Diagnostic and Prognostic Value of 18F-FDG PET/CT in Bone Marrow Infiltration of Newly Diagnosed Diffuse Large B-Cell Lymphoma / 中国实验血液学杂志

OBJECTIVE@#To explore the diagnostic value of 18F-FDG PET/CT in bone marrow infiltration (BMI) of newly diagnosed diffuse large B-cell lymphoma (DLBCL), compared with the results of bone marrow biopsy (BMB) and investigate whether the BMI diagnosed by 18F-FDG PET/CT and other factors have independent prognostic values.@*METHODS@#Ninety-four newly diagnosed DLBCL patients who underwent PET/CT in Clinical Medical College of Shanghai General Hospital of Nanjing Medical University were included. BMB was performed within 2 weeks before or after PET/CT, and standardized treatment was performed after PET/CT. The manifestations of bone marrow (BM) FDG uptake were recorded. The diagnostic criteria of BMI were BMB positive or focal BM FDG uptake confirmed by imaging follow-up. The relationship between clinical features and BM FDG uptake and the values of PET/CT and BMB in the diagnosis of BMI was analyzed. The progression-free survival (PFS) was analyzed by Kaplan-Meier survival curves, log-rank test was used to compare PFS rate, and Cox regression model was used to analyze the independent risk factors affecting PFS.@*RESULTS@#Among 94 DLBCL patients, 34 patients showed focal BM uptake (fPET), 7 patients showed super BM uptake (sBMU), 11 patients showed diffuse homogenous uptake higher than liver (dPET), and the other 42 patients had normal BM uptake (nPET) (lower than liver). BMB positive was found in all sBMU patients, in 20.6%(7/34) of fPET patients, and in 27.3% (3/11) of dPET patients. All nPET patients had negative BMB results. dPET patients were associated with lower hemoglobin level and leukocyte count compared with nPET group (P < 0.001, P =0.026). Compared with fPET patients, sBMU patients were more likely to have B symptoms and elevated lactate dehydrogenase (LDH). A total of 44 patients were diagnosed BMI, including 17 cases with BMB+. The sensitivity and specificity of BMB in the diagnosis of BMI was 38.6% (17/44) and 100% (50/50), respectively. Using fPET and sBMU as criteria of PET BMI, the diagnostic sensitivity and specificity of PET/CT was 93.2% (41/44) and 100% (50/50), respectively. Kaplan-Meier analysis showed that there was no significant difference in 2-year PFS rate between nPET and dPET patients (P >0.05), while sBMU patients had lower 2-year PFS rate compared with fPET patients (P < 0.001). Multivariate analysis showed that higher Ann Arbor stage (HR=9.010, P =0.04) and sBMU (HR=3.964, P =0.002) were independent risk factors affecting PFS.@*CONCLUSIONS@#Increased BM FDG uptake of DLBCL can be manifested as dPET, fPET and sBMU. fPET and sBMU can replace BMB to diagnose BMI. Although dPET cannot completely exclude the possibility of BMI, it does not affect the prognosis, so it can be diagnosed as PET BMI negative. sBMU is an independent prognostic risk factor.

Prognostic Value of Interim / 中国实验血液学杂志

OBJECTIVE@#To explore the value of interim @*METHODS@#Twenty-one patients with ENKTL who were pathologically diagnosed at Shanghai General Hospital of Nanjing Medical University (Shanghai General Hospital) from January 2015 to December 2018 were retrospectively collected, and @*RESULTS@#After treatment, 11 patients had complete remission (CR), 3 had partial remission (PR), 1 had stable disease (SD), and 6 had disease progression (PD). The CR patients' △SUVmax was significantly higher than non-CR patients ［(66.07±22.33)% vs (36.87±23.28)%, t=2.927, P=0.009］. Calculated from the receiver operating curve (ROC), the optimal cut-off point of ΔSUVmax was 51.45%. The median follow-up time was 32 months. Kaplan-Meier survival analysis showed that KPI, DS and ΔSUVmax had significance in predicting PFS and OS (P<0.05). COX regression analysis showed that DS was an independent risk factor affecting PFS (P<0.05), and KPI and ΔSUVmax were independent risk factors affecting OS (P<0.05).@*CONCLUSION@#Interim

(18)F-FDG PET/CT for extranodular natural killer/T-cell lymphoma nasal type: imaging findings and clinical value / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the value of (18)F-FDG PET/CT in the diagnosis and treatment evaluation in patients with pretreatment or recurrent extranodular natural killer/T-cell lymphoma nasal type (ENTCL).</p><p><b>METHODS</b>(18)F-FDG PET/CT images and clinical records of 35 cases (67 scans) of pathologically confirmed ENTCL treated in our hospital within the last 9 years were analyzed. The imaging characteristics of the upper aerodigestive tract (UAT) and the non-aerodigestive tract (NUAT) lesions were analyzed. Lesion distribution, clinical stages, SUVmax and patient survival data were compared between pretreatment and recurrent cases.</p><p><b>RESULTS</b>s All the ENTCL lesions were hypermetabolic. The UAT lesions involved mainly the nasal cavity and pharynx, while the NUAT lesions may involve the lymph nodes and all the organs. UAT lesions were more common in pretreatment cases while NUAT lesions tended to increase in recurrent cases. The SUVmax of pretreatment and recurrent lesions were 10.4∓4.4 and 9.6∓5.2, and showed no significant difference among patients with different lesion distribution patterns, clinical stages, or treatment history. The tumor remission rate evaluated by PET/CT were higher in cases with an initial diagnosis than in those with recurrence [(89.5% (17/19) vs 33.3% (5/15), P<0.005)]. Cox regression analysis revealed no significant differences in the survival rates among patients with different treatment history, clinical stages, lesion distribution patterns, or SUVmax levels (P>0.05).</p><p><b>CONCLUSION</b>(18)F-FDG PET/CT can sensitively detect the pretreatment or recurrent lesions in ENTCL patients and helps in accurate tumor staging and curative effect evaluation.</p>

