DOI: 10.1007/s00259-017-3758-5Pages: 1-7

Poor predictive value of positive interim FDG-PET/CT in primary mediastinal large B-cell lymphoma

1. Gustave Roussy and Université Paris Saclay, Department of Hematology

2. Gustave Roussy and Université Paris Saclay, Department of Nuclear Medicine and Endocrine Oncology

3. Gustave Roussy and Université Paris Saclay, Department of Radiology

4. Gustave Roussy and Université Paris Saclay, Department of Drug Development (DITEP)

5. Marie Lannelongue Hospital, Department of Thoracic Surgery

6. Marie Lannelongue Hospital, Department of Pathology

7. Gustave Roussy and Université Paris Saclay, Department of Pathology

Correspondence to:
David Ghez
Tel: 33 1 42 11 45 14
Email: david.ghez@gustaveroussy.fr

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Abstract

Purpose

Though commonly used to assess response to therapy, the prognostic value of interim FDG-PET/CT in Primary Mediastinal Large B-cell Lymphoma (PMBCL) is unclear.

Methods

We conducted a retrospective study on 36 consecutive patients treated at our institution for a PMBCL between 2006 and 2014. All patients with a positive interim FDG-PET/CT had undergone histological restaging consisting either in a surgical debulking of the residual lesion (15 patients) or a CT-guided core needle biopsy (two patients). All FDG-PET/CT were secondarily reviewed according to the more recent Deauville criteria.

Results

Interim FDG-PET/CT was considered positive in 17/36 patients using visual evaluation. Among these patients, 14 had a Deauville score of 4. Histological restaging was negative in all but one case, showing inflammation and/or fibrosis. After a median follow-up of 48.5 months, a total of five patients have relapsed, two patients in the positive FDG-PET/CT group, and three patients in the negative FDG-PET/CT group, respectively.

Conclusions

These data indicate that a positive interim FDG-PET/CT does not reflect persistence of active disease in the vast majority of PMBCL cases. The relapse rate appears similar regardless of interim FDG-PET/CT results and interpretation criteria. This suggests that interim FDG-PET/CT has a poor positive predictive value, thus kt should be used with caution in PMBCL.

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  • Accepted: Jun 8, 2017
  • Online: Jun 21, 2017

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