[18F]FDG in childhood lymphoma: clinical utility and impact on management (original) (raw)
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18F-FDG PET/CT in paediatric lymphoma: comparison with conventional imaging
European Journal of Nuclear Medicine and Molecular Imaging, 2011
Purpose In children with Hodgkin's disease and non-Hodgkin's lymphoma, the ability of 18 F-fluoro-2-deoxy-D-glucose PET/CT and conventional imaging (CI) to detect malignant lesions and predict poor lesion response to therapy was assessed and compared. Methods A retrospective review of findings reported on PET/CT and CI was performed using a lesion-based analysis of 16 lymph node and 8 extra-nodal regions. Lesions were defined by histopathological findings or follow-up > 6 months. Results The study included 209 PET/CT scans with a valid CI comparator. A total of 5,014 regions (3,342 lymph node, 1,672 extra-nodal) were analysed. PET/CT performed significantly better than CI in the detection of malignant lesions with sensitivity and specificity of 95.9 and 99.7% compared to 70.1 and 99.0%, respectively. For predicting poor lesion response to therapy, PET/CT had fewer false-positive lesions than CI. The specificity for predicting poor lesion response to treatment for PET/ CT was 99.2% compared to 96.9% for CI. PET/CT was the correct modality in 86% of lesions with discordant findings. Conclusion PET/CT is more accurate than CI in detecting malignant lesions in childhood lymphoma and in predicting poor lesion response to treatment. In lesions with discordant findings, PET/CT results are more likely to be correct.
F-18 FDG-PET imaging and correlation with CT in staging and follow-up of pediatric lymphomas
Pediatric Radiology, 2006
Background: We hypothesized that F-18 FDG-PET could be a useful, functional imaging modality for assessing the initial staging, response to therapy and follow-up of children diagnosed with lymphoma. Objective: To assess the role of whole-body F-18 FDG-PET imaging in patients with lymphoma as an initial staging modality and to measure its predictive value for monitoring the response to therapy and disease recurrence compared to CT and clinical follow-up studies. Materials and methods: As part of their routine clinical care, 24 patients with histologically proven lymphoma (18 Hodgkin disease and 6 non-Hodgkin lymphoma) underwent an F-18 FDG-PET and a CT scan. A total of 28 studies were performed and the entire set of scans retrospectively reviewed. Seven studies were performed for initial staging, 12 for monitoring therapy response and 9 for detecting recurrence. Initial diagnosis was confirmed by histopathology while the gold standard at follow-up was established by clinical follow-up, additional imaging modalities and/or biopsy. F-18 FDG-PET was visually compared to CT on a lesion-by-lesion basis. Fifteen anatomic regions (seven nodal and eight extranodal) were analyzed. Results: Of the 414 regions analyzed, PET and CT were concordant in 366 (positive in 16 and negative in 350). Discordance was found in 48 regions. Overall sensitivities, specificities, and positive and negative predictive values were 78%, 98%, 94% and 90% for F-18 FDG-PET and 79%, 88%, 90% and 46% for CT, respectively. Conclusion: F-18 FDG-PET imaging is a useful technique for the staging and follow-up of pediatric patients with lymphoma.
Journal of the Egyptian National Cancer Institute, 2016
To evaluate the sensitivity (Se), specificity (Sp), and predictive values (PV) of PET scan during management of pediatric mature B cell non-Hodgkin's lymphoma (NHL) in comparison with conventional computed tomography (CT) scan. A retrospective study enrolled on pediatric NHL patients at Children Cancer Hospital Egypt (CCHE) during the period from July 2007 to the end of June 2013. For 115 pediatric patients diagnosed with mature B cell NHL, 152 PET and 152 CT scans were done simultaneously. Median age was 5.7years. They were 85 males (74%) and 30 females (26%). One hundred twenty six scans (82.9%) were done for 100 (87%) Burkitt lymphoma (BL) patients, while 26 scans (17.1%) were done for 15 (13.0%) patients with diffuse large B cell NHL (DLBC). Nineteen examination (12.5%) were done before starting chemotherapy (group 1), 107 (70.3%) at time of evaluation (group 2), and 26 (17.1%) during follow up (group C). Overall sensitivity was 91.6% for PET and 70.0% for conventional CT (p...
Productivity of 18F-FDG-PET/CT Diagnostic Tool in the Management of Pediatric Lymphoblastic Lymphoma
Nuclear medicine review. Central & Eastern Europe, 2019
BACKGROUND Lymphoblastic lymphoma (LL) comprises approximately 20% of childhood non-Hodgkin lymphoma (NHL); however, few studies had investigated the role of 18F-FDG-PET/CT in pediatric LL patients. We aim in this study to assess the role of 18F-FDG-PET/CT in the initial staging of newly diagnosed pediatric patients with LL as well as in the assessment of response after induction chemotherapy. PATIENTS AND METHODS A prospective study enrolled biopsy proven newly diagnosed pediatric LL patients presenting in the Children Cancer Hospital Egypt (CCHE) during the period from October 2014 to October 2016. 18F-FDG-PET/CT was done initially before therapy and after induction chemotherapy in all patients. The patients were followed until the end of April 2018 (mean 23.5 months). RESULTS All lymphoma involvement lesions (n = 43) were FDG avid and the intensity of nodal FDG uptake was variable. Two patients (11%) had bone marrow (BM) involvement by < 25% blast cells with corresponding posi...
