The role of positron emission tomography and combined positron emission tomography with computed tomography in staging and response assessment in patients with non-Hodgkin’s lymphoma


Authors: T. Papajík 1;  M. Mysliveček 2;  E. Buriánková 2;  M. Skopalová 3;  A. Malán 4;  V. Koza 5;  M. Trněný 6;  P. Koranda 2;  J. Ptáček 2;  K. Indrák 1
Authors‘ workplace: Hemato-onkologická klinika FNO a LF UP v Olomouci, 2Klinika nukleární medicíny FNO a LF UP v Olomouci, 3PET centrum Nemocnice na Homolce, 4Oddělení nukleární medicíny FN Plzeň, 5Hematologicko-onkologické oddělení FN Plzeň, 6I. interní klinika VFN Praha 1
Published in: Transfuze Hematol. dnes,14, 2008, No. 3, p. 110-118.
Category: Comprehensive Reports, Original Papers, Case Reports

Overview

2-[fluorin-18] fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET) is a noninvasive, 3-dimensional imaging modality sufficiently reliable for the initial diagnosis and staging, for the evaluation of therapeutic response and for the detection of recurrence of various type of non-Hodgkin’s lymphoma (NHL). 18F-FDG PET has been demonstrated more sensitive and specific than either 67scintigraphy or computed tomography (CT) and generally offers more than 88% of sensitivity and 94% of specificity in the diagnosis of NHL. However, 18F-FDG PET may not precisely anatomically localize pathological lesions in the human body. Actually, combined PET and CT – PET/CT system - has developed into the fastest growing imaging modality worldwide and the integration of PET and CT provides precise localization of the lesions on the 18F-FDG PET scans within the anatomic reference frame provided by CT, thereby increasing specificity of the examination. Some authors founded that high glycolytic rates, determined by 18FDG uptake, are associated predominantly with high-grade lymphoma, and low-grade and certain other lymphoma subtypes (e.g., peripheral T-cell NHL) have low 18F-FDG uptake that can result in negative scans. Others founded no significant difference between low-grade and high-grade NHL or B- and T-cell NHL in this respect, suggesting that the diagnostic accuracy of PET is not affected by tumor subtype or grade. In fact, a large overlap may exist between the metabolic/glycolytic activity of various lymphoma entities. On the other hand, hypermetabolic conditions (sarcoidosis, tuberculosis, fungal infections, inflammation, etc.) may be a source of “false-positive” 18F-FDG PET scans and integrated PET-CT system can help improve the specificity of the findings and our differential diagnostic accuracy in these situations.

Key words:
18F- FDG PET, PET/CT, lymphoma, staging


Sources

1. Cheson BD, Pfistner B, Juweid ME, et al. Revised response criteria for malignant lymphoma. J Clin Oncol 2007; 25: 579–586.

2. Barentsz J, Takahashi S, Oyen W, et al. Commonly used imaging techniques fo diagnosis and staging. J Clin Oncol 2006; 24: 3234–3244.

3. Jhanwar YS, Straus DJ. The role of PET in lymphoma. J Nucl Med 2006; 47: 1326–1334.

4. Barrington SF, O’Doherty MJ. Limitations of PET for imaging lymphoma. Eur J Nucl Med Mol Imaging 2003; 30 (Suppl 1): 117–127.

5. Schulthess GK, Steinert HC, Hany TF. Integrated PET/CT: Current applications and future directions. Radiology 2006; 238: 405–422.

6. Phelps ME. Inaugural article: Positrone emission tomography provides molecular imaging of biological processes. Proc Natl Acad Sci U. S. A. 2000; 97: 9226–9233.

7. Warburg O. On the origin of cancer cells. Science 1956; 123: 309–314.

8. Aloj L, Caracao C, Jagoda E, et al. Glut-1 and hexokinase expression: Relationship with 2-fluoro-2-deoxy-D-glucose uptake in A431 and T47D cells in culture. Cancer Res 1999; 59: 4709–4714.

9. Bakheet SM, Powe J. Benign causes of 18-FDG uptake on whole body imaging. Semin Nucl Med 1998; 28: 352–358.

10. Kinahan PE, Townsend DW, Beyer T, Sashin D. Attenuation correction for a combined 3D PET/CT scanner. Med Phys 1998; 25: 2046–2053.

