(18)F-FDG PET/CT bone/bone marrow findings in Hodgkin's lymphoma may circumvent the use of bone marrow trephine biopsy at diagnosis staging.

PURPOSE: Accurate staging of Hodgkin's lymphoma (HL) is necessary in selecting appropriate treatment. Bone marrow trephine biopsy (BMB) is the standard procedure for depicting bone marrow involvement. BMB is invasive and explores a limited part of the bone marrow. (18)F-FDG PET/CT is now widely used for assessing response to therapy in HL and a baseline study is obtained to improve accuracy. The aim of this retrospective analysis was to assess whether routine BMB remains necessary with concomitant (18)F-FDG PET/CT. METHODS: Data from 83 patients (newly diagnosed HL) were reviewed. All patients had received contrast-enhanced CT, BMB and (18)F-FDG PET/CT. Results of BMB were not available at the time of (18)F-FDG PET/CT imaging. RESULTS: Seven patients had lymphomatous involvement on BMB. Four patients had bone involvement on conventional CT (two with negative BMB). All patients with bone marrow and/or bone lesions at conventional staging were also diagnosed on (18)F-FDG PET/CT scan. PET/CT depicted FDG-avid bone/bone marrow foci in nine additional patients. Four of them had only one or two foci, while the other had multiple foci. However, the iliac crest, site of the BMB, was not involved on (18)F-FDG PET/CT. Osteolytic/sclerotic lesions matching FDG-avid foci were visible on the CT part of PET/CT in three patients. MRI ordered in three other patients suggested bone marrow involvement. Interim and/or end-therapy (18)F-FDG PET/CT documented response of FDG-avid bone/bone marrow foci to chemotherapy in every patient. CONCLUSION: (18)F-FDG PET/CT highly improves sensitivity for diagnosis of bone/bone marrow lesions in HL compared to conventional staging.

Effect of (18)F-FDG PET/CT imaging in patients with clinical Stage II and III breast cancer.

PURPOSE: To investigate the potential effect of using (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in the initial assessment of patients with clinical Stage II or III breast cancer. METHODS AND MATERIALS: During 14 consecutive months, 39 patients (40 tumors) who presented with Stage II or III breast cancer on the basis of a routine extension assessment were prospectively included in this study. PET/CT was performed in addition to the initial assessment. RESULTS: In 3 cases, PET/CT showed extra-axillary lymph node involvement that had not been demonstrated with conventional techniques. Two of these patients had hypermetabolic lymph nodes in the subpectoral and infraclavicular regions, and the third had a hypermetabolic internal mammary node. PET/CT showed distant uptake in 4 women. Of these 4 women, 1 had pleural involvement and 3 had bone metastasis. Overall, of the 39 women, the PET/CT results modified the initial stage in 7 (18%). The modified staging altered the treatment plan for 5 patients (13%). It led to radiotherapy in 4 patients (bone metastasis, pleural lesion, subpectoral lymph nodes, and internal mammary nodes) and excision of, and radiotherapy to, the infraclavicular lymph nodes in 1 patient. CONCLUSIONS: PET/CT can provide information on extra-axillary lymph node involvement and can uncover occult distant metastases in a significant percentage of patients. Therefore, initial PET/CT could enable better treatment planning for patients with Stage II and III breast cancer.

Whole-body (18)F-FDG PET and conventional imaging for predicting outcome in previously treated breast cancer patients.

