| PET/CT surveillance in patients with Hodgkin lymphoma in first remission is associated with low positive predictive value and high costs. | |
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MedLine Citation:
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PMID: 22207683 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Background. The value of performing post-therapy routine surveillance imaging in patients with Hodgkin lymphoma is controversial. This study evaluates the utility of positron emission tomography / computed tomography using 2-[18F]fluoro-2-deoxyglucose (PET/CT) for this purpose and in situations with suspected lymphoma relapse. Design and Methods. We conducted a multicenter retrospective study. Patients with newly diagnosed Hodgkin lymphoma achieving at least a partial remission on first-line therapy were eligible if they received PET/CT surveillance during follow-up. Two types of surveillance PET/CTs were analyzed; routine PET/CT when patients showed no signs of relapse at referral to PET/CT, and clinically indicated PET/CT when recurrence was suspected. Results. A total of 211 routine and 88 clinically indicated PET/CTs were performed in 161 patients. In ten of 22 patients with Hodgkin lymphoma recurrence, a routine PET/CT was the primary tool for the diagnosis of relapse. Extranodal disease, interim PET positive lesions and PET activity at response evaluation were all associated with a PET/CT diagnosed preclinical relapse. The true positive rates of routine PET/CT vs. clinically indicated PET/CT were 5 and 13%, respectively (p=0.02). The overall positive predictive value and negative predictive value of PET/CT was 28% and 100%, respectively. The estimated cost per routine PET/CT diagnosed relapse was 50.778 USD. Conclusions. A negative PET/CT reliably rules out a relapse. The high false positive rate, however, is an important limitation and a confirmatory biopsy is mandatory for the diagnosis of a relapse. With no proven survival benefit for patients with a pre-clinically diagnosed relapse, the high costs and low positive predictive value make PET/CT unfit for routine surveillance of Hodgkin lymphoma patients. |
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Authors:
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Tarec El-Galaly; Karen Juul Mylam; Peter Brown; Lena Specht; Ilse Christiansen; Lars Munksgaard; Hans Erik Johnsen; Annika Loft; Anne Bukh; Victor Iyer; Anne Lerberg Nielsen; Martin Hutchings |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-12-29 |
Journal Detail:
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Title: Haematologica Volume: - ISSN: 1592-8721 ISO Abbreviation: - Publication Date: 2011 Dec |
Date Detail:
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Created Date: 2011-12-30 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0417435 Medline TA: Haematologica Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Aalborg Hospital, Aarhus University Hospital, Denmark; |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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