European Radiology

, Volume 26, Issue 12, pp 4632–4639 | Cite as

Clinical significance of post-treatment 18F-fluorodeoxyglucose uptake in cervical lymph nodes in patients with diffuse large B-cell lymphoma

  • Young-Sil An
  • Joon-Kee Yoon
  • Su Jin Lee
  • Seong Hyun Jeong
  • Hyun Woo Lee
Nuclear Medicine
First Online:
Received:
Revised:
Accepted:

Abstract

Objectives

We assessed the clinical significance of FDG uptake in cervical lymph nodes after treatment of patients with DLBCL.

Methods

In total, 87 patients with DLBCL were enrolled. All patients had newly appeared FDG uptake in cervical lymph nodes on PET/CT during follow-up after cessation of therapy. Cervical lymph nodes were finally diagnosed as benign or malignant according to histopathological findings or follow-up PET. Clinical characteristics and PET findings were compared between groups and factors associated with malignant lesions were evaluated.

Results

Only 8 (9.2 %) patients with cervical lymph nodes with FDG uptake ultimately had malignancy. FDG uptake lymph nodes appeared significantly earlier in the malignant group than in patients with benign FDG uptake (p = 0.013). Primary nodal lymphoma was more frequent in patients with cancer spread than in those with benign FDG uptake in lymph nodes (p < 0.001).

Conclusion

Most cervical lymph nodes with FDG uptake (about 91 %) appearing after treatment of malignant DLBCL were ultimately benign. The elapsed time between the end of therapy and the appearance of cervical lymph nodes with FDG uptake and the primary sites of lymphomas are helpful clues in determining which cases are malignant.

Key Points

• About 91 % appearing after treatment of DLBCL were benign.

• Elapsed time between therapy and FDG uptake was associated with malignancy.

• Primary sites of lymphoma are helpful clues to determine malignancy.

Keywords

Cervical lymph node Positron emission tomography F-18 fluorodeoxyglucose Diffuse large B-cell lymphoma Malignancy 

Abbreviations

FDG

18F-fluorodeoxyglucose

DLBCL

Diffuse large B-cell lymphoma

PET

Positron emission tomography

IQR

Interquartile range

R-CHOP

Cyclophosphamide, doxorubicin, vincristine, prednisone, rituximab

LDH

Lactate dehydrogenase

ECOG

Eastern Cooperative Oncology Group

IPI

International Prognostic Index

SUVmax

Maximum standardized uptake value

OR

Odds ratio

CI

Confidence interval

This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

The scientific guarantor of this publication is Young-Sil An. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, observational, performed at one institution. The design of this retrospective study was approved by the institutional review board of Ajou University (MED-MDB-15-220).

References

  1. 1.
    Kostakoglu L, Leonard JP, Coleman M, Goldsmith SJ (2004) The role of FDG-PET imaging in the management of lymphoma. Clin Adv Hematol Oncol 2:115–121PubMedGoogle Scholar
  2. 2.
    Purohit BS, Ailianou A, Dulguerov N, Becker CD, Ratib O, Becker M (2014) FDG-PET/CT pitfalls in oncological head and neck imaging. Insights Imaging 5:585–602CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Tamura M, Oda M, Matsumoto I, Waseda R, Watanabe G (2012) Pattern and predictors of false positive lymph node involvement on positron emission tomography in patients with non-small cell lung cancer. Thorac Cardiovasc Surg 60:105–110CrossRefPubMedGoogle Scholar
  4. 4.
    Castellucci P, Zinzani P, Pourdehnad M et al (2005) 18F-FDG PET in malignant lymphoma: significance of positive findings. Eur J Nucl Med Mol Imaging 32:749–756CrossRefPubMedGoogle Scholar
  5. 5.
    Shreve PD, Anzai Y, Wahl RL (1999) Pitfalls in oncologic diagnosis with FDG PET imaging: physiologic and benign variants. Radiographics 19:61–77, quiz 150–151CrossRefPubMedGoogle Scholar
  6. 6.
    Zhuang H, Pourdehnad M, Lambright ES et al (2001) Dual time point 18F-FDG PET imaging for differentiating malignant from inflammatory processes. J Nucl Med 42:1412–1417PubMedGoogle Scholar
  7. 7.
    Hu YY, Zhang X, Long W et al (2015) Cervical lymph node hyperplasia on [(18)F]-fluorodeoxyglucose positron emission tomography/computed tomography scan after treatment of children and adolescents with malignant lymphoma. Eur J Radiol 84:1378–1382CrossRefPubMedGoogle Scholar
  8. 8.
    Meignan M, Gallamini A, Meignan M, Gallamini A, Haioun C (2009) Report on the First International Workshop on Interim-PET-Scan in Lymphoma. Leuk Lymphoma 50:1257–1260CrossRefPubMedGoogle Scholar
  9. 9.
    Lopez-Guillermo A, Colomo L, Jimenez M et al (2005) Diffuse large B-cell lymphoma: clinical and biological characterization and outcome according to the nodal or extranodal primary origin. J Clin Oncol 23:2797–2804CrossRefPubMedGoogle Scholar
  10. 10.
    de Leval L, Bonnet C, Copie-Bergman C et al (2012) Diffuse large B-cell lymphoma of Waldeyer’s ring has distinct clinicopathologic features: a GELA study. Ann Oncol 23:3143–3151CrossRefPubMedGoogle Scholar
  11. 11.
    Zhen Z, Sun X, Xia Y et al (2010) Clinical analysis of thymic regrowth following chemotherapy in children and adolescents with malignant lymphoma. Jpn J Clin Oncol 40:1128–1134CrossRefPubMedGoogle Scholar
  12. 12.
    Park SK, Yun J, Kim SH, Hong DS (2011) A controversial conclusion regarding primary extranodal diffuse large B-cell lymphoma. Korean J Hematol 46:207–208CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Krol AD, le Cessie S, Snijder S, Kluin-Nelemans JC, Kluin PM, Noordijk EM (2003) Primary extranodal non-Hodgkin’s lymphoma (NHL): the impact of alternative definitions tested in the Comprehensive Cancer Centre West population-based NHL registry. Ann Oncol 14:131–139CrossRefPubMedGoogle Scholar
  14. 14.
    Sonet A, Graux C, Nollevaux MC, Krug B, Bosly A, Vander Borght T (2007) Unsuspected FDG-PET findings in the follow-up of patients with lymphoma. Ann Hematol 86:9–15CrossRefPubMedGoogle Scholar
  15. 15.
    Zinzani PL, Tani M, Trisolini R et al (2007) Histological verification of positive positron emission tomography findings in the follow-up of patients with mediastinal lymphoma. Haematologica 92:771–777CrossRefPubMedGoogle Scholar
  16. 16.
    Maayan H, Ashkenazi Y, Nagler A, Izbicki G (2011) Sarcoidosis and lymphoma: case series and literature review. Sarcoidosis Vasc Diffuse Lung Dis 28:146–152PubMedGoogle Scholar

Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Young-Sil An
    • 1
  • Joon-Kee Yoon
    • 1
  • Su Jin Lee
    • 1
  • Seong Hyun Jeong
    • 2
  • Hyun Woo Lee
    • 2
  1. 1.Department of Nuclear Medicine and Molecular ImagingAjou University School of MedicineSuwon-siKorea
  2. 2.Department of Hematology-OncologyAjou University School of MedicineSuwonKorea

Personalised recommendations