Open AccessUtilization of 18 F‐FDG PET/CT as a staging tool in patients with newly diagnosed lymphoma
Author(s) -
Cho ShihFeng,
Chang ChinChuan,
Liu YiChang,
Chang ChaoSung,
Hsiao HuiHua,
Liu TaChih,
Huang ChiungTang,
Lin ShengFung
Publication year - 2015
Publication title -
the kaohsiung journal of medical sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.439
H-Index - 36
eISSN - 2410-8650
pISSN - 1607-551X
DOI - 10.1016/j.kjms.2014.11.012
Subject(s) - medicine , concordance , lymphoma , bone marrow , positron emission tomography , biopsy , nuclear medicine , occult , radiology , pathology , alternative medicine
The aim of this study was to investigate the role of 2‐fluorine‐18‐fluoro‐2‐deoxy‐ D ‐glucose ( 18 F‐FDG) positron emission tomography/computed tomography (PET/CT) in the initial staging and prediction of bone marrow involvement in patients with newly diagnosed lymphoma. A total of 185 patients with newly diagnosed lymphoma were enrolled. All patients received PET/CT and bone marrow biopsy as part of a staging work‐up. At the initial staging, 17 patients (9.2%) with occult nodal or extranodal lesions were upstaged after a review of the PET/CT studies. PET/CT was found to be useful in the differentiation of aggressive lymphoma subtypes from the indolent subtype based on higher standardized uptake value (SUV) (16.67 vs. 7.98, p < 0.001). The results of bone marrow biopsy and PET/CT in the detection of bone marrow involvement were concordant in 152 patients (82.1%); positive concordance was observed in 21 patients, and negative concordance was observed in 131 patients. A high concordance rate was found between aggressive B cell lymphoma and Hodgkin's lymphoma (88.1% and 93.8%, respectively). High negative predictive values (NPVs) for excluding bone marrow involvement were observed in aggressive B‐cell lymphoma (93.2%) and Hodgkin's lymphoma (100%). Diffuse bone marrow FDG uptake accurately predicted bone marrow in aggressive B‐cell lymphoma with a positive predictive value (PPV) of 100%. The concordance rate was lower in indolent B‐cell lymphoma (66.0%). In conclusion, PET/CT resulted in the upstaging of patients with occult extranodal or nodal lesions. A high SUV level can predict aggressive subtype of lymphoma and detect aggressive components in indolent lymphoma. PET/CT had a high PPV for aggressive B‐cell lymphoma with diffuse bone marrow FDG uptake and high NPVs for excluding bone marrow involvement in aggressive B‐cell lymphoma and Hodgkin's lymphoma. Bone marrow biopsy may be omitted for the above subgroups of patients with medical conditions not suitable for this procedure. For patients with indolent B‐cell lymphoma, bone marrow biopsy is still an indispensable procedure for staging.