UNLABELLED: This study was conducted to determine the ability of (18)F-FDG PET and conventional imaging (CI) to predict the outcomes in breast cancer patients who have previously undergone primary treatment. METHODS: The study population consisted of 61 female patients (median age, 54 y; range, 32--91 y) who were reevaluated with (18)F-FDG PET and CI after treatment. The median interval between the last treatment and PET was 0.4 y (range, 0--16 y). PET was performed within 3 mo of CI (median interval, 25 d; range, 2--84 d). To determine the independent impact of PET on outcome, PET images were reinterpreted in a blind fashion. Availability of clinical information after PET scanning (21 plus minus 12 mo) was required for study inclusion. Study endpoints were clinical evidence of progression of disease or death. RESULTS: Of 61 patients, 19 (31.1%) had no clinical evidence and 38 (62.3%) had evidence of residual or recurrent disease by the end of follow-up. Four patients (6.6%) had died. The positive and negative predictive values (PPV and NPV, respectively) of PET were 93% and 84%, respectively. CI yielded a PPV of 85% and an NPV of 59%. The prognostic accuracy of single whole-body PET was superior to that of multiple procedures with CI (90% vs. 75%; P < 0.05). Kaplan--Meier estimates of disease-free survival in patients with negative PET findings compared with those with positive PET findings revealed a significant difference between the 2 curves (log-rank test = 0.001). Kaplan--Meier estimates of disease-free survival stratified by CI results showed a marginally significant difference between CI-positive and CI-negative patients (log-rank test = 0.04). CONCLUSION: FDG PET can be used to improve prediction of the clinical outcome of previously treated breast cancer patients relative to what is achievable through CI alone.

Conventional imaging and 2-deoxy-2-[(18)F]fluoro-D-glucose positron emission tomography for predicting the clinical outcome of patients with previously treated Hodgkin's disease.

PURPOSE: The aim of this study was to determine the ability of 2-deoxy-2-[(18)F]fluoro-d-glucose positron emission tomography (FDG-PET) to predict the clinical outcome of previously treated patients with Hodgkin's Disease (HD). PATIENTS AND METHODS: Thirty-two patients were studied with PET within a median interval of 5.2 months after treatment. Conventional imaging (CI) performed within two months before PET included 2.9+/-1.2 imaging tests/patient. To determine the independent ability of FDG-PET to predict the clinical outcome, PET images were reread without knowledge of CI and clinical history. Study end points were disease-free survival, or clinical evidence of disease or death. PET and CI stages were also compared for each patient. RESULTS: Using the clinical outcome as gold standard after a median follow-up of 14 months, 21 of 32 patients (65%) were considered disease-free while 11 of 32 patients (35%) had evidence for disease or had died. The predictive accuracy of PET was 91% vs. 66% for conventional imaging (P<0.05). The positive predictive value (PPV) was also significantly higher for PET (79% vs. 50%, P<0.05), while its negative predictive value (NPV) tended to be higher than that of CI (100% vs. 86%, P=0.08). Kaplan-Meier analysis for disease-free survival showed a significant difference between PET-negative and -positive results. No such difference was observed between CI-positive and -negative results (P=0.35). CONCLUSION: Whole-body FDG-PET imaging modified the clinical stage in 28% of patients. Moreover, FDG-PET predicted patient outcome with a higher predictive accuracy than CI. This superior prognostic accuracy was achieved with a single FDG-PET study vs. 2.9+/-1.2 CI procedures/patient.

Conventional imaging and 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography for predicting the clinical outcome of previously treated non-Hodgkin's lymphoma patients.

PURPOSE: The aim of this study was to determine the impact of positron emission tomography (PET) with 2-deoxy-2-[18F]fluoro-D-glucose (FDG) and combined conventional imaging on clinical stage and their ability to predict the clinical outcome of previously treated lymphoma patients. PROCEDURES: Seventy-eight patients with Non-Hodgkin's Lymphoma (NHL) were studied with PET within a median interval of 5.3 months after treatment. Conventional imaging performed after treatment and within three months before PET included 3.3+/-1.3 imaging tests/patient. To determine the independent ability of PET for predicting clinical outcome, PET images were re-read in a blinded fashion. Study endpoints were disease-free survival, or clinical evidence of disease or death. RESULTS: PET downstaged 18 patients, upstaged nine and revealed the same stage as conventional imaging in 51 patients. Using the clinical outcome as gold standard, the positive and negative predictive values of PET were 95% and 83% versus 72% and 67% for conventional imaging (P<0.05). The prognostic accuracy of PET was superior to that of conventional imaging (90 vs. 71%; P<0.05). Kaplan-Meier analysis for disease-free survival showed a significant difference between PET negative and PET positive results (P<0.0001). CONCLUSION: Whole-body FDG-PET imaging modified the clinical stage in 35% of lymphoma patients who were reevaluated after treatment. Moreover, FDG-PET predicted patient outcome with a higher predictive accuracy than conventional imaging. This superior prognostic accuracy was achieved with a single FDG-PET study versus multiple conventional imaging procedures/patient.

