semiquantitative 18F-fluorodeoxyglucose positron emission tomography metrics and necrosis in classical Hodgkin lymphoma