Lymphoma

The ability of whole body [18F]-FDG PET to accurately stage lymphoma has emerged as an important role of PET in patient management. In the staging of Hodgkins Disease and non-Hodgkins lymphoma (NHL) the sensitivity and specificity of [18F]-FDG PET in detecting sites of disease has been reported as

86-90% and 93-96% respectively, and superior to CT scan [2,8,62]. Compared to conventional imaging (e.g., CT scans) [18F]-FDG PET is more sensitive in identifying extra-nodal sites of disease. [18F]-FDG PET has been shown to change management in up to 40% of patients undergoing staging at initial diagnosis [21, 63-65]. In comparison to 67Ga scans, [18F]-FDG PET has been shown to have a greater sensitivity for disease detection (particularly spleen), and in view of the potential advantage of a same day procedure has supplanted 67Ga scans in many oncology centres [66]. In some cases of low grade lymphoma [18F]-FDG uptake may not be high, however this is dependent on histo-logic subtype, and high sensitivity for disease sites has been reported for follicular and marginal zone low grade lymphoma, and with management change reported in up to 34% of patients (Fig. 16.5) [64,67].

[18F]-FDG PET has also been shown to have superior accuracy compared to conventional imaging in the restaging of lymphoma patients, particularly where residual masses are present [68, 69]. In comparison to 67Gallium scans, [18F]-FDG PET has been shown to be more accurate in identifying active disease in residual masses (66, 70). [18F]-FDG PET performed as part of the assessment of treatment response for NHL has also been shown to be superior to conventional imaging and to be a strong prognostic indicator of response and progression free survival [68,71]. [18F]-FDG PET therefore has a major role in both the initial staging, and restaging/therapy response assessment of patients with lymphoma.

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