Clinical impact of whole body FDG-PET on the staging and therapeutic decision making for malignant lymphoma

• Published in: Annals of nuclear medicine 2002-07, Vol.16 (5), p.337-345
• Main Authors: Sasaki, Masayuki, Kuwabara, Yasuo, Koga, Hirofumi, Nakagawa, Makoto, Chen, Tao, Kaneko, Kouichirou, Hayashi, Kazutaka, Nakamura, Katsumasa, Masuda, Kouji
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Bone marrow; Citrates; Decision Making; Evaluation; Female; Fluorodeoxyglucose F18; Gallium; Health services; Hodgkin Disease - classification; Hodgkin Disease - diagnostic imaging; Hodgkin Disease - pathology; Hodgkin Disease - therapy; Humans; Lesions; Lymphoma; Lymphoma - diagnostic imaging; Lymphoma, Non-Hodgkin - classification; Lymphoma, Non-Hodgkin - diagnostic imaging; Lymphoma, Non-Hodgkin - pathology; Lymphoma, Non-Hodgkin - therapy; Male; Medical imaging; Middle Aged; Neoplasm Recurrence, Local - classification; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - therapy; Neoplasm Staging - methods; Patient Care Management - methods; Patients; Positron emission; Positron emission tomography; Radiopharmaceuticals; Reproducibility of Results; Scintigraphy; Sensitivity; Sensitivity and Specificity; Tomography, Emission-Computed - methods; Treatment Outcome; Whole-Body Counting - methods
• ISSN: 0914-7187; 1864-6433
• DOI: 10.1007/bf02988618

The aim of this study is to evaluate the clinical impact of whole-body FDG-PET for the pre-therapeutic evaluation of malignant lymphoma and compared to that of 67Ga-scintigraphy when added to non-RI examinations. We examined 46 patients with malignant lymphoma including 42 newly diagnosed cases and 4 relapsed cases. Whole-body FDG-PET was started 63 minutes after the administration of FDG with ECAT EXACT HR+. The clinical stage of each patient was determined based on the results of a non-RI examination (consisting of physical examination, CT, gastrointestinal studies and bone marrow aspiration), 67Ga planar images and FDG-PET. Discrepant findings were verified based on the response to treatment and the findings of a follow-up examination more than 6 months after treatment. Finally, 152 nodal regions and 19 extranodal tissues were found to be involved by disease. In the 152 nodal lesions, FDG-PET detected 54 nodal lesions in addition to 98 lesions detected by non-RI examinations, whereas 67Ga-scintigraphy detected 14 additional lesions. The sensitivity of non-RI, non-RI + 67Ga and non-RI + FDG was 64.5%, 73.7% and 100.0%, respectively. In 19 extranodal lesions, FDG-PET detected 5 extranodal lesions in addition to 13 lesions detected by non-RI examinations, whereas 67Ga-scintigraphy detected 1 additional lesion. The sensitivity of non-RI, non-RI + 67Ga and non-RI + FDG was 68.4%, 73.7% and 94.7%, respectively. When combining the FDG-PET findings with the non-RI findings, the improvement of the detectability was much higher than that when 67Ga findings were combined to the non-RI findings. For the staging of lymphoma, the non-RI and non-RI + 67Ga findings accurately diagnosed 76.1% and 80.4%, respectively, whereas the non-RI + FDG findings accurately diagnosed 82.6%. Finally, FDG-PET resulted in changes in the clinical management of 8 patients (17.4%). FDG-PET offers more information in addition to the findings of conventional diagnostic methods than 67Ga-scintigraphy in order to accurately detect malignant lymphoma. FDG-PET can therefore play an important role in therapeutic decision making on lymphoma.