Application of 18F-FDG PET/CT in prognostic stratification of patients with primary mediastinal diffuse large B-cell lymphoma
Authors:
Lenka Henzlová 1; Pavel Koranda 1; Vít Procházka 2; Tomáš Papajík 2; Jana Zapletalová 3
Authors‘ workplace:
Klinika nukleární medicíny
1; Hemato-onkologická klinika
2; Ústav lékařské biofyziky, LF Univerzity Palackého v Olomouci a FN Olomouc, ČR
3
Published in:
NuklMed 2017;6:22-27
Category:
Original Article
Overview
Introduction:
Primary mediastinal diffuse large B-cell lymphoma (PMBCL) is characterized by rapid growth of a large tumor mass in anterior mediastinum. In this era of immunochemotherapy, the five-year survival rate is presently 80–90 %. Nevertheless, early relapse occurs in a selection of patients with an unfavorable prognosis. Positron emission tomography combined with computed tomography (PET/CT) using 18F-fluordeoxyglucose is widely used for staging and treatment monitoring. The Deauville score and percentage decrease in SUVmax is used as an addition to visual analysis.
Subjects and methods:
Retrospective analysis was performed on 44 patients with PMBCL, who underwent staging PET/CT (26 patients) and PET/CT after 2–3 cycles of chemotherapy (36 patients). Visual analysis and the Deauville score were used. Maximum SUV value (SUVmax) was measured on the most intense uptake, and the percentage SUVmax changes over time between staging PET/CT and interim PET/CT were calculated.
Results:
The Deauville score categorized to 2 groups (Deauville 1–3 and Deauville 4–5) was a statistically significant predictor of Progression Free Survival (PFS), with p = 0.028. An optimal ΔSUVmax cut-off value of 68 % was determined through ROC analysis. A significant decrease in metabolic activity of tumor tissue was associated with a significantly higher estimated PFS using both our cut-off value and the cut-off value reported in literature (66 %), with p = 0.014 in both cases.
Conclusions:
The Deauville 5-point scale is a better prognostic factor compared to dichotomic visual analysis. ΔSUVmax is another strong prognostic factor for PFS prediction.
Key Words:
primary mediastinal diffuse large B-cell lymphoma, FDG, Deauville score, prognosis
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Nuclear Medicine
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