THE IMPACT OF FDG PET-CT IN THE STAGING OF FOLLICULAR LYMPHOMA - A SINGLE CENTRE EXPERIENCE
(Abstract release date: 05/19/16)
EHA Library. Fernandez R. 06/09/16; 132708; E1159
Mr. Ruben Fernandez
Contributions
Contributions
Abstract
Abstract: E1159
Type: Eposter Presentation
Background
18-F-fluorodeoxyglucose positron emission tomography-CT (FDG PET-CT) is now the recommended imaging technique for staging and response assessment in follicular lymphoma (FL) (Cheson et al. 2014). However, the relevance of FDG PET-CT in the staging of FL is not well established, apart from selected cases for specific purposes (accurate assessment of stage I and for guidance of biopsy when transformation is suspected). PET scanning is readily available at our centre and it is often included as part of standard staging procedures in FL patients (pts).
Aims
We aimed to investigate the value of FDG PET-CT scans in the staging of FL pts in routine clinical practice.
Methods
Retrospective study of pts with grade 1-3a FL who had undergone conventional staging workup (contrast-enhanced CT and bone marrow biopsy [BMB]) along with FDG PET-CT at our centre. Pts with concurrent diagnosis of diffuse large B cell lymphoma were excluded. We compared the disease extent based on conventional investigations with the incorporation of PET to staging.
Results
A total of 55 pts (female - 29, male - 26) were included, with a median age of 64 years (range, 33-82). Forty-eight pts (87%) were staged at the time of initial diagnosis, whereas 7 pts (13%) had received prior treatment and were staged at relapse. By conventional staging, 42 pts (76%) had advanced stage (III/IV) and 20 pts (36%) had high-risk FLIPI score. GELF criteria were met in 37 pts (67%). Following staging procedures, 49 pts (89%) received treatment with diverse regimens, while 6 pts (11%) were managed expectantly.Pathological uptake was detected for all FDG PET-CT scans. The median SUVmax of most FDG avid lesions was 9.04 (range, 2.8-37.5). However SUVmax was not correlated with the histological grade.PET identified a higher number of nodal areas than CT scan in 29 pts (53%). Furthermore, 25 pts (45%) showed 'new' extranodal lesions not seen on CT. Overall, PET revealed 71 additional nodal areas (+31%) and 28 extranodal lesions not visualized by CT (+127%). Bone marrow involvement was reported in 19 pts on PET, compared to only one case on CT. The uptake pattern was focal in 12 cases (9 multiple, 3 single) and diffuse in 7 cases. In 5 cases (4 focal, 1 diffuse) BMB showed no infiltration. No guided biopsies were performed to explore these discordant cases. However, focal lesions resolved after treatment in all pts, supporting the presence of disease pretherapy. The sensitivity, specificity, positive and negative preditive value of FDG PET-CT with respect to BMB was 50.0%, 81.5%, 73.7% and 61.1% respectively. PET also detected five splenic involvements not seen on CT. Among 13 pts initially classified as localized stage (I/II) by conventional staging, 5 pts (representing 38%) were found to have stage IV using FDG PET-CT, due to bone lesions on PET. Overall, the incorporation of PET led to a change in Ann Arbor stage in 8 pts (14%), all of them were up-staged. As anticipated, the FLIPI distribution was modified when PET was taken into account: five pts (9%) were re-classified as high risk group on the basis of higher number of nodal areas and/or more advanced stage on PET.
Conclusion
FDG PET-CT identifies a greater extent of nodal and extranodal disease in FL compared with conventional CT, accounting for an improved stage accuracy. The addition of PET leads to stage migration in a proportion of pts, where it has the potential to modify therapy decisions. Whether this additional information provided by PET improves prognostic stratification remains to be determined.
Session topic: E-poster
Keyword(s): Follicular lymphoma, PET, Staging
Type: Eposter Presentation
Background
18-F-fluorodeoxyglucose positron emission tomography-CT (FDG PET-CT) is now the recommended imaging technique for staging and response assessment in follicular lymphoma (FL) (Cheson et al. 2014). However, the relevance of FDG PET-CT in the staging of FL is not well established, apart from selected cases for specific purposes (accurate assessment of stage I and for guidance of biopsy when transformation is suspected). PET scanning is readily available at our centre and it is often included as part of standard staging procedures in FL patients (pts).
Aims
We aimed to investigate the value of FDG PET-CT scans in the staging of FL pts in routine clinical practice.
Methods
Retrospective study of pts with grade 1-3a FL who had undergone conventional staging workup (contrast-enhanced CT and bone marrow biopsy [BMB]) along with FDG PET-CT at our centre. Pts with concurrent diagnosis of diffuse large B cell lymphoma were excluded. We compared the disease extent based on conventional investigations with the incorporation of PET to staging.
