Julien Lazarovici1, Marie Terroir2, Julia Arfi-Rouche3, Jean-Marie Michot4, Sacha Mussot5, Valentina Florea5, Maria-Rosa Ghigna6, Peggy Dartigues7, Cynthia Petrovanu1, Alina Danu1, Christophe Fermé1, Vincent Ribrag1, David Ghez8. 1. Department of Hematology, Gustave Roussy and Université Paris Saclay, 114 Rue Edouard Vaillant, 94805, Villejuif, France. 2. Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, 114 Rue Edouard Vaillant, 94805, Villejuif, France. 3. Department of Radiology, Gustave Roussy and Université Paris Saclay, 114 Rue Edouard Vaillant, 94805, Villejuif, France. 4. Department of Drug Development (DITEP), Gustave Roussy and Université Paris Saclay, 114 Rue Edouard Vaillant, 94805, Villejuif, France. 5. Department of Thoracic Surgery, Marie Lannelongue Hospital, 133 avenue de la Résistance, 92350, Le Plessis Robinson, France. 6. Department of Pathology, Marie Lannelongue Hospital, 133 avenue de la Résistance, 92350, Le Plessis Robinson, France. 7. Department of Pathology, Gustave Roussy and Université Paris Saclay, 114 Rue Edouard Vaillant, 94805, Villejuif, France. 8. Department of Hematology, Gustave Roussy and Université Paris Saclay, 114 Rue Edouard Vaillant, 94805, Villejuif, France. david.ghez@gustaveroussy.fr.
Abstract
PURPOSE: Though commonly used to assess response to therapy, the prognostic value of interim FDG-PET/CT in Primary Mediastinal Large B-cell Lymphoma (PMBCL) is unclear. METHODS: We conducted a retrospective study on 36 consecutive patients treated at our institution for a PMBCL between 2006 and 2014. All patients with a positive interim FDG-PET/CT had undergone histological restaging consisting either in a surgical debulking of the residual lesion (15 patients) or a CT-guided core needle biopsy (two patients). All FDG-PET/CT were secondarily reviewed according to the more recent Deauville criteria. RESULTS: Interim FDG-PET/CT was considered positive in 17/36 patients using visual evaluation. Among these patients, 14 had a Deauville score of 4. Histological restaging was negative in all but one case, showing inflammation and/or fibrosis. After a median follow-up of 48.5 months, a total of five patients have relapsed, two patients in the positive FDG-PET/CT group, and three patients in the negative FDG-PET/CT group, respectively. CONCLUSIONS: These data indicate that a positive interim FDG-PET/CT does not reflect persistence of active disease in the vast majority of PMBCL cases. The relapse rate appears similar regardless of interim FDG-PET/CT results and interpretation criteria. This suggests that interim FDG-PET/CT has a poor positive predictive value, thus kt should be used with caution in PMBCL.
PURPOSE: Though commonly used to assess response to therapy, the prognostic value of interim FDG-PET/CT in Primary Mediastinal Large B-cell Lymphoma (PMBCL) is unclear. METHODS: We conducted a retrospective study on 36 consecutive patients treated at our institution for a PMBCL between 2006 and 2014. All patients with a positive interim FDG-PET/CT had undergone histological restaging consisting either in a surgical debulking of the residual lesion (15 patients) or a CT-guided core needle biopsy (two patients). All FDG-PET/CT were secondarily reviewed according to the more recent Deauville criteria. RESULTS: Interim FDG-PET/CT was considered positive in 17/36 patients using visual evaluation. Among these patients, 14 had a Deauville score of 4. Histological restaging was negative in all but one case, showing inflammation and/or fibrosis. After a median follow-up of 48.5 months, a total of five patients have relapsed, two patients in the positive FDG-PET/CT group, and three patients in the negative FDG-PET/CT group, respectively. CONCLUSIONS: These data indicate that a positive interim FDG-PET/CT does not reflect persistence of active disease in the vast majority of PMBCL cases. The relapse rate appears similar regardless of interim FDG-PET/CT results and interpretation criteria. This suggests that interim FDG-PET/CT has a poor positive predictive value, thus kt should be used with caution in PMBCL.
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