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Strikingly high false positivity of surveillance FDG-PET/CT scanning among patients with diffuse large cell lymphoma in the rituximab era.
MedLine Citation:
PMID:  23423884     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Predictive value (PV) of surveillance fluorodeoxyglucose positron emission tomography (FDG-PET) in patients with diffuse large B-cell lymphoma (DLBCL) treated with chemotherapy-rituximab (R) versus chemotherapy only, remains unclear. The aim of the current study was to compare the performance of surveillance PET in DLBCL patients receiving CHOP (cyclophosphamide, hydroxydaunorubicin hydrochloride, vincristine and prednisone) alone versus CHOP-R. Institutional database was retrospectively searched for adults with newly diagnosed DLBCL, receiving CHOP or CHOP-R, who achieved complete remission and underwent surveillance PETs. Follow-up (FU) PET was considered positive for recurrence in case of an uptake unrelated to physiological or known benign process. Results were confirmed by biopsy, imaging and clinical FU. 119 patients, 35 receiving CHOP and 84 CHOP-R, who underwent 422 FU-PETs, were analyzed. At a median PET-FU of 3.4 years, 31 patients relapsed (17 vs 14, respectively; p=0.02). PET detected all relapses, with no false-negative studies. Specificity and positive PV (PPV) were significantly lower for patients receiving CHOP-R vs CHOP (84% vs 87%, p=0.023; 23% vs 74%, p<0.0001), reflecting a higher false-positive (FP) rate in subjects receiving CHOP-R (77% vs 26%, p<0.001). In the latter group, FP-rate remained persistently high upto 3 years post-therapy. Multivariate analysis confirmed rituximab to be the most significant predictor for FP-PET. In conclusion, routine surveillance FDG-PET is not recommended in DLBCL treated with rituximab; strict criteria identifying patients in whom FU-PET is beneficial are required. Am. J. Hematol., 2013. © 2013 Wiley Periodicals, Inc.
Authors:
Irit Avivi; Ariel Zilberlicht; Eldad J Dann; Ronit Leiba; Tal Faibish; Jacob M Rowe; Rachel Bar-Shalom
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-2-20
Journal Detail:
Title:  American journal of hematology     Volume:  -     ISSN:  1096-8652     ISO Abbreviation:  Am. J. Hematol.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610369     Medline TA:  Am J Hematol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Wiley Periodicals, Inc., A Wiley Company.
Affiliation:
Department of Hematology & Bone Marrow Transplantation, Rambam Health Care Campus, Haifa; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
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