scholarly journals SAT-190 Are Pet Scans Needed in Evaluating Lipid Rich Adrenal Adenomas?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jessica Castellanos-Diaz ◽  
Sherin Elsa Mathews ◽  
Walter Drane ◽  
Stephen Staal ◽  
Hans Kumar Ghayee ◽  
...  
Keyword(s):  
Ct Scan ◽  
Metastatic Melanoma ◽  
Metastatic Lesion ◽  
Imaging Features ◽  
Gadolinium Contrast ◽  
Metastatic Lesions ◽  
Pet Ct ◽  
Biochemical Testing ◽  
Adrenal Nodule

Abstract Introduction Adrenal glands are highly vascularized organs and can be the foci of metastatic disease. Incidentally discovered adrenal nodules should be evaluated with CT or MRI imaging and biochemical testing. Metastatic lesions do not have a specific clinical presentation or imaging features but are suspected when there is attenuation greater than 10 HU, presence of calcification, hemorrhage, or abnormal enhancement signals in CT scan or MRI. However, malignant lesions can be present along with benign ones as described here. Clinical Case A 74-year-old female initially presented with uncontrolled hypertension in 2002, at which time she was found to have a left adrenal incidentaloma. MRI/MRA of the abdomen with and without gadolinium contrast showed a 2.5 x 2.6 cm left adrenal nodule, described as a benign lipid rich adrenal adenoma. Biochemical testing revealed no evidence of pheochromocytoma, hyperaldosteronism, or hypercortisolism. Follow-up CT scan in 2003 showed the left adrenal nodule was slightly larger (3.0 x 2.5 cm) but remained lipid rich (<10 HU). There was also a new sub-centimeter nodule in the left medial-posterior limb with similar appearance. In the interim, she was diagnosed with a melanoma on her back in 2003, which was resected without any evidence of invasion. In 2004, abdominal MRI with and without gadolinium contrast showed stable left adrenal nodules. As she continued to have persistent hypertension, uncontrolled with several medications, biochemical work-up for pheochromocytoma, hyperaldosteronism, and hypercortisolism was repeated and was again negative. Surveillance CT imaging in 2005 did not show any changes to her adrenal adenomas. In 2016, she presented to the emergency room with a hemorrhagic cerebrovascular accident. MRI of the brain was consistent with metastatic lesions. CT scan of the chest, abdomen and pelvis showed metastatic lesions in the lungs, liver, bone, and spleen. There was a new 8 mm right adrenal nodule noted with no changes in the left adrenal nodules. Biopsy of a subcutaneous chest wall nodule revealed metastatic melanoma. Thus, she was started on palliative immunotherapy with nivolumab. During her follow-up, she had a series of PET CT scans over a 6 month period, which showed increasing size (up to 4.3 cm) and FDG uptake in the left adrenal nodule. Surprisingly, the left adrenal nodule had a predominantly fatty density (mean of 5 HU) but with an area of hyperdensity which could represent either an adenoma with a coexisting metastatic lesion or angiomyolipoma. Biopsy of the left adrenal nodule revealed a metastatic melanoma. Conclusion This case describes a benign adrenal nodule coexistent with a metastatic lesion. As the patient had metastatic melanoma, a PET-CT was ordered. Melanoma is known to metastasize to the adrenal. This case serves to remind clinicians to perform a careful medical history as management and outcomes can be affected.

