Tamás Györke1,2, Robert Carr3, Juliano J Cerci4, Claudio Meneghetti5, Francisca Redondo6, Monica Celli7, Charity Gorospe8, Chirayu U Auewarakul9,10, Linda Jorgov11, Diana Paez12, Stefano Fanti7. 1. Department of Nuclear Medicine, Semmelweis University, Budapest, Hungary gyorke.tamas@med.semmelweis-univ.hu. 2. ScanoMed Medical Diagnostic Research and Training Ltd., Budapest, Hungary. 3. Guy's and St. Thomas' Hospital, King's College, London, United Kingdom. 4. Quanta-Diagnóstico e Terapia, Curitiba, Brazil. 5. University of São Paulo, São Paulo, Brazil. 6. Oncologic Institute Fundacion Arturo Lopez Perez, Santiago, Chile. 7. Policlinico S. Orsola, University of Bologna, Bologna, Italy. 8. St. Luke's Medical Center, Quezon City, Philippines. 9. Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand. 10. Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; and. 11. Department of Nuclear Medicine, Semmelweis University, Budapest, Hungary. 12. International Atomic Energy Agency, Vienna, Austria.
Abstract
The purpose of this study was to assess the predictive and prognostic value of interim FDG PET (iPET) in evaluating early response to immunochemotherapy after 2 cycles (PET-2) in diffuse large B-cell lymphoma (DLBCL) by applying 2 different methods of interpretation: the Deauville visual 5-point scale (5-PS) and a change in SUV (ΔSUV) by semiquantitative evaluation. Methods: In total, 145 patients with newly diagnosed DLBCL underwent pretreatment PET and PET-2 assessment. PET-2 was classified according to both 5-PS and percentage ΔSUV. Receiver-operating-characteristic analysis was performed to compare the accuracy of the 2 methods for predicting progression-free survival. Survival estimates, based on each method separately and combined, were calculated for iPET-positive (iPET+) and iPET-negative (iPET-) groups and compared. Results: Both with 5-PS and with ΔSUV-based evaluations, significant differences were found between the progression-free survival of iPET- and iPET+ patient groups (P < 0.001). Visually, the best negative predictive value (NPV) and positive predictive value (PPV) occurred when iPET was defined as positive if the Deauville score was 4-5 (89% and 59%, respectively). Using the 66% ΔSUV cutoff reported previously, NPV and PPV were 80% and 76%, respectively. ΔSUV at the 48.9% cutoff, reported for the first time here, produced 100% specificity along with the highest sensitivity (24%). The 5-PS and a semiquantitative ΔSUV of less than 48.9% for each PET-2 gave the same PET-2 classification (positive or negative) in 70% (102/145) of all patients. This combined classification delivered NPV and PPV of 89% and 100%, respectively, and all iPET+ patients failed to achieve or remain in remission. Conclusion: In this large consistently treated and assessed series of DLBCL patients, iPET had good prognostic value interpreted either visually or semiquantitatively. We determined that the most effective ΔSUV cutoff was 48.9% and that when combined with 5-PS assessment, a positive PET-2 result was highly predictive of treatment failure.
The purpose of this study was to assess the predictive and prognostic value of interim FDG PET (iPET) in evaluating early response to immunochemotherapy after 2 cycles (PET-2) in diffuse large B-cell lymphoma (DLBCL) by applying 2 different methods of interpretation: the Deauville visual 5-point scale (5-PS) and a change in SUV (ΔSUV) by semiquantitative evaluation. Methods: In total, 145 patients with newly diagnosed DLBCL underwent pretreatment PET and PET-2 assessment. PET-2 was classified according to both 5-PS and percentage ΔSUV. Receiver-operating-characteristic analysis was performed to compare the accuracy of the 2 methods for predicting progression-free survival. Survival estimates, based on each method separately and combined, were calculated for iPET-positive (iPET+) and iPET-negative (iPET-) groups and compared. Results: Both with 5-PS and with ΔSUV-based evaluations, significant differences were found between the progression-free survival of iPET- and iPET+ patient groups (P < 0.001). Visually, the best negative predictive value (NPV) and positive predictive value (PPV) occurred when iPET was defined as positive if the Deauville score was 4-5 (89% and 59%, respectively). Using the 66% ΔSUV cutoff reported previously, NPV and PPV were 80% and 76%, respectively. ΔSUV at the 48.9% cutoff, reported for the first time here, produced 100% specificity along with the highest sensitivity (24%). The 5-PS and a semiquantitative ΔSUV of less than 48.9% for each PET-2 gave the same PET-2 classification (positive or negative) in 70% (102/145) of all patients. This combined classification delivered NPV and PPV of 89% and 100%, respectively, and all iPET+ patients failed to achieve or remain in remission. Conclusion: In this large consistently treated and assessed series of DLBCL patients, iPET had good prognostic value interpreted either visually or semiquantitatively. We determined that the most effective ΔSUV cutoff was 48.9% and that when combined with 5-PS assessment, a positive PET-2 result was highly predictive of treatment failure.
Authors: J J Eertink; C N Burggraaff; M W Heymans; U Dührsen; A Hüttmann; C Schmitz; S Müller; P J Lugtenburg; S F Barrington; N G Mikhaeel; R Carr; S Czibor; T Györke; L Ceriani; E Zucca; M Hutchings; L Kostakoglu; A Loft; S Fanti; S E Wiegers; S Pieplenbosch; R Boellaard; O S Hoekstra; J M Zijlstra; H C W de Vet Journal: Blood Adv Date: 2021-05-11
Authors: Gerben J C Zwezerijnen; Jakoba J Eertink; Coreline N Burggraaff; Sanne E Wiegers; Ekhlas A I N Shaban; Simone Pieplenbosch; Daniela E Oprea-Lager; Pieternella J Lugtenburg; Otto S Hoekstra; Henrica C W de Vet; Josee M Zijlstra; Ronald Boellaard Journal: J Nucl Med Date: 2021-03-05 Impact factor: 11.082