Advertisement

Annals of Nuclear Medicine

, Volume 32, Issue 5, pp 372–377 | Cite as

FDG-PET/CT at the end of immuno-chemotherapy in follicular lymphoma: the prognostic role of the ratio between target lesion and liver SUVmax (rPET)

  • Salvatore AnnunziataEmail author
  • Annarosa Cuccaro
  • Maria Chiara Tisi
  • Stefan Hohaus
  • Vittoria Rufini
Short Communication

Abstract

Aim

To retrospectively investigate the prognostic role of the ratio between target lesion and liver SUVmax (rPET) in patients with follicular lymphoma (FL) submitted to FDG-PET/CT at the end of immuno-chemotherapy (PI-PET), and to compare rPET with International Harmonization Project criteria (IHP), Deauville Score (5p-DS) and FL International Prognostic Index at diagnosis (FLIPI).

Methods

Eighty-nine patients with FL undergoing PI-PET were evaluated. The receiver operating characteristic (ROC) approach was applied to identify the optimal cut-point of rPET with respect to 5-years progression free survival (PFS). The prognostic significance of rPET was compared with IHP, DS and FLIPI. Positive predictive value (PPV) and negative predictive value (NPV) were calculated using the presence of adverse events as gold standard.

Results

The ROC analysis for rPET as predictor of progression showed an optimal rPET cut-point of 0.98. Patients with positive values of IHP, DS and rPET had a PFS of 50, 30 and 31%. PPV were of 56, 80 and 80%, NPV of 83, 86 and 88%, respectively. DS and rPET differed only in two patients. FLIPI was not predictive of progression and relapse.

Conclusions

rPET is a prognostic factor in patients with FL submitted to PI-PET. Although it has a similar prognostic power as DS, it can have methodological advantages over visual analysis. PI-PET with different evaluation systems has a stronger prognostic power than FLIPI at diagnosis, so it could be useful to identify patients with FL at risk for early relapse after immuno-chemotherapy.

Keywords

Follicular lymphoma FDG PET/CT rPET Deauville Score IHP FLIPI 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Wong-Sefidan I, Byrtek M, Zhou X, et al. [18F] Positron emission tomography response after rituximab-containing induction therapy in follicular lymphoma is an independent predictor of survival after adjustment for FLIPI in academic and community-based practice. Leuk Lymphoma. 2017;58(4):809–15.CrossRefPubMedGoogle Scholar
  2. 2.
    Kostakoglu L, Goy A, Martinelli G, et al. FDG-PET is prognostic and predictive for progression-free survival in relapsed follicular lymphoma: exploratory analysis of the GAUSS study. Leuk Lymphoma. 2017;58(2):372–81.CrossRefPubMedGoogle Scholar
  3. 3.
    Dupuis J, Berriolo-Riedinger A, Julian A, et al. Impact of [(18)F]fluorodeoxyglucose positron emission tomography response evaluation in patients with high-tumor burden follicular lymphoma treated with immunochemotherapy: a prospective study from the Groupe d’Etudes des Lymphomes de l’Adulte and GOELAMS. J Clin Oncol. 2012;30(35):4317–22.CrossRefPubMedGoogle Scholar
  4. 4.
    Lu Z, Lin M, Downe P, et al. The prognostic value of mid- and post-treatment [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) in indolent follicular lymphoma. Ann Nucl Med. 2014;28(8):805–11.CrossRefPubMedGoogle Scholar
  5. 5.
    Luminari S, Biasoli I, Versari A, et al. The prognostic role of post-induction FDG-PET in patients with follicular lymphoma: a subset analysis from the FOLL05 trial of the Fondazione Italiana Linfomi (FIL). Ann Oncol. 2014;25(2):442–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Trotman J, Luminari S, Boussetta S, et al. Prognostic value of PET-CT after first-line therapy in patients with follicular lymphoma: a pooled analysis of central scan review in three multicentre studies. Lancet Haematol. 2014;1(1):e17–27.CrossRefPubMedGoogle Scholar
  7. 7.
    Tychyj-Pinel C, Ricard F, Fulham M, et al. PET/CT assessment in follicular lymphoma using standardized criteria: central review in the PRIMA study. Eur J Nucl Med Mol Imaging. 2014;41(3):408–15.CrossRefPubMedGoogle Scholar
  8. 8.
    Adams HJ, Nievelstein RA, Kwee TC. Prognostic value of interim and end-of-treatment FDG-PET in follicular lymphoma: a systematic review. Ann Hematol. 2016;95(1):11–18.CrossRefPubMedGoogle Scholar
  9. 9.
    Adams HJ, Kwee TC. No convincing evidence to support postinduction FDG-PET in follicular lymphoma. Ann Hematol. 2016;95(12):2085–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Annunziata S, Cuccaro A, Calcagni ML, et al. Interim FDG-PET/CT in Hodgkin lymphoma: the prognostic role of the ratio between target lesion and liver SUVmax (rPET). Ann Nucl Med. 2016;30(8):588–92.CrossRefPubMedGoogle Scholar
  11. 11.
    Hasenclever D, Kurch L, Mauz-Körholz C, et al. qPET—a quantitative extension of the Deauville scale to assess response in interim FDG-PET scans in lymphoma. Eur J Nucl Med Mol Imaging. 2014;41:1301–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Provencio Pulla M, Alfaro Lizaso J, de la Cruz Merino L, et al. SEOM clinical guidelines for the treatment of follicular non-Hodgkin’s lymphoma. Clin Transl Oncol. 2015;17(12):1014–9.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Chiaravalloti A, Danieli R, Abbatiello P, et al. Factors affecting intrapatient liver and mediastinal blood pool 18F-FDG standardized uptake value changes during ABVD chemotherapy in Hodgkin’s lymphoma. Eur J Nucl Med Mol Imaging. 2014;41:1123–32.PubMedGoogle Scholar
  14. 14.
    Laffon E, Marthan R. Interim FDG PET scans in lymphoma: SUV measurement error may impair qPET methodology. Eur J Nucl Med Mol Imaging. 2014;41:2154.CrossRefPubMedGoogle Scholar
  15. 15.
    Hasenclever D, Kurch L, Kluge R. Sources of variability in FDG PET imaging and the qPET value: reply to Laffon and Marthan. Eur J Nucl Med Mol Imaging. 2014;41:2155–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Laffon E, de Clermont H, Lamare F, et al. Liver SUV versus stage in Hodgkin’s lymphoma: the total amount of uptake may play a role in the inverse relationship. Eur J Nucl Med Mol Imaging. 2015;42:164–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Chiaravalloti A, Schillaci O. Reply to comments by Laffon et al. Liver SUV versus stage in Hodgkin’s lymphoma: the total amount of uptake may play a role in the inverse relationship. Eur J Nucl Med Mol Imaging. 2015;42:166.CrossRefPubMedGoogle Scholar
  18. 18.
    Adams MC, Turkington TG, Wilson JM, et al. A systematic review of the factors affecting accuracy of SUV measurements. AJR Am J Roentgenol. 2010;195:310–20.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Society of Nuclear Medicine 2018

Authors and Affiliations

  • Salvatore Annunziata
    • 1
    Email author
  • Annarosa Cuccaro
    • 2
  • Maria Chiara Tisi
    • 2
  • Stefan Hohaus
    • 2
  • Vittoria Rufini
    • 1
  1. 1.Institute of Nuclear MedicineUniversità Cattolica del Sacro CuoreRomeItaly
  2. 2.Institute of HematologyUniversità Cattolica del Sacro CuoreRomeItaly

Personalised recommendations