Chemotherapy Response Assessment by FDG-PET-CT in Early-stage Classical Hodgkin Lymphoma: Moving Beyond the Five-Point Deauville Score

Abstract Purpose [18F]Fluoro-deoxy-glucose positron emission tomography/computed tomography (FDG-PET/CT) is used for response assessment during therapy in Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Clinicians report the scans visually using Deauville criteria. Improved performance in modern PET/CT scanners could allow for a reduction in scan time without compromising diagnostic image quality. Additionally, patient throughput can be increased with increasing cost-effectiveness. We investigated the effects of reducing scan time of response assessment FDG-PET/CT in HL and NHL patients on Deauville score (DS) and image quality. Methods Twenty patients diagnosed with HL/NHL referred to a response assessment FDG-PET/CT were included. PET scans were performed in list-mode with an acquisition time of 120 s per bed position(s/bp). From PET list-mode data images with full acquisition time of 120 s/bp and shorter acquisition times (90, 60, 45, and 30 s/bp) were reconstructed. All images were assessed by two specialists and assigned a DS. We estimated the possible savings when reducing scan time using a simplified model based on assumed values/costs for our hospital. Results There were no significant changes in the visually assessed DS when reducing scan time to 90 s/bp, 60 s/bp, 45 s/bp, and 30 s/bp. Image quality of 90 s/bp images were rated equal to 120 s/bp images. Coefficient of variance values for 120 s/bp and 90 s/bp images was significantly < 15%. The estimated annual savings to the hospital when reducing scan time was 8000-16,000 €/scanner. Conclusion Acquisition time can be reduced to 90 s/bp in response assessment FDG-PET/CT without compromising Deauville score or image quality. Reducing acquisition time can reduce costs to the clinic.

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PREDICTIVE VALUE OF QUANTITATIVE 18 F‐FDG‐PET‐CT RADIOMICS ANALYSIS IN 174 PATIENTS WITH RELAPSED/REFRACTORY CLASSICAL HODGKIN LYMPHOMA

Hematological Oncology ◽

10.1002/hon.21_2879 ◽

2021 ◽

Vol 39 (S2) ◽

Author(s):

J Driessen ◽

G. J. C Zwezerijnen ◽

H Schöder ◽

A. J Moskowitz ◽

M. J Kersten ◽

...

Keyword(s):

Hodgkin Lymphoma ◽

Predictive Value ◽

Fdg Pet ◽

Classical Hodgkin Lymphoma ◽

Pet Ct ◽

Fdg Pet Ct

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Clinical impact of FDG-PET/CT in the planning of radiotherapy for early-stage Hodgkin lymphoma

European Journal Of Haematology ◽

10.1111/j.1600-0609.2006.00802.x ◽

2007 ◽

Vol 78 (3) ◽

pp. 206-212 ◽

Cited By ~ 84

Author(s):

Martin Hutchings ◽

Annika Loft ◽

Mads Hansen ◽

Anne Kiil Berthelsen ◽

Lena Specht

Keyword(s):

Hodgkin Lymphoma ◽

Fdg Pet ◽

Early Stage ◽

Clinical Impact ◽

Pet Ct ◽

Fdg Pet Ct

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18F-FDG PET/MRI for staging and interim response assessment in pediatric and adolescent Hodgkin lymphoma: a prospective study with 18F-FDG PET/CT as reference standard

Journal of Nuclear Medicine ◽

10.2967/jnumed.120.260059 ◽

2021 ◽

pp. jnumed.120.260059

Author(s):

Martijn Vincent Verhagen ◽

Leon J Menezes ◽

Deena Neriman ◽

Tom A Watson ◽

Shonit Punwani ◽

...

Keyword(s):

Prospective Study ◽

Hodgkin Lymphoma ◽

Fdg Pet ◽

Response Assessment ◽

Reference Standard ◽

Pet Ct ◽

18F Fdg ◽

A Prospective Study ◽

Fdg Pet Ct

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Prediction of lymph node metastasis using 5-point visual scale criteria of [18F]-fluoro-2-deoxy-D-glucose on positron emission tomography / computed tomography for early stage lung adenocarcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e21084 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e21084-e21084

Author(s):

Atsushi Kagimoto ◽

Yasuhiro Tsutani ◽

Yoshinori Handa ◽

Takahiro Mimae ◽

Yoshihiro Miyata ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Lung Adenocarcinoma ◽

Fdg Pet ◽

Early Stage ◽

Fdg Uptake ◽

Node Metastasis ◽

Deauville Score ◽

Pet Ct ◽

Fdg Pet Ct

e21084 Background: This study aimed to investigate the efficacy of the Deauville criteria, a 5-point visual scale criteria to assess the maximum standardized uptake value (SUVmax) of [18F]-fluoro-2-deoxy-D-glucose (FDG) on positron emission tomography (PET)/computed tomography (CT), in predicting lymph node metastasis and other pathological invasive characteristics of early-stage lung adenocarcinoma. Methods: In this retrospective study including 453 patients undergoing lobectomy or segmentectomy with lymph node dissection for clinical N0 lung adenocarcinoma with a whole size ≤ 3 cm between April 2011 and March 2019, the FDG-PET/CT scans were evaluated using the Deauville criteria to analyze the relationship of Deauville score with the clinicopathological characteristics and prognosis.The scoring method was as follows: Deauville score of 1, no FDG uptake by the primary tumor (same as background); Deauville score of 2, tumor FDG uptake that is the same as or weaker than that of mediastinum; Deauville score of 3, tumor FDG uptake that is stronger than that of mediastinum but same as or weaker than that of liver; Deauville score of 4, tumor FDG uptake that is moderately higher than that of liver; Deauville score of 5, tumor FDG uptake that is markedly stronger than that of liver. Results: The lymph node metastases were present in 0 (0%), 2 (1.1%), 6 (9.5%), 6 (15.8%), and 13 (15.7%) patients with Deauville scores of 1, 2, 3, 4 and 5, respectively. The pathological invasive characteristics (lymphatic, vascular, or visceral pleural invasion) were detected in 2 (2.4%), 17 (9.9%), 18 (28.6%), 23 (60.5%), and 54 (65.1%) patients, respectively. Similar results were found when the study cohort was analyzed according to the institutions where the FDG-PET/CT scans were performed. The 3-year recurrence-free survival was longer in the patients with a Deauville score of 1–2 (97.2%) than those with a Deauville score of 3 (86.2%, p < 0.001) or 4–5 (80.7%, p < 0.001). Conclusions: The 5-point-scale evaluation of the SUVmax on FDG-PET/CT using the Deauville score was useful in predicting not only lymph node metastasis but also other malignancy characteristics of early-stage lung adenocarcinoma.

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The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease

Hematology ◽

10.1182/asheducation-2014.1.135 ◽

2014 ◽

Vol 2014 (1) ◽

pp. 135-143 ◽

Cited By ~ 5

Author(s):

Andrew M. Evens ◽

Lale Kostakoglu

Keyword(s):

Hodgkin Lymphoma ◽

Fdg Pet ◽

Early Stage ◽

Combined Modality Therapy ◽

Imaging Biomarkers ◽

Predictive Tool ◽

Early Stage Disease ◽

Combined Modality ◽

Pet Ct ◽

Fdg Pet Ct

Abstract Given the excellent survival rates for early-stage Hodgkin lymphoma (HL), the young age of many patients, and concerns regarding acute and late treatment-related toxicities, there is a desire to have a predictive tool that enables therapy to be tailored toward the individual patient. Early (or interim) 18F-fluorodeoxyglucose positron emission tomography with computerized tomography (FDG-PET/CT), as a test of tumor sensitivity to ongoing/planned therapy, has been shown to be prognostic for survival in HL. Based on results of interim FDG-PET/CT, therapy may be subsequently modified through minimization or via intensification for low- and high-risk patient populations, respectively (ie, response-adapted therapy). Important data have been generated to standardize the interpretability and reproducibility of interim FDG-PET/CT (eg, the Deauville 5-point system), and observational and noncontrolled prospective studies have produced evidence supporting the hypothesis that response-adapted therapy may potentially serve as a predictive tool. Furthermore, results from noninferiority phase 3 clinical trials randomizing early-stage HL patients with negative interim FDG-PET/CT to combined modality therapy versus chemotherapy alone have been reported. The current collective findings from these randomized early-stage HL studies have shown that acute relapse rates are lower with combined modality therapy, even in patients with negative interim FDG-PET/CT. Additional randomized response-adapted studies are ongoing and novel FDG-PET/CT applications involving quantitative techniques and innovative imaging modalities are being investigated to identify more robust imaging biomarkers. Treatment of early-stage HL remains a clinical management choice for physicians and patients to make with consideration of acute and long-term outcomes.

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The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease

Blood ◽

10.1182/blood-2014-05-577627 ◽

2014 ◽

Vol 124 (23) ◽

pp. 3356-3364 ◽

Cited By ~ 28

Author(s):

Andrew M. Evens ◽

Lale Kostakoglu

Keyword(s):

Hodgkin Lymphoma ◽

Fdg Pet ◽

Early Stage ◽

Combined Modality Therapy ◽

Imaging Biomarkers ◽

Predictive Tool ◽

Early Stage Disease ◽

Combined Modality ◽

Pet Ct ◽

Fdg Pet Ct

Abstract Given the excellent survival rates for early-stage Hodgkin lymphoma (HL), the young age of many patients, and concerns regarding acute and late treatment-related toxicities, there is a desire to have a predictive tool that enables therapy to be tailored toward the individual patient. Early (or interim) 18F-fluorodeoxyglucose positron emission tomography with computerized tomography (FDG-PET/CT), as a test of tumor sensitivity to ongoing/planned therapy, has been shown to be prognostic for survival in HL. Based on results of interim FDG-PET/CT, therapy may be subsequently modified through minimization or via intensification for low- and high-risk patient populations, respectively (ie, response-adapted therapy). Important data have been generated to standardize the interpretability and reproducibility of interim FDG-PET/CT (eg, the Deauville 5-point system), and observational and noncontrolled prospective studies have produced evidence supporting the hypothesis that response-adapted therapy may potentially serve as a predictive tool. Furthermore, results from noninferiority phase 3 clinical trials randomizing early-stage HL patients with negative interim FDG-PET/CT to combined modality therapy versus chemotherapy alone have been reported. The current collective findings from these randomized early-stage HL studies have shown that acute relapse rates are lower with combined modality therapy, even in patients with negative interim FDG-PET/CT. Additional randomized response-adapted studies are ongoing and novel FDG-PET/CT applications involving quantitative techniques and innovative imaging modalities are being investigated to identify more robust imaging biomarkers. Treatment of early-stage HL remains a clinical management choice for physicians and patients to make with consideration of acute and long-term outcomes.

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