Marc Bertaux1,2,3, Caroline Houillier4,5, Véronique Edeline6,5, Marie-Odile Habert7,8,5, Karima Mokhtari9,5, Alain Giron8,5, Sébastien Bergeret7, Khe Hoang-Xuan4,5, Nathalie Cassoux5,10, Valérie Touitou11,10, Sylvain Choquet5,12, Carole Soussain13,5, Aurélie Kas7,8,5. 1. Médecine Nucléaire, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. marc.bertaux@gmail.com. 2. Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, 75006, Paris, France. marc.bertaux@gmail.com. 3. Réseau expert national pour les Lymphomes Oculo-Cérébraux (LOC), Paris, France. marc.bertaux@gmail.com. 4. Neurologie 2-Mazarin, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, IHU, ICM, Paris, France. 5. Réseau expert national pour les Lymphomes Oculo-Cérébraux (LOC), Paris, France. 6. Département de Médecine nucléaire, Institut Curie, Site de Saint-Cloud, Saint-Cloud, France. 7. Médecine Nucléaire, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. 8. Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, 75006, Paris, France. 9. Neuropathologie, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France. 10. Département d'oncologie chirurgicale, Institut Curie, Université Paris V Descartes, Paris, France. 11. Ophtalmologie, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France. 12. Hématologie, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France. 13. Département d'Hématologie, Institut Curie, Site de Saint-Cloud, Saint-Cloud, France.
Abstract
INTRODUCTION: Primary Central Nervous System Lymphoma (PCNSL) is a rare disease with different therapeutic implications than systemic lymphoma. In this study, we evaluated whole-body 18FDG-PET/CT for pre-chemotherapy imaging of suspected PCNSL. METHODS: One hundred and thirty consecutive immunocompetent patients were retrospectively included. The results of initial 18FDG-PET/CT, contrast-enhanced CT (CeCT) and bone marrow biopsy (BMB) when available were compared to a gold standard based on pathological diagnosis or follow-up. RESULTS: CNS lesion pathology showed large B-cell lymphoma in 95% of patients, including 11 patients with primary vitro-retinal lymphoma. Ten patients (8%) where ultimately diagnosed with systemic lymphoma involvement, including five pathologically confirmed cases, all of which were detected by 18FDG-PET/CT. 18FDG-PET/CT showed incidental systemic findings unrelated to lymphoma in 14% of patients. An SUVmax threshold of nine enabled good discrimination between systemic lymphoma and other lesions (sensitivity 92% and specificity 89%). CeCT and BMB performed in 108 and 77 patients respectively revealed systemic lesions in only three patients. CONCLUSION: 18FDG-PET/CT detected concomitant occult systemic involvement in a non-negligible proportion of suspected PCNSL cases (8%). In this setting its sensitivity is higher than that of CeCT. All of our patients ultimately diagnosed with concomitant systemic involvement had positive 18FDG-PET/CT. We believe it constitutes a safe one-stop shop evaluation for the systemic pre-treatment imaging of suspected PCNSL.
INTRODUCTION:Primary Central Nervous System Lymphoma (PCNSL) is a rare disease with different therapeutic implications than systemic lymphoma. In this study, we evaluated whole-body 18FDG-PET/CT for pre-chemotherapy imaging of suspected PCNSL. METHODS: One hundred and thirty consecutive immunocompetent patients were retrospectively included. The results of initial 18FDG-PET/CT, contrast-enhanced CT (CeCT) and bone marrow biopsy (BMB) when available were compared to a gold standard based on pathological diagnosis or follow-up. RESULTS: CNS lesion pathology showed large B-cell lymphoma in 95% of patients, including 11 patients with primary vitro-retinal lymphoma. Ten patients (8%) where ultimately diagnosed with systemic lymphoma involvement, including five pathologically confirmed cases, all of which were detected by 18FDG-PET/CT. 18FDG-PET/CT showed incidental systemic findings unrelated to lymphoma in 14% of patients. An SUVmax threshold of nine enabled good discrimination between systemic lymphoma and other lesions (sensitivity 92% and specificity 89%). CeCT and BMB performed in 108 and 77 patients respectively revealed systemic lesions in only three patients. CONCLUSION:18FDG-PET/CT detected concomitant occult systemic involvement in a non-negligible proportion of suspected PCNSL cases (8%). In this setting its sensitivity is higher than that of CeCT. All of our patients ultimately diagnosed with concomitant systemic involvement had positive 18FDG-PET/CT. We believe it constitutes a safe one-stop shop evaluation for the systemic pre-treatment imaging of suspected PCNSL.
Authors: Florian Scheichel; Daniel Pinggera; Branko Popadic; Camillo Sherif; Franz Marhold; Christian Franz Freyschlag Journal: Front Oncol Date: 2022-04-20 Impact factor: 5.738