Value of F-18 fluorodeoxyglucose positron emission tomography for predicting the clinical outcome of patients with aggressive lymphoma prior to and after autologous stem-cell transplantation.

STUDY OBJECTIVES: To determine and compare the values of positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) and CT for predicting clinical outcome of patients with aggressive lymphoma undergoing salvage cytoreductive chemotherapy followed by high-dose chemotherapy and autologous stem-cell transplantation (ASCT). PATIENTS AND METHODS: Forty-three patients with lymphoma who underwent ASCT with FDG-PET evaluation were studied. Group 1 (n = 20) patients (6 patients with Hodgkin disease [HD], and 14 patients with non-Hodgkin lymphoma [NHL]) underwent PET 2 to 5 weeks after initiation of salvage chemotherapy, prior to ASCT. Group 2 (n = 23) patients (6 patients with HD, and 17 patients with NHL) underwent PET within a median interval of 2.4 months (range, 2 to 6 months) after ASCT. MEASUREMENTS AND RESULTS: Study end points were complete remission, relapse, or death. In group 1, 8 of 20 patients (40%) were disease free after a median follow-up of 13.3 months; 12 patients relapsed or died. PET findings were true-negative in 7 of 8 patients and true-positive in 11 of 12 patients who relapsed after ASCT. In group 2, 9 of 23 patients (39%) were disease free after a median follow-up of 16.5-months; 14 patients relapsed. PET findings were true-negative in 8 of 9 patients and true-positive in 13 of 14 patients who relapsed. Positive and negative predictive values of PET were 92% and 88% (group 1) and 93% and 89% (group 2), respectively. Predictive accuracy values of PET were 90% and 91% for group 1 and group 2, respectively, vs 58% and 67% for CT (p < 0.05). CONCLUSIONS: PET findings but not CT results were strongly correlated with disease-free survival (p < 0.01). Our results show that FDG-PET can be used to predict the post-ASCT outcome of lymphoma patients with high accuracy.

Positron Emission Tomography (PET) and breast cancer in clinical practice.

The landscape of oncologic practice has changed deeply during the past few years and there is now a need, through a multidisciplinary approach, for imaging to provide accurate evaluation of morphology and function and to guide treatment (Image Guided Therapy). Increasing emphasis has been put on Position Emission Tomography (PET) role in various cancers among clinicians [Juweid ME, Cheson BD. Positron-emission tomography and assessment of cancer therapy. N Engl J Med 2006;354:496-507; Koh DM, Cook GJR, Husband JE. New horizons in oncologic imaging. N Engl J Med 2003;348:25; Tafra L, positron emission tomography (PET) and mammography (PEM) for breast cancer: importance to surgeons. Ann Surg Oncol 2006;14(1):3-13] and patients despite a general context of healthcare expenditure limitation. Positron Emission Tomography has currently a limited role in breast cancer, but also general radiologists and specialists should be aware of these indications, especially when staging aggressive cancers and looking for recurrence. Currently, the hybrid systems associating PET and Computed Tomography (CT) and in the same device [Rohren EM, Turkington TG, Coleman RE. Clinical applications of PET in oncology. Radiology 2004;231:305-32; Blodgett TM, Meltzer CM, Townsend DW. PET/CT: form and function. Radiology 2007;242:360-85; von Schulthess GK, Steinert HC, Hany TF. Integrated PET/CT: current applications and futures directions. Radiology 2006;238(2):405-22], or PET-CT, are more commonly used and the two techniques are adding their potentialities. Other techniques, MRI in particular, may also compete with PET in some instance and as far as ionizing radiations dose limitation is considered, some breast cancers becoming some form of a chronic disease. Breast cancer is a very complex, non-uniform, disease and molecular imaging at large may contribute to a better knowledge and to new drugs development. Ongoing research, Positron Emission Mammography (PEM) and new tracers, are likely to bring improvements in patient care [Kelloff GJ, Hoffman JM, Johnson B, et al. Progress and promise of FDG-PET Imaging for cancer patient management and oncologic drug development. Clin Cancer Res 2005;1(April (8)): 2005].

