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Use of FDG-PET/CT for systemic assessment of suspected primary central nervous system lymphoma: a LOC study

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Abstract

Introduction

Primary Central Nervous System Lymphoma (PCNSL) is a rare disease with different therapeutic implications than systemic lymphoma. In this study, we evaluated whole-body 18FDG-PET/CT for pre-chemotherapy imaging of suspected PCNSL.

Methods

One hundred and thirty consecutive immunocompetent patients were retrospectively included. The results of initial 18FDG-PET/CT, contrast-enhanced CT (CeCT) and bone marrow biopsy (BMB) when available were compared to a gold standard based on pathological diagnosis or follow-up.

Results

CNS lesion pathology showed large B-cell lymphoma in 95% of patients, including 11 patients with primary vitro-retinal lymphoma. Ten patients (8%) where ultimately diagnosed with systemic lymphoma involvement, including five pathologically confirmed cases, all of which were detected by 18FDG-PET/CT. 18FDG-PET/CT showed incidental systemic findings unrelated to lymphoma in 14% of patients. An SUVmax threshold of nine enabled good discrimination between systemic lymphoma and other lesions (sensitivity 92% and specificity 89%). CeCT and BMB performed in 108 and 77 patients respectively revealed systemic lesions in only three patients.

Conclusion

18FDG-PET/CT detected concomitant occult systemic involvement in a non-negligible proportion of suspected PCNSL cases (8%). In this setting its sensitivity is higher than that of CeCT. All of our patients ultimately diagnosed with concomitant systemic involvement had positive 18FDG-PET/CT. We believe it constitutes a safe one-stop shop evaluation for the systemic pre-treatment imaging of suspected PCNSL.

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Authors and Affiliations

  1. Médecine Nucléaire, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l’Hôpital, 75013, Paris, France

    Marc Bertaux, Marie-Odile Habert, Sébastien Bergeret & Aurélie Kas

  2. Laboratoire d’Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, 75006, Paris, France

    Marc Bertaux, Marie-Odile Habert, Alain Giron & Aurélie Kas

  3. Neurologie 2-Mazarin, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, IHU, ICM, Paris, France

    Caroline Houillier & Khe Hoang-Xuan

  4. Département de Médecine nucléaire, Institut Curie, Site de Saint-Cloud, Saint-Cloud, France

    Véronique Edeline

  5. Département d’Hématologie, Institut Curie, Site de Saint-Cloud, Saint-Cloud, France

    Carole Soussain

  6. Neuropathologie, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France

    Karima Mokhtari

  7. Réseau expert national pour les Lymphomes Oculo-Cérébraux (LOC), Paris, France

    Marc Bertaux, Caroline Houillier, Véronique Edeline, Marie-Odile Habert, Karima Mokhtari, Alain Giron, Khe Hoang-Xuan, Nathalie Cassoux, Sylvain Choquet, Carole Soussain & Aurélie Kas

  8. Ophtalmologie, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France

    Valérie Touitou

  9. Département d’oncologie chirurgicale, Institut Curie, Université Paris V Descartes, Paris, France

    Nathalie Cassoux & Valérie Touitou

  10. Hématologie, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France

    Sylvain Choquet

Authors
  1. Marc Bertaux
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  2. Caroline Houillier
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  3. Véronique Edeline
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  4. Marie-Odile Habert
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  7. Sébastien Bergeret
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  8. Khe Hoang-Xuan
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  9. Nathalie Cassoux
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  10. Valérie Touitou
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  11. Sylvain Choquet
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  12. Carole Soussain
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  13. Aurélie Kas
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Correspondence to Marc Bertaux.

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Bertaux, M., Houillier, C., Edeline, V. et al. Use of FDG-PET/CT for systemic assessment of suspected primary central nervous system lymphoma: a LOC study. J Neurooncol 148, 343–352 (2020). https://doi.org/10.1007/s11060-020-03525-5

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  • DOI: https://doi.org/10.1007/s11060-020-03525-5

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