11. Beyer T, Townsend DW, Brun T, et al. A combined PET/CT scanner for clinical oncology. J Nucl Med 2000; 41: 1369–1379.

12. Lardinois D, Weder W, Hany TF, et al. Staging of non-small cell lung cancer with integrated positron-emission tomography and computed tomography. N. Engl J Med 2003; 348: 2500–2507.

13. Hany TF, Steinert HC, Goerres G.W, et al. PET diagnostic accuracy: improvement with in-line PET-CT system: initial results. Radiology 2002; 225: 575–581.

14. Carbone P. Kaplan H, Musshoff K, et al. Report of the Committee on Hodgkin’s disease staging. Cancer Res 1971; 31: 1860–1861.

15. Cheson BD, Pfistner B, Juweid ME, et al. Revised response criteria for malignant lymphoma. J Clin Oncol 2007; 25: 579 – 86.

16. Isasi CR, Lu P, Blaufox MD. A metaanalysis of 18F-2-deoxy-2-fluoro-D-glucose positron emission tomography in the staging and restaging of patients with lymphoma. Cancer 2005; 104: 1066–1074.

17. Buchmann I, Reinhardt M. Elsner K, et al. 2-(Fluorine-18)fluoro-2-deoxy-D-glucose positron emission tomography in the detection and staging of malignant lymphoma. A bicenter trial. Cancer 2001; 91: 889–899.

18. Kostakoglu L, Leonard JP, Kuji I, et al. Comparison of fluorine-18 fluorodeoxyglucose positron emission tomography and Ga-67 scintigraphy in evaluation of lymphoma. Cancer 2002; 94: 879–888.

19. Wirth A, Seymour JF, Hicks RJ, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography, gallium-67 scintigraphy and conventional staging for Hodgkin’s disease and non-Hodgkin’s lymphoma. Am J Med 2002; 112: 262–268.

20. Thill R, Neuerburg J, Fabry U, et al. Comparison of findings with 18-FDG PET and CT in pretherapeutic staging of malignant lymphoma. Nuklearmedizin 1997; 36: 234–239.

21. Moog F, Bangerter M, Diederichs CG, et al. Lymphoma: role of whole body 2-deoxy-2-(F-18) fluoro-D-glucose (FDG) PET in nodal staging. Radiology 1997; 203: 795–800.

22. Jerusalem G, Warland V, Najjar F, et al. Whole-body 18F-FDG PET for the evaluation of patient with Hodgkin’s disease and non-Hodgkin’s lymphoma. Nucl Med Commun 1999; 20: 13–20.

23. Delbeke D, Martin WH, Morgan DS, et al. 2-deoxy-2-(F-18) fluoro-D-glucose imaging with positron emission tomography for initial staging of Hodgkin’s disease and lymphoma. Mol Imaging Biol 2002; 4: 105–114.

24. Moog F, Bangerter M, Diederichs CG. Extranodal malignant lymphoma: detection with FDG PET versus CT. Radiology 1998; 2006: 475–481.

25. Kostakoglu L, Goldsmith S. Fluorine-18 fluorodeoxyglucose positron emission tomography in the staging and follow-up of lymphoma: is it time to shift gears? Eur J Nucl Med 2000; 27: 1564–1578.

26. Moog F, Bangerter M, Kotzerke J, et al. 18-F-fluorodeoxyglucose-positron emission tomography as a new approach to detect lymphomatous bone marrow. J Clin Oncol 1998; 16: 603–609.

27. Carr R, Barrington SF, Madan B, et al. Detection of lymphoma in bone marrow by whole-body positron emission tomography. Blood 1998; 91: 3340–3346.

28. Kostakoglu L, Leonard JP, Kuji I, et al. Evaluation of FDG-PET in the detection of bone marrow involvement in lymphoma. J Nucl Med 2000; 41: 71p.

29. Heald AE, Hoffman JM, Bartlett JA, Waskin HA. Differentiation of central nervous system lesions in AIDS patients using positron emission tomography (PET). Int J Std AIDS 1996; 7: 337–346.

30. Schaefer NG, Hany TF, Taverna C, et al. Non-Hodgkin lymphoma and Hodgkin disease: coregistered FDG PET and CT at staging and restaging – do we need contrast-enhanced CT? Radiology 2004; 232: 823–829.