Indian Journal of Radiology and Imaging, 2013
Lymphomas are a heterogeneous group of diseases that arise from the constituent cells of the immune system or from their precursors. 18F-fl udeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) is now the cornerstone of staging procedures in the state-of-the-art management of Hodgkin's disease and aggressive non-Hodgkin's lymphoma. It plays an important role in staging, restaging, prognostication, planning appropriate treatment strategies, monitoring therapy, and detecting recurrence. However, its role in indolent lymphomas is still unclear and calls for further investigational trials. The protean PET/CT manifestations of lymphoma necessitate a familiarity with the spectrum of imaging fi ndings to enable accurate diagnosis. A meticulous evaluation of PET/CT fi ndings, an understanding of its role in the management of lymphomas, and knowledge of its limitations are mandatory for the optimal utilization of this technique.
Added Value of Semi-quantitative Analysis in Interim FDG-PET/CT in Pediatric Lymphoma
The Egyptian Journal Nuclear Medicine, 2013
Pediatric lymphoma (PL) is one of the few pediatric malignancies that shares aspects of its biology and natural history with adult lymphoma. However, it differs from the adult counterparts, mainly in terms of histopathology and therapeutic strategies (1). It comprises 6% of all childhood cancers worldwide (2). In Egypt, childhood lymphoma represents 1.3% of all incident cancers and 28.7% of all childhood cancer occupying the second rank among all childhood malignancies (3).
Role of PET/CT in malignant pediatric lymphoma
European Journal of Nuclear Medicine and Molecular Imaging, 2010
Introduction Malignant pediatric lymphoma accounts for 10–15% of all pediatric cancers, (representing 2–3% of all malignancies), with a peak incidence between 5–9 years. Chemotherapy is usually the first and most common mode of treatment. The choice of treatment and prediction of prognosis depend on the histological type of tumor, initial staging, evaluating treatment response, and detection of early recurrence. Conventional imaging modalities have many limitations. PET/CT is more accurate, however so far the literature lacks the results of a large group of patients. Aim of study To report the role of PET/CT in the above-mentioned objectives at the newly established Children’s Cancer Hospital in Cairo, Egypt, which is one of the busiest dedicated pediatric oncology centers of such purposes in the world. All findings were proven by histopathology, clinically, and by clinical follow-up. Patient population A total of 152 patients (35 girls and 117 boys) with histologically proven malignant lymphoma (117 HD, 35 NHL) were included in this study. They were divided into four groups. Group I: 41 patients for initial staging. Group II: 51 patients for evaluating early treatment response after two to three cycles of chemotherapy. Group III: 42 patients for evaluating treatment response 4–8 weeks after the end of their treatment. Group IV: 18 patients evaluated for long-term follow-up. Results of PET/CT were compared with the other conventional imaging modalities (CIM). Results The sensitivity, specificity, accuracy, and positive and negative predictive values of PET/CT and CIM were as follows: In Group I: PET/CT modified staging and treatment in 11 out of 41 cases (26.8%), upstaged 5(12.2%) patients and down-staged six (14.6%) patients. Group II: 100%, 97.7%, 98%, 85.7%, 100%, respectively, for PET/CT and 83%, 66.6%, 68.6%, 25%, 96.7% for CIM respectively Group III: At the end of chemotherapy 100%, 90.9%, 92.8%, 75%, 100%, respectively, for PET/CT and 55.5%, 57.5%, 57.1%, 26.3%, 82.6% for CIM, respectively. Group IV: For long-term follow-up, all the parameters scored 100% for PET/CT, 100%, 38.4%, 72.2%, 50%, 100% for CIM, respectively. Conclusion PET/CT in pediatric lymphoma is more accurate than CIM. We recommend that it should be the first modality for all purposes in initial staging, evaluating treatment response and follow-up.
FDG-PET/CT in Early Assessment of Response to Therapy in Pediatric Hodgkin Lymphoma
The Egyptian Journal Nuclear Medicine, 2013
Purpose of the study: was to estimate the value of early assessment of response in pediatric Hodgkin lymphoma (PHL) patients using FDG-PET/CT. Methods: prospective analysis of 195 patients presented in Children's Cancer Hospital, Egypt (CCHE) with pathologically proven untreated PHL, they underwent 18 F-fluorodeoxyglucose positron emission tomography (F-18 FDG PET/CT) early after 2 cycles of chemotherapy (PET 2).This chemotherapy regimen consists of concurrent treatment with Adriamycin, Bleomycin ,Vinblastine & Dacarbazine (ABVD). Analysis of PET 2 was done according to the Deauville score (5-point score) with cutoff 3-4 between Minimal Residual Uptake (MRU) and positive result. Results: Follow-up was done for mean period of 2.9 years (range, 0.6 to 5.2 years).Visual assessment of PET 2 was found to be significantly correlated with Overall Survival (OS) and Progression Free Survival (PFS) in advanced stages PHL (intermediate and high risk patients); the estimate for OS and PFS was 83.3% and 68.8 respectively in the PET-positive (PET +ve) group compared with 97.3% and 92.6|% respectively in the PET-negative (PETve) group (p-value <0.0001 and 0.0001). Conclusion: Early assessment of FDG-PET/CT after 2 cycles of ABVD in PHL shows potential value in prediction of OS and PFS in advanced stages (intermediate and high risk patients).