Suspected osseous recurrence visualized on a 68Ga- DOTATATE PET/CT scan during the follow-up of a patient with a resected pulmonary carcinoid tumour

2011 ◽  
Vol 50 (05) ◽  
pp. N57-N59
Author(s):  
S. Geiger ◽  
S. Horster ◽  
A. R. Haug ◽  
A. Hausmann ◽  
M. Schlemmer ◽  
...  
Keyword(s):  
Ct Scan ◽  
Carcinoid Tumour ◽  
Pulmonary Carcinoid ◽  
Pet Ct ◽  
Pet Ct Scan

scholarly journals Imaging analysis of 13 rare cases of renal collecting (Bellini) duct carcinoma in northern China: a case series and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhehao Lyu ◽  
Lili Liu ◽  
Huimin Li ◽  
Haibo Wang ◽  
Qi Liu ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Ct Scan ◽  
Clinical Manifestations ◽  
Northern China ◽  
Renal Tumors ◽  
Imaging Features ◽  
Duct Carcinoma ◽  
Pet Ct ◽  
Bellini Duct Carcinoma ◽  
Mass Type

Abstract Background Collecting (Bellini) duct carcinoma (CDC) is a highly malignant and rare kidney tumor. We report our 12-year experience with CDC and the results of a retrospective analysis of patients and tumor characteristics, clinical manifestations, and imaging features by computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)/CT. Methods Retrospective examination of tumors between January 2007 and December 2019 identified 13 cases of CDC from three medical centers in northern China. All 13 patients underwent CT scan, among which eight underwent dynamic enhanced CT scan, two underwent PET/CT scan, and one underwent magnetic resonance cholangiopancreatography (MRCP) examination. The lesions were divided into nephritis type and mass type according to the morphology of the tumors. Results The study group included ten men and three women with an average age of 64.23 ± 10.74 years. The clinical manifestations were gross hematuria, flank pain, and waist discomfort. The mean tumor size was 8.48 ± 2.48 cm. Of the 13 cases, six (46.2%) were cortical-medullary involved type and seven (53.8%) were cortex–medullary–pelvis involved type. Eleven (84.6%) cases were nephritis type and two (15.4%) were mass type. The lesions appeared solid or complex solid and cystic on CT and MRI. The parenchymal area of the tumors showed isodensity or slightly higher density on unenhanced CT scan in the 13 cases. PET/CT in two cases showed increased radioactivity intake. Evidence of intra-abdominal metastatic disease was present on CT in nine (69.2%) cases. Conclusions The imaging characteristics of CDC differ from those of other renal cell carcinomas. In renal tumors located in the junction zone of the renal cortex and medulla that show unclear borders, slight enhancement, and metastases in the early stage, a diagnosis of CDC needs to be considered. PET/CT provides crucial information for the diagnosis of CDC, as well as for designing treatment strategies including surgery.

scholarly journals Lack of Prognostic Significance of Pre-Treatment Total Metabolic Tumor Volume (TMTV) in Diffuse Large B-Cell Lymphoma (DLBCL)

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1720-1720
Author(s):  
Mayur Narkhede ◽  
Sadaf Qureshi ◽  
Maryam Yazdy ◽  
Roxanna Juarez ◽  
Giuseppe Esposito
Keyword(s):  
Ct Scan ◽  
B Cell ◽  
Prognostic Significance ◽  
B Cell Lymphoma ◽  
Pet Ct ◽  
The Mean ◽  
Pre Treatment ◽  
Pet Ct Scan ◽  
Stage Stage

