TITLE:
Predictive Potential of FDG-PET/CT for Histological Transformation in Patients with Indolent Lymphoma
AUTHORS:
Peter E. Blase, Pieternel C. M. Pasker-de Jong, Anton Hagenbeek, Rob Fijnheer, Marie J. de Haas, John M. H. de Klerk
KEYWORDS:
Indolent; Lymphoma; Transformation; PET/CT; Predictive Value
JOURNAL NAME:
Advances in Molecular Imaging,
Vol.4 No.1,
January
13,
2014
ABSTRACT:
Backgrounds and Purpose—In indolent non-Hodgkin lymphoma, histological
transformation is a dramatic event which reduces the prognosis significantly.
SUVmax values from FDG-PET/CT help differentiate between aggressive and
indolent lymphomas, and transformed indolent lymphomas also show an increased
FDG uptake. Possibly FDG uptake increases early in the clinical course and
could predict histological transformation. Our objective was to predict
histological transformation in indolent lymphomas from initial staging
FDG-PET/CT. Patients and Methods—A
retrospective study was performed. Patients with biopsy-proven indolent
lymphoma who had had initial staging FDG-PET/CT were included. Qualitative
(foci compared with FDG uptake liver) and semiquantitative (SUVmax-value per
focus) analyses were performed of all abnormal foci. Patient characteristics
and outcome were evaluated. Results—We included 88 patients, 5 of whom developed a histological
transformation. Semiquantitative analysis showed a relation between maximum
standardized uptake value and histological transformation (odds ratio 1.25, 95%
CI 1.024 - 1.513). Qualitative analysis showed a negative
predictive relation of FDG uptake less than or equal to liver in the occurrence
of histological transformation. Transformation-free survival was 100% over 30 months in those with FDG uptake lower
than or equal to liver. More FDG uptake than liver showed transformation-free survival of 88% over 30 months. Conclusion—Qualitative analysis of staging FDG-PET/CT in
indolent lymphomas could be useful to rule out transformation in the next 30
months. In our study, semiquantitative analysis was statistically significantly associated with
histological transformation and maximum standardized uptake value. However,
because of the small number of patients, cautious interpretation of the results is warranted. More studies
are needed to investigate the role of staging PET/CT in patient with indolent
non-Hodkin lymphoma in the prediction of transformation.