Results
A total of 55 pts (female - 29, male - 26) were included, with a median age of 64 years (range, 33-82). Forty-eight pts (87%) were staged at the time of initial diagnosis, whereas 7 pts (13%) had received prior treatment and were staged at relapse. By conventional staging, 42 pts (76%) had advanced stage (III/IV) and 20 pts (36%) had high-risk FLIPI score. GELF criteria were met in 37 pts (67%). Following staging procedures, 49 pts (89%) received treatment with diverse regimens, while 6 pts (11%) were managed expectantly.Pathological uptake was detected for all FDG PET-CT scans. The median SUVmax of most FDG avid lesions was 9.04 (range, 2.8-37.5). However SUVmax was not correlated with the histological grade.PET identified a higher number of nodal areas than CT scan in 29 pts (53%). Furthermore, 25 pts (45%) showed 'new' extranodal lesions not seen on CT. Overall, PET revealed 71 additional nodal areas (+31%) and 28 extranodal lesions not visualized by CT (+127%). Bone marrow involvement was reported in 19 pts on PET, compared to only one case on CT. The uptake pattern was focal in 12 cases (9 multiple, 3 single) and diffuse in 7 cases. In 5 cases (4 focal, 1 diffuse) BMB showed no infiltration. No guided biopsies were performed to explore these discordant cases. However, focal lesions resolved after treatment in all pts, supporting the presence of disease pretherapy. The sensitivity, specificity, positive and negative preditive value of FDG PET-CT with respect to BMB was 50.0%, 81.5%, 73.7% and 61.1% respectively. PET also detected five splenic involvements not seen on CT. Among 13 pts initially classified as localized stage (I/II) by conventional staging, 5 pts (representing 38%) were found to have stage IV using FDG PET-CT, due to bone lesions on PET. Overall, the incorporation of PET led to a change in Ann Arbor stage in 8 pts (14%), all of them were up-staged. As anticipated, the FLIPI distribution was modified when PET was taken into account: five pts (9%) were re-classified as high risk group on the basis of higher number of nodal areas and/or more advanced stage on PET.
Conclusion
FDG PET-CT identifies a greater extent of nodal and extranodal disease in FL compared with conventional CT, accounting for an improved stage accuracy. The addition of PET leads to stage migration in a proportion of pts, where it has the potential to modify therapy decisions. Whether this additional information provided by PET improves prognostic stratification remains to be determined.
Session topic: E-poster
Keyword(s): Follicular lymphoma, PET, Staging
Abstract: E1159
Type: Eposter Presentation
Background
18-F-fluorodeoxyglucose positron emission tomography-CT (FDG PET-CT) is now the recommended imaging technique for staging and response assessment in follicular lymphoma (FL) (Cheson et al. 2014). However, the relevance of FDG PET-CT in the staging of FL is not well established, apart from selected cases for specific purposes (accurate assessment of stage I and for guidance of biopsy when transformation is suspected). PET scanning is readily available at our centre and it is often included as part of standard staging procedures in FL patients (pts).
Aims
We aimed to investigate the value of FDG PET-CT scans in the staging of FL pts in routine clinical practice.
Methods
Retrospective study of pts with grade 1-3a FL who had undergone conventional staging workup (contrast-enhanced CT and bone marrow biopsy [BMB]) along with FDG PET-CT at our centre. Pts with concurrent diagnosis of diffuse large B cell lymphoma were excluded. We compared the disease extent based on conventional investigations with the incorporation of PET to staging.
Results
A total of 55 pts (female - 29, male - 26) were included, with a median age of 64 years (range, 33-82). Forty-eight pts (87%) were staged at the time of initial diagnosis, whereas 7 pts (13%) had received prior treatment and were staged at relapse. By conventional staging, 42 pts (76%) had advanced stage (III/IV) and 20 pts (36%) had high-risk FLIPI score. GELF criteria were met in 37 pts (67%). Following staging procedures, 49 pts (89%) received treatment with diverse regimens, while 6 pts (11%) were managed expectantly.Pathological uptake was detected for all FDG PET-CT scans. The median SUVmax of most FDG avid lesions was 9.04 (range, 2.8-37.5). However SUVmax was not correlated with the histological grade.PET identified a higher number of nodal areas than CT scan in 29 pts (53%). Furthermore, 25 pts (45%) showed 'new' extranodal lesions not seen on CT. Overall, PET revealed 71 additional nodal areas (+31%) and 28 extranodal lesions not visualized by CT (+127%). Bone marrow involvement was reported in 19 pts on PET, compared to only one case on CT. The uptake pattern was focal in 12 cases (9 multiple, 3 single) and diffuse in 7 cases. In 5 cases (4 focal, 1 diffuse) BMB showed no infiltration. No guided biopsies were performed to explore these discordant cases. However, focal lesions resolved after treatment in all pts, supporting the presence of disease pretherapy. The sensitivity, specificity, positive and negative preditive value of FDG PET-CT with respect to BMB was 50.0%, 81.5%, 73.7% and 61.1% respectively. PET also detected five splenic involvements not seen on CT. Among 13 pts initially classified as localized stage (I/II) by conventional staging, 5 pts (representing 38%) were found to have stage IV using FDG PET-CT, due to bone lesions on PET. Overall, the incorporation of PET led to a change in Ann Arbor stage in 8 pts (14%), all of them were up-staged. As anticipated, the FLIPI distribution was modified when PET was taken into account: five pts (9%) were re-classified as high risk group on the basis of higher number of nodal areas and/or more advanced stage on PET.