31. Hernandez-Maraver D, Hernandez-Navarro F, Gomez-Leon N, et al. Positron emission tomography/computed tomography: diagnostic accuracy in lymphoma. Br J Haematology 2006; 135: 293–302.

32. la Fougere C, Hundt W, Bröckel N, et al. Value of PET/CT versus PET and CT performed as separate investigations in patients with Hodgkin’s disease and non-Hodgkin’s lymphoma. Eur J Nucl Med Mol Imaging 2006; 33: 1417–1425.

33. Israel O, Keidar Z, Bar-Shalom R. Positron emission tomography in the evaluation of lymphoma. Sem Nucl Med 2004; 24: 166–179.

34. Friedberg JW, Chengazi V. PET scans in the staging of lymphoma. Oncologist 2003; 8: 438–447.

35. Jerusalem G, Beguin Y, Najjar F, et al. Positron emission tomography (PET) with 18F-fluorodeoxyglucose (18FDG) for the staging of low-grade non-Hodgkin’s lymphoma (NHL). Ann Oncol 2001; 12: 825–830.

36. Elstrom R, Guan L. Baker G, et al. Utility of FDG-PET scanning in lymphoma by WHO classification. Blood 2003; 101: 3875–3876.

37. Karam M, Novak L, Cyriac J, et al. Role of fluorine-18 fluoro-deoxyglucose positron emission tomography scan in the evaluation and follow-up of patients with low-grade lymphomas. Cancer 2006; 107: 175–183.

38. Wöhrer S, Jaeger U, Kletter K, et al. 18fluoro-deoxy-glucose positron emission tomography (18F-FDG-PET) visualizes follicular lymphoma irrespective of grading. Ann Oncol 2006; 17: 780–784.

39. Bishu S, Quigley J, Bishu SR, et al. Predictive value and diagnostic accuracy of F-18-fluoro-deoxy-glucose positron emission tomography treated grade 1 and 2 follicular lymphoma. Leuk Lymphoma 2007; 48: 1548–1555.

40. Quigley JM, Bishu S, Hankons J, Armitage JO. FDG-PET in peripheral T-cell lymphoma. Blood 2006; 108: 5499a.

41. Bishu S, Quigley JM, Schmitz J, et al. F-18-fluoro-deoxy-glucose positron emission tomography in the assesment of peripheral T-cell lymphomas. Leuk Lymphoma 2007; 48: 1531–1538.

42. Juweid ME, Stroobants S, Hoekstra OS, et al. Use of positron emission tomography for response assessment of lymphoma: Consensus of the imaging subcommittee of Internal harmonization Project in lymphoma. J Clin Oncol 2007; 25: 571–578.

43. Weber W.A, Ziegler S.I, Thodtmann R, et al. Reproducibility of metabolic measurements in malignant tumors using FDG PET. J Nucl Med 1999; 40: 1771–1777.

44. Rodriguez M, Rehn S, Ahlstrom H, et al. Predicting malignancy grade with PET in non-Hodgkin’s lymphoma. J Nucl Med 1995; 1790–1796.

45. Lapela M, Leskinen S, Minn H.R, et al. Increased glucose metabolism in untreated non-Hodgkin’s lymphoma: A study with positron emission tomography and fluorine-18-fluorodeoxyglucose. Blood 1995; 86: 3522–3527.

46. Schöder H, Noy A, Gönen M, et al. Intensity of 18fluorodeoxyglucose uptake in positron emission tomography distinguishes between indolent and agressive non-Hodgkin’s lymphoma. J Clin Oncol 2005; 23: 4643–4651.

47. Wong CO, Thie J, Parling-Lynch KJ, et al. Glucose-normalized standardized uptake value from 18F-FDG PET in classifying lymphomas. J Nucl Med 2005; 46: 1659–1663.

48. Strauss LG. Fluorine-18 deoxyglucose and false-positive results: a major problem in the diagnostic of oncological patients. Eur J Nucl Med 1996; 23: 1409–1415.

49. Kazama T, Faria SC, Varavithya V, et al. FDG PET in the evaluation of treatment for lymphoma: clinical usefulness and pitfalls. Radiographics 2005; 25: 191–207.

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Haematology Internal medicine Clinical oncology
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