The role of 18F-FDG SPECT-CT in detecting recurrence and metastases in breast cancer patients with elevated tumor markers / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare retrospectively the role of (18)F-FDG SPECT-CT and conventional imaging in the detection of recurrence and metastases in postoperative breast cancer patients with elevated level of tumor markers, and to evaluate the impact of (18)F-FDG SPECT-CT on the management of breast cancer patients.</p><p><b>METHODS</b>(18)F-FDG SPECT-CT was performed in 35 breast cancer patients with suspected recurrence based on elevated level of serum tumor markers. Chest, abdomen and pelvic CT were performed in all patients and whole-body bone scan was performed in only 21 patients. The final diagnosis of recurrent breast cancer was confirmed by either pathology or observation by imaging during the follow-up for more than 1 year.</p><p><b>RESULTS</b>Among the 35 patients, the final diagnosis of recurrence or metastasis was established in 19 patients. Of the 114 sites of increased FDG uptake, 93 were interpreted as malignant and 21 as benign. On site-based analysis, the sensitivity, specificity, accuracy, positive and negative predictive values were 93.1%, 55.6%, 84.2%, 87.1% and 71.4%, respectively, for (18)F-FDG SPECT-CT, and 80.5%, 60.5%, 75.6%, 80.2% and 65.1%, respectively, for conventional imaging. On the patient-based analysis, the sensitivity, specificity, accuracy, positive and negative predictive values were 84.2%, 62.5%, 74.3%, 72.7% and 76.9%, respectively, for (18)F-FDG SPECT-CT, and 74.1%, 67.6%, 70.6%, 68.3% and 73.9%, respectively, for conventional imaging. The results of (18)F-FDG SPECT-CT led to changes in the subsequent clinical management of 40.0% of these patients.</p><p><b>CONCLUSION</b>In postoperative breast cancer patients with elevated level of tumor markers during the follow-up, (18)F-FDG SPECT-CT is more sensitive for detecting recurrence and metastases than conventional imaging.</p>

Comparison of 18F-FDG coincidence SPECT imaging and computed tomography in the initial staging and therapeutic evaluation of lymphomas / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical value of 18F-fluorodeoxyglucose (18F-FDG) coincidence SPECT imaging versus computed tomography (CT) for malignant lymphoma in the initial staging, early response to therapy, evaluation after completion of therapy and long-term follow-up.</p><p><b>METHODS</b>18F-FDG SPECT scans was performed on 61 patients with pathologically proven malignant lymphoma. The mean age of this series was 55 years ranged from 12 to 85 years. The data of these patients were retrospectively analyzed, and the result of 18F-FDG SPECT scan was compared with the CT imaging result performed within 2 weeks before or after FDG scan. 161 18F-FDG SPECT scans were performed for initial tumor staging (n=61), early response to therapy (n=42), evaluation after completion of therapy (n=26) and long-term follow-up (n=32). Each patient had a follow-up >6 months.</p><p><b>RESULTS</b>(1) Compared with CT scan, 18F-FDG SPECT imaging accurately upstaged the disease for 34.4% (21/61) of these patients at initial staging. It detected the lesions which were undetected by CT including bone marrow infiltration (n=17), foci of lymph node (n=3) and liver involvement (n=1). However, 3 patients were incorrectly staged, either downstaged or upstaged by 18F-FDG SPECT imaging. Of 212 lesions in 61 patients, 18-FDG SPECT imaging detected more lesions than CT (P < 0.01). The correspondence rate of '18-FDG SPECT imaging with marrow histology was 80.3% (49/61). (2) In early evaluation of the response to treatment, the accuracy, positive predictive value and negative predictive value of 18F-FDG SPECT imaging was 85.7%, 92.0% and 76.5% respectively, which is much higher than that of CT (64.3%, 75.0% and 50.0%), therefore, the therapeutic scheme in 21.4% (9/42) of these patients was changed by 18F-FDG SPECT imaging. Of 17 cases with negative 18F-FDG SPECT scan in early evaluation of therapy, clinical remission (13 complete remission and 3 partial remission) were achieved in 16 patients. Of the 25 patients with positive ones, 13 were considered as having progressive disease. (3) In the evaluation at the end of therapy or during follow-up, 58 18F-FDG SPECT imagings were performed in 26 patients. The specificity and positive predictive value were 85.7% and 68.4% versus 59.5% and 43.3%, respectively, by CT scan. Of 14 patients with residual masses detected by CT scan, 8 were diagnosed as complete remission (CR) by 18F-FDG SPECT imaging based on persistently negative FDG scans; The other 6 were interpreted as CR (n=1), partial remission (PR, n=2), non-remission (n=1) and progressive disease (n=2), thus there was only one false-positive FDG scan in these 14 patients.</p><p><b>CONCLUSION</b>18F-FDG imaging is quite effective and superior to CT scan for malignant lymphoma in initial staging, evaluation of early response to therapy and after completion of therapy, and long-term follow-up, especially for evaluating the residual masse.</p>