The impact of pre- and post-transplantation positron emission tomography using 18-fluorodeoxyglucose on poor-prognosis lymphoma patients undergoing autologous stem cell transplantation.

BACKGROUND: In patients with lymphoma who had a poor prognosis, pretransplantation 18-fluorodeoxyglucose (FDG)-positron-emission tomography (PET) was important for the evaluation of response and outcome. However, little is known about the correlation of FDG-PET with post-transplantation PET. The current study was designed to ascertain whether positive pretransplantation PET images are modified by the conditioning regimen. METHODS: Sixty consecutive patients who had achieved remission and underwent consolidation by autologous stem cell transplantation (ASCT) had PET images obtained before ASCT (after 3 or 4 chemotherapy cycles) and 100 days after ASCT. The correlation was explored between the presence of abnormal 18-FDG uptake (PET positive) or its absence (PET negative) and patient outcomes. RESULTS: Before ASCT, 31 patients achieved complete remission (CR), and 23 patients achieved uncertain CR. Before ASCT, 44 patients (75%) were had negative PET images; and, after ASCT, 48 patients (80%) had negative PET images. One year after ASCT, the estimated event-free survival (EFS) rate was 80% in patients who had negative pre-ASCT PET images compared with 43% in patients who had positive pre-ASCT PET images (P = .0002). The EFS rate was 81% in patients who had negative post-ASCT PET images compared with 25% in patients who had negative post-ASCT PET images (P < .0001). In multivariate analysis, only the results for pre- and post-ASCT PET images retained prognostic value, with relative risks of failure estimated at 4.9 and 11.9, respectively. CONCLUSIONS: A positive pre-ASCT PET image indicated a high risk of ASCT failure, which was increased by a positive post-ASCT PET image. For patients with lymphoma who have positive pre-ASCT PET images, more investigations using new treatment approaches will be required. For patients who have negative pre-ASCT PET images, obtaining post-ASCT PET images does not seem to be mandatory.

PET for staging of Hodgkin's disease and non-Hodgkin's lymphoma.

Metabolic or molecular imaging with fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) has emerged as a powerful imaging modality for diagnosis, staging, and therapy monitoring of a variety of cancers. The accuracy of FDG-PET as an imaging tool for the primary staging of lymphoma suffers from the absence of a reference criterion to which all imaging modalities can be compared. For ethical reasons, pathological diagnosis is usually not possible for all of the lesions and abnormalities found. In this article, the current state of the art for staging of primary lymphoma is reviewed and the implications for staging and the impact on patient management discussed. Whole-body PET using FDG is superior to conventional staging, i.e., physical examination, laboratory tests, plain radiography, and CT, by 10-20%. The sensitivity of FDG-PET varies for different regions of the body and appears lowest for infradiaphragmatic disease involvement. Staging with metabolic imaging leads in 10-40% of patients to a change in clinical stage. Highly variable results have been reported on whether up- or downstaging of lymphoma with PET leads to changes in the therapeutic approach for primary lymphoma.