Conclusion
FDG PET-CT identifies a greater extent of nodal and extranodal disease in FL compared with conventional CT, accounting for an improved stage accuracy. The addition of PET leads to stage migration in a proportion of pts, where it has the potential to modify therapy decisions. Whether this additional information provided by PET improves prognostic stratification remains to be determined.
Session topic: E-poster
Keyword(s): Follicular lymphoma, PET, Staging
Type: Eposter Presentation
Background
18-F-fluorodeoxyglucose positron emission tomography-CT (FDG PET-CT) is now the recommended imaging technique for staging and response assessment in follicular lymphoma (FL) (Cheson et al. 2014). However, the relevance of FDG PET-CT in the staging of FL is not well established, apart from selected cases for specific purposes (accurate assessment of stage I and for guidance of biopsy when transformation is suspected). PET scanning is readily available at our centre and it is often included as part of standard staging procedures in FL patients (pts).
Aims
We aimed to investigate the value of FDG PET-CT scans in the staging of FL pts in routine clinical practice.
Methods
Retrospective study of pts with grade 1-3a FL who had undergone conventional staging workup (contrast-enhanced CT and bone marrow biopsy [BMB]) along with FDG PET-CT at our centre. Pts with concurrent diagnosis of diffuse large B cell lymphoma were excluded. We compared the disease extent based on conventional investigations with the incorporation of PET to staging.
Results
A total of 55 pts (female - 29, male - 26) were included, with a median age of 64 years (range, 33-82). Forty-eight pts (87%) were staged at the time of initial diagnosis, whereas 7 pts (13%) had received prior treatment and were staged at relapse. By conventional staging, 42 pts (76%) had advanced stage (III/IV) and 20 pts (36%) had high-risk FLIPI score. GELF criteria were met in 37 pts (67%). Following staging procedures, 49 pts (89%) received treatment with diverse regimens, while 6 pts (11%) were managed expectantly.Pathological uptake was detected for all FDG PET-CT scans. The median SUVmax of most FDG avid lesions was 9.04 (range, 2.8-37.5). However SUVmax was not correlated with the histological grade.PET identified a higher number of nodal areas than CT scan in 29 pts (53%). Furthermore, 25 pts (45%) showed 'new' extranodal lesions not seen on CT. Overall, PET revealed 71 additional nodal areas (+31%) and 28 extranodal lesions not visualized by CT (+127%). Bone marrow involvement was reported in 19 pts on PET, compared to only one case on CT. The uptake pattern was focal in 12 cases (9 multiple, 3 single) and diffuse in 7 cases. In 5 cases (4 focal, 1 diffuse) BMB showed no infiltration. No guided biopsies were performed to explore these discordant cases. However, focal lesions resolved after treatment in all pts, supporting the presence of disease pretherapy. The sensitivity, specificity, positive and negative preditive value of FDG PET-CT with respect to BMB was 50.0%, 81.5%, 73.7% and 61.1% respectively. PET also detected five splenic involvements not seen on CT. Among 13 pts initially classified as localized stage (I/II) by conventional staging, 5 pts (representing 38%) were found to have stage IV using FDG PET-CT, due to bone lesions on PET. Overall, the incorporation of PET led to a change in Ann Arbor stage in 8 pts (14%), all of them were up-staged. As anticipated, the FLIPI distribution was modified when PET was taken into account: five pts (9%) were re-classified as high risk group on the basis of higher number of nodal areas and/or more advanced stage on PET.
Conclusion
FDG PET-CT identifies a greater extent of nodal and extranodal disease in FL compared with conventional CT, accounting for an improved stage accuracy. The addition of PET leads to stage migration in a proportion of pts, where it has the potential to modify therapy decisions. Whether this additional information provided by PET improves prognostic stratification remains to be determined.
Session topic: E-poster
Keyword(s): Follicular lymphoma, PET, Staging
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