Lucia Zanoni1, Alessandro Broccoli2, Alessandro Lambertini3, Cinzia Pellegrini2, Vittorio Stefoni2, Filippo Lodi3, Cristina Fonti3, Cristina Nanni3, Pier Luigi Zinzani2, Stefano Fanti3. 1. Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Via Albertoni 15, 40138, Bologna (BO), Italy. lucia.zanoni@aosp.bo.it. 2. Hematology "L. e A. Seràgnoli", Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy. 3. Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Via Albertoni 15, 40138, Bologna (BO), Italy.
Abstract
PURPOSE: To evaluate the role of F-18-Fluorothymidine (FLT) PET/CT in lymphoma patients with suspected recurrent or residual disease. METHODS: Adult lymphoma patients presenting with positive or equivocal F-18-FDG PET/CT at end-treatment or follow-up were prospectively addressed to an additional F-18-FLT-PET/CT. SUV max and tumour-to-background ratios (TBRs) were recorded for the most avid lesion. Biopsy or, when not available, clinical or imaging assessment were employed as standard of reference. RESULTS: Overall 52 patients were recruited. Histology was available in 20/52 patients (38%), proliferation-index (Ki-67) in 14/20. Disease was excluded in 13/52 patients (25%) (one reactive follicular hyperplasia, five reactive-inflammatory tissues, four reactive nodes, two nodal sarcoid-like and one non-specific peri-caecal finding). FDG and FLT scans were concordant in disease restaging in 34/52 patients (65%), whereas in 18/52 cases (35%) relevant discrepancies were recorded. SUV max and TBR were significantly higher in the disease versus the disease-free group, with both tracers (p = 0.0231 and 0.0219 for FDG; p = 0.0008 and 0.0016 for FLT). FLT-SUVmax demonstrated slightly better performance in discriminating benign from malignant lesions (ROC-AUC: 0.8116 and 0.7949 for FLT-SUV max and TBR; 0.7120 and 0.7140 for FDG). Optimal FLT-SUV max cut-offs were searched: three would lead to 95% sensitivity, 81% accuracy, and 39% specificity, whereas seven led to 100%, 41%, and 56% respectively. No statistically significant correlation was observed between the two FLT indices and Ki-67. CONCLUSIONS: According to our results in a clinical setting of recurrent or residual lymphoma, FLT is not significantly superior to FDG and it is unlikely that it will be employed independently. FLT may be restricted to a few specific cases, as complementary to standard FDG imaging, to confirm a diagnosis or to define a better target to biopsy. However, due to FLT suboptimal performance, many findings would remain inconclusive, requiring further diagnostic procedures and reducing the effectiveness of performing an additional FLT scan.
PURPOSE: To evaluate the role of F-18-Fluorothymidine (FLT) PET/CT in lymphomapatients with suspected recurrent or residual disease. METHODS: Adult lymphomapatients presenting with positive or equivocal F-18-FDG PET/CT at end-treatment or follow-up were prospectively addressed to an additional F-18-FLT-PET/CT. SUV max and tumour-to-background ratios (TBRs) were recorded for the most avid lesion. Biopsy or, when not available, clinical or imaging assessment were employed as standard of reference. RESULTS: Overall 52 patients were recruited. Histology was available in 20/52 patients (38%), proliferation-index (Ki-67) in 14/20. Disease was excluded in 13/52 patients (25%) (one reactive follicular hyperplasia, five reactive-inflammatory tissues, four reactive nodes, two nodal sarcoid-like and one non-specific peri-caecal finding). FDG and FLT scans were concordant in disease restaging in 34/52 patients (65%), whereas in 18/52 cases (35%) relevant discrepancies were recorded. SUV max and TBR were significantly higher in the disease versus the disease-free group, with both tracers (p = 0.0231 and 0.0219 for FDG; p = 0.0008 and 0.0016 for FLT). FLT-SUVmax demonstrated slightly better performance in discriminating benign from malignant lesions (ROC-AUC: 0.8116 and 0.7949 for FLT-SUV max and TBR; 0.7120 and 0.7140 for FDG). Optimal FLT-SUV max cut-offs were searched: three would lead to 95% sensitivity, 81% accuracy, and 39% specificity, whereas seven led to 100%, 41%, and 56% respectively. No statistically significant correlation was observed between the two FLT indices and Ki-67. CONCLUSIONS: According to our results in a clinical setting of recurrent or residual lymphoma, FLT is not significantly superior to FDG and it is unlikely that it will be employed independently. FLT may be restricted to a few specific cases, as complementary to standard FDG imaging, to confirm a diagnosis or to define a better target to biopsy. However, due to FLT suboptimal performance, many findings would remain inconclusive, requiring further diagnostic procedures and reducing the effectiveness of performing an additional FLT scan.
Authors: Melissa M Rhodes; Dominique Delbeke; James A Whitlock; William Martin; John F Kuttesch; Haydar A Frangoul; Sadhna Shankar Journal: J Pediatr Hematol Oncol Date: 2006-05 Impact factor: 1.289
Authors: Andreas K Buck; Martin Bommer; Stephan Stilgenbauer; Malik Juweid; Gerhard Glatting; Holger Schirrmeister; Torsten Mattfeldt; Djurdja Tepsic; Donald Bunjes; Felix M Mottaghy; Bernd J Krause; Bernd Neumaier; Hartmut Döhner; Peter Möller; Sven N Reske Journal: Cancer Res Date: 2006-11-15 Impact factor: 12.701
Authors: Esther G C Troost; Wouter V Vogel; Matthias A W Merkx; Piet J Slootweg; Henri A M Marres; Wenny J M Peeters; Johan Bussink; Albert J van der Kogel; Wim J G Oyen; Johannes H A M Kaanders Journal: J Nucl Med Date: 2007-05 Impact factor: 10.057
Authors: Henryk Barthel; Marcel C Cleij; David R Collingridge; O Clyde Hutchinson; Safiye Osman; Qimin He; Sajinder K Luthra; Frank Brady; Pat M Price; Eric O Aboagye Journal: Cancer Res Date: 2003-07-01 Impact factor: 12.701
Authors: Bernd Kasper; Gerlinde Egerer; Martina Gronkowski; Sabine Haufe; Thomas Lehnert; Michael Eisenhut; Gunhild Mechtersheimer; Anthony D Ho; Uwe Haberkorn Journal: Leuk Lymphoma Date: 2007-04
Authors: Hubert Vesselle; John Grierson; Lanell M Peterson; Mark Muzi; David A Mankoff; Kenneth A Krohn Journal: J Nucl Med Date: 2003-09 Impact factor: 10.057