[ 18 F]‐FDG PET/CT in the staging and management of indolent lymphoma: A prospective multicenter PET registry study

BACKGROUND To measure the clinical impact of pretreatment fludeoxyglucose positron emission tomography/computed tomography (PET/CT) on the staging and management of apparent limited stage indolent lymphoma being considered for curative radiation therapy. METHODS We conducted a prospective multicenter registry study that included 197 patients accrued between May 1, 2012, and December 31, 2015. Pre‐PET/CT stage, determined by clinical and CT data, was documented. If pre‐PET/CT stage was indeterminate, a stage was assigned to the patient by the referring oncologist according to best clinical judgment and treatment intent. After PET/CT, revised stage and planned management were recorded and compared with data on actual treatment received available through provincial databases (n = 155). RESULTS PET/CT resulted in the upstaging of 47 (23.9%) patients with presumed limited stage disease (stage I‐II) to advanced stage disease (stage III‐IV) ( P < .0001). Ten (5.1%) patients were downstaged by PET/CT, 4 of whom migrated from advanced to limited stage disease. Twenty‐eight (14.2%) patients with a specific pre‐PET/CT stage had equivocal PET/CT findings that required further evaluation to confirm disease extent. After PET/CT, 95 (61.3%) patients were planned to receive active treatment. Of the 59 patients planned for radiotherapy alone post‐PET/CT, 34 (57.6%) received this treatment ( P = .002), and nearly 80% of them (n = 27) had confirmed limited stage disease. CONCLUSION PET/CT has a significant impact on staging and management in patients with apparent limited stage indolent lymphoma who are being considered for curative radiotherapy. PET/CT should be routinely incorporated into the workup of these patients. Cancer 2017;123:2860–66. © 2017 American Cancer Society .