Abstract Background DLBCL is the most common non-Hodgkin lymphoma (NHL), making up about 30%-40% of NHL in the U.S. PET-CT is recommended as the most accurate imaging technique in DLBCL for staging and response assessment. Pretreatment assessment of PET-CT scan derived metrics such as TMTV has been shown to correlate with PFS and/or overall survival (OS) in DLBCL (Sasanelli 2014) We attempted to replicate this finding using EFS at 24 months as a primary endpoint and compare it with pre-treatment TMTV, TLG and cell of origin (COO). Methods 47 pts with newly diagnosed DLBCL and treated with R-CHOP at our institution between 2014 to 2018 were identified from our electronic medical record system for retrospective analysis after IRB approval. All pts had a pretreatment PET-CT scan available for TMTV measurement. All pts had a pretreatment biopsy which were reviewed along with their clinical information regarding treatment outcome and follow up. Patients were classified as to germinal center B cell (GCB) and non-GCB based on immunochemistry using the Hahn's algorithm. PET-CT scans were reviewed by two nuclear medicine physicians using synovia software, and measurements for TMTV and TLG were recorded. TMTV was calculated using a threshold of 41% of the max pixel value (based on prior studies) to draw the volume of interest (VOI) for a lesion. Pooled t-test was performed to compare TMTV, TLG and COO with EFS at 24 mos. Chi-Square test compared TMTV with COO Results Median age of pts was 58 years, with a median duration of follow up of 26 months. There were 33% with limited stage (Stage I or II) and 67% were advanced stage (Stage III or IV). The mean pretreatment TMTV and pretreatment TLG was 295cm3 and 4519 units. 49% were GCB subtype and 47 % non-GCB. Amongst all patients 19.2 % had an event within 24 mos. When TMTV was compared to EFS at 24 months the mean TMTV was 304 for those who had an event versus 294 without (p=0.95). TLG compared to EFS at 24 months showed a mean TLG of 3391 for those who had an event versus 4914 without (P=0.40). GCB and non-GCB had mean TMTV of 264 and 339 respectively with p =0.59. COO when compared to TLG had means of 4365 and 4933 for GCB and non-GBB respectively with p=0.79.Whereas there was no correlation between stage and COO (p=0.4296) TMTV correlated with Ann Arbor staging (p=0.0002). Conclusion This retrospective study failed to demonstrate a correlation between pre-treatment TMTV, TLG, COO and EFS at 24 months revealing the lack of prognostic significance of pretreatment PET scan derived metrics in DLBCL. Prior studies with TMTV did not evaluate EFS at 24 months as an endpoint and therefore, longer follow up might be needed to demonstrate prognostic significance of pretreatment TMTV minimizing it clinical significance. The different subtypes of DLBCL based on COO as assessed by Hahns algorithm also did not differ in their disease burden as measured by TMTV. Disclosures No relevant conflicts of interest to declare.

Circulating tumor cells (CTC), [18F]fluorodeoxyglucose positron emission tomography, and computed tomography (PET/CT) for treatment monitoring in patients with metastatic breast cancer (MBC)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e12007-e12007
Author(s):  
D. Tamkus ◽  
S. R. Chandana ◽  
K. Berger ◽  
T. Aung
Keyword(s):  
Ct Scan ◽  
Metastatic Disease ◽  
Response To Therapy ◽  
Predictive Values ◽  
Positive Correlation ◽  
Time Points ◽  
Female Patients ◽  
18F Fluorodeoxyglucose ◽  
Pet Ct

e12007 Background: Use of [18F]-fluorodeoxyglucose PET /CT and/or CTC is being investigated to follow up response to treatment in patients with MBC. It is not clear if these tests can be a surrogate for one another. Methods: We retrospectively analyzed a database of female patients with MBC undergoing chemotherapy or hormonal therapy. Most of these patients received at least 2 lines of therapy. Standard CT scan tumor measurements were used to assess response to therapy. CTC were defined either low (0–5) or high (>5). Maximum standard uptake values (max SUV) on PET scan were defined either low (<3) or high (>3). Correlation between the max SUV and CTC counts was statistically analyzed. Sensitivity, specificity, positive and negative predictive values were calculated from 2 x 2 table. Results: A total of 9 female patients with MBC were identified (mean age of 52 years). The receptor status of these patients includes 67 % positive for ER and 33 % positive for HER-2/neu. Median follow up was 9.8 months. There were 59 time points (> or = 4 weeks apart) when either PET/CT or CTC were performed. The results of PET/CT scans were compared with CTC at 38 events. The sensitivity of CTC to detect metastatic disease shown on PET/CT was 32% and specificity of 100%. The positive and negative predictive values were 100% and 32% respectively. There was a positive correlation between the max SUV and CTC count (p = 0.001). However in three patients, despite of progression of disease per