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Title: Combined Visual and Semiquantitative Evaluation Improves Outcome Prediction by Early Midtreatment <sup>18</sup>F-FDG PET in Diffuse Large B-Cell Lymphoma
Authors: Tamás Györke
Robert Carr
Juliano J. Cerci
Claudio Meneghetti
Francisca Redondo
Monica Celli
Charity Gorospe
Chirayu U. Auewarakul
Linda Jorgov
Diana Paez
Stefano Fanti
St. Luke's Medical Center Quezon City
Alma Mater Studiorum Università di Bologna
Semmelweis Egyetem
International Atomic Energy Agency, Vienna
Faculty of Medicine, Siriraj Hospital, Mahidol University
Universidade de Sao Paulo - USP
Guy's and St Thomas' NHS Foundation Trust
Chulabhorn Royal Academy
Quanta Diagnóstico e Terapia
Fundación Arturo López Pérez
Keywords: Medicine
Issue Date: 1-Jul-2020
Citation: Journal of nuclear medicine : official publication, Society of Nuclear Medicine. Vol.61, No.7 (2020), 999-1005
Abstract: © 2020 by the Society of Nuclear Medicine and Molecular Imaging. The purpose of this study was to assess the predictive and prognostic value of interim FDG PET (iPET) in evaluating early response to immunochemotherapy after 2 cycles (PET-2) in diffuse large B-cell lymphoma (DLBCL) by applying 2 different methods of interpretation: the Deauville visual 5-point scale (5-PS) and a change in SUV (ΔSUV) by semiquantitative evaluation. Methods: In total, 145 patients with newly diagnosed DLBCL underwent pretreatment PET and PET-2 assessment. PET-2 was classified according to both 5-PS and percentage ΔSUV. Receiver-operating-characteristic analysis was performed to compare the accuracy of the 2 methods for predicting progression-free survival. Survival estimates, based on each method separately and combined, were calculated for iPET-positive (iPET+) and iPET-negative (iPET-) groups and compared. Results: Both with 5-PS and with ΔSUV-based evaluations, significant differences were found between the progression-free survival of iPET- and iPET+ patient groups (P < 0.001). Visually, the best negative predictive value (NPV) and positive predictive value (PPV) occurred when iPET was defined as positive if the Deauville score was 4-5 (89% and 59%, respectively). Using the 66% ΔSUV cutoff reported previously, NPV and PPV were 80% and 76%, respectively. ΔSUV at the 48.9% cutoff, reported for the first time here, produced 100% specificity along with the highest sensitivity (24%). The 5-PS and a semiquantitative ΔSUV of less than 48.9% for each PET-2 gave the same PET-2 classification (positive or negative) in 70% (102/145) of all patients. This combined classification delivered NPV and PPV of 89% and 100%, respectively, and all iPET+ patients failed to achieve or remain in remission. Conclusion: In this large consistently treated and assessed series of DLBCL patients, iPET had good prognostic value interpreted either visually or semiquantitatively. We determined that the most effective ΔSUV cutoff was 48.9% and that when combined with 5-PS assessment, a positive PET-2 result was highly predictive of treatment failure.
ISSN: 15355667
Appears in Collections:Scopus 2020

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