Hounsfield units from unenhanced 18F-FDG-PET/CT are useful in evaluating supradiaphragmatic lymph nodes in children and adolescents with classical Hodgkin’s lymphoma (original) (raw)
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Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2008
The most commonly used approach for the assessment for differentiating malignant versus reactive lymph nodes is the measurement of the cross-section diameter of the lymph nodes in the transversal CT-planes. The intention of this article is to assess the impact of varying definitions of pathological lymph node size in CT-imaging in patients with Hodgkin lymphoma and to evaluate its effect on staging, chemotherapy regimes and radiation field size. Pretherapeutic CT-scans of 10 consecutive patients with Hodgkin lymphoma have been evaluated based on two different definitions for malignant lymph node size; the classification of the German study group for Hodgkin lymphoma (1.0 cm) and the classification according to the results of the Cotswold consensus meeting 1989 (1.5 cm). Applying the definitions of the DHSG and the Cotswold meeting we found more affected lymph node regions compared to the evaluation of the referring institutions in 9/10 and 6/10 patients, higher stages in 2/10 and 1/...
Strahlentherapie und Onkologie, 2011
To determine interobserver variability in clinical target volume (CTV) of supra-diaphragmatic Hodgkin's lymphoma. Materials and Methods: At the 2008 AIRO (Italian Society of Radiation Oncology) Meeting, the Radiation Oncology Department of Chieti proposed a multi-institutional contouring dummy-run of two cases of early stage supra-diaphragmatic Hodgkin's lymphoma after chemotherapy. Clinical history, diagnostics, and planning CT imaging were available on Chieti's radiotherapy website (www.radioterapia.unich.it). Participating centers were requested to delineate the CTV and submit it to the coordinating center. To quantify interobserver variability of CTV delineations, the total volume, craniocaudal, laterolateral, and anteroposterior diameters were calculated. Results: A total of 18 institutions for case A and 15 institutions for case B submitted the targets. Case A presented significant variability in total volume (range: 74.1-1,157.1 cc), craniocaudal (range: 6.5-22.5 cm; median: 16.25 cm), anteroposterior (range: 5.04-14.82 cm; median: 10.28 cm), and laterolateral diameters (range: 8.23-22.88 cm; median: 15.5 cm). Mean CTV was 464.8 cc (standard deviation: 280.5 cc). Case B presented significant variability in total volume (range: 341.8-1,662 cc), craniocaudal (range: 8.0-28.5 cm; median: 23 cm), anteroposterior (range: 7.9-1.8 cm; median: 11.1 cm), and laterolateral diameters (range: 12.9-24.0 cm; median: 18.8 cm). Mean CTV was 926.0 cc (standard deviation: 445.7 cc). Conclusion: This significant variability confirms the need to apply specific guidelines to improve contouring uniformity in Hodgkin's lymphoma.
Aim: To determine the prognostic diagnostic value of the increased lymph nodes SUVmax in NSCLC patients and its relation to their survival. Materials and Methods: We studied 73 pre-treatment patients with NSCLC using 18FDG-РЕТ/СТ. There were 53 men (72,6%) and 20 women (27,4%), in the range of 18-79 years old. Increased pathologic SUVmax was detected in 184 lymph nodes. Patients were staged according to TNM and final diagnosis registered in Bulgarian National Cancer Registry (BNCR). Disease beginning in the BNCR was considered either the date of registration or the operation date. Patients who presented with NSCLC between July 2009 and July 2012 were included in18FDG-РЕТ/СТ pre-treatment examination and survival was followed-up until April 2014. The distribution in BNCR according to N was as follows: 18 patients had N0 (24,7%), 10 had N1 (13,7%), 21 had N2 (28,8%), 11 had N3 (15,1%) and 13 patients had Nx (17,8%). The correlations between the primary tumor’s SUVmax and the lymph nodes’ SUVmax were evaluated by Spearman’ correlation coefficient. A cutoff point was defined through the log-rank test and the Wilcoxon test. Survival analysis was performed by use of the Kaplan-Meier method. The test for comparing the equality of the survival distributions between the study groups was done by use of the Mantel-Cox Log Rank, with an inclusion criterion of a P value less than 0,05. Results: Between the primary tumor’ SUVmax and the lymph nodes’ SUVmax there was statistically significant (Р<0,05) positive weak correlation (r=0,297). Between the lymph nodes’ SUVmax and the survival there was statistically significant (Р=0,0001) moderate inverse correlation (r=-0,311). At cutoff point equal to 4,5 for the lymph nodes SUVmax, the following NSCLC patients survival rate was estimated in months: for SUVmax<4,5, Mean=23,1, Median=16,8; for SUVmax≥4,5, Mean=10,5, Median=7,1. The studied factor lymph nodes’ SUVmax was considered as a dichotomous variable. It influenced statistically significant the survival of the NSCLC patients (Р=0,0001). Statistically significant correlation was not established between the survival, the presence of lymph nodes with increased SUVmax and the histology of the primary tumor. Conclusion: The survival of the NSCLC patients is significantly dependent on the regional lymph nodes’ SUVmax before treatment. Regional lymph nodes’ SUVmax before treatment over 4,5 is a cutoff point which defines risk for worse survival and in operable patients it implies additional treatment options after the surgical intervention.
Lymphangiography in Hodgkin's disease: indications and contraindications
Cancer Research, 1966
Lymphangiography is an invaluable tool for the detection of retroperitoneal lymphoma, and helps determine prognosis, since prognosis varies with clinical extent of disease. Patients with Stage I and IIA Hodgkin's disease should have a lymphangiogram in order to definitely determine whether disease exists below the diaphragm in the retroperitoneal space. If disease is found, current evidence indicates that it should be treated with radiation therapy. Lymphangiography is usually not indicated in patients with Stages IIB and III disease. Retroperitoneal disease almost invariably exists and the procedure should only be done for specific indications. The contraindica tions of this procedure should be kept in mind and carefully scrutinized in every patient who undergoes the procedure. The error in interpretation of lymphangiogram films is at least 10%, and may well be higher, especially in inexperienced hands. Errors are almost invariably falsely negative readings, not false posi tives. The value of uncovering occult asymptomatic retroperitoneal Hodgkin's disease is still unknown. One would have to assume that, with our current therapeutic tools, the therapy of all ap parent foci of disease is of value in patients with generalized Hodgkin's disease. We do not know that this is so. Although the lymphangiogram has given us a great deal of information about extent and patterns of disease in lymphoma, and has helped us with supportive management in symptomatic patients, we still do not know whether the therapy of asymptomatic nodes demon strable on a lymphangiogram is of benefit to the patient.
Radiologic Assessment of Lymph Nodes in Oncologic Patients
Current Radiology Reports, 2013
Status of lymph node metastasis has important implications in deciding treatment of oncologic patients. The appropriate choice of imaging modality is crucial to obtain accurate evaluation of lymph node status. Current imaging methods are mainly divided into two categories, conventional structural imaging and more recently emerging functional imaging. In depth understanding of these imaging tools is essential in making the correct choice for individual patients, and eventually for better diagnosis and treatment. Keywords Lymph nodes Á Cancer Á Metastasis Á Sonography Á Computed tomography Á Magnetic resonance imaging This article is part of the Topical Collection on Essentials in Oncologic Imaging.
Turkish Journal of Medical Sciences, 2015
Background/aim: We aimed to define the optimal SUVmax cutoff value in determination of mediastinal-hilar lymph node metastasis, by comparing positive PET/CT results with the results of endobronchial ultrasound guided transbronchial needle aspiration biopsy (EBUS-TBNA). Materials and methods: Thirty-one patients with malignancy whose PET/CT imaging revealed a hypermetabolic mediastinal and/ or hilar lymph node and who had undergone EBUS-TBNA were evaluated retrospectively. Histopathology was regarded as the gold standard. The diagnostic role of PET/CT in mediastinal/hilar lymph node metastasis was investigated and compared with the results of contrast-enhanced CT. Results: When a SUVmax value of 2.5 was used, the sensitivity, positive predictive value (PPV), and diagnostic accuracy of the PET/CT were 100%, 65.4%, and 65.4% respectively. In the ROC analysis, the SUVmax cutoff value with the highest diagnostic accuracy (75%) was calculated as 6.3, and when this value was considered, the sensitivity, specificity, PPV, negative predictive value, and diagnostic accuracy of the PET/CT were determined as 70.6%, 83.3%, 88.9%, 60%, and 75% respectively (AUC: 0.779). The sensitivity, PPV, and diagnostic accuracy of the thorax CT were calculated as 91.1%, 72%, and 71.1%, respectively. Conclusion: When determining mediastinal-hilar lymph node metastasis via PET/CT, although a SUVmax cutoff value of 6.3 increases specificity and diagnostic accuracy, we think that a SUVmax cutoff value of 2.5 and above give more optimal results in routine practice.
Strahlentherapie Und Onkologie, 2008
Background and Purpose: Radiotherapy of Hodgkin's lymphoma has evolved from extended-field to involved-field (IF) radiotherapy reducing toxicity whilst maintaining high cure rates. Recent publications recommend further reduction in the radiation field to involved-node (IN) radiotherapy; however, this concept has never been tested in a randomized trial. The German Hodgkin Study Group aims to compare it with standard IF radiotherapy in their future HD17 trial. Patients and Methods: All patients must be examined by the radiation oncologist before the start of chemotherapy. At that time, patients must have complete staging CT scans. For patients with IN radiotherapy, a radiation planning CT before and after chemotherapy with patients in the treatment position is recommended. Fusion techniques, allowing the overlapping of the pre-and postchemotherapy CT scans, should be used. Usage of PET-CT scans with patients in the treatment position is recommended, whenever possible. Results: The clinical target volume encompasses the initial volume of the lymph node(s) before chemotherapy and incorporates the initial location and extent of the disease taking the displacement of the normal tissues into account. The margin of the planning target volume should be 2 cm in axial and 3 cm in craniocaudal direction. If necessary, it can be reduced to 1-1.5 cm. To minimize lung and cardiac toxicity, the target definition in the mediastinum is different. Conclusion: The concept of IN radiotherapy has been proposed as a means to further improve the therapeutic ratio by reducing the risk of radiation-induced toxicity, including second malignancies. Field sizes will further decrease compared to IF radiotherapy.
Do we need a new suvmax threshold value for the evaluation of mediastinal lymph nodes?
Current Thoracic Surgery
Background: Mediastinal lymph node involvement is the most important factor determining the treatment and the prognosis with non-small cell lung cancer (NSCLC). In our study, the role of PET-CT was assessed in the evaluation of intrathoracic lymph node involvement in patients with preoperative NSCLC. Materials and Methods: The study included 510 cases selected according to the criteria identified between January 2009 and July 2011. PET-CT staging and thorax-CT, size of lymph nodes, histological type of tumor, mediastinal lymph nodes taken and the pathological results were assessed. Results: SUVmax cutoff value was taken as 2.5 for the metastatic analysis of lymph nodes in PET-CT and N1 and N2 lymph node stations were evaluated. Sensitivity for the N2 lymph node stations, was 74.7%, specificity 49.4%, Positive Predictive Value 25.4%, Negative Predictive Value 89,.5% and accuracy 54.1% (p < 0.001). Following the statistical analysis, the new SUVmax cutoff value for the N1 lymph node groups was calculated as 3.34, and for N2 lymph node groups 5.6. Based on the new SUVmax cutoff value for N2 lymph node groups, the sensitivity of PET-CT was calculated as 43.2%, specificity 94.4%, PPV 64.1%, NPV 87.8% and accuracy 84.9% (p < 0.001). Conclusions: Calculating a new cut off value of SUVmax all around the world would increase the NPV of PET-CT and so it would reduce to use of invasive methods. PPV of PET-CT is still not at an acceptable level, so positive results of PET-CT for mediastinal lymph node staging should be confirmed with invasive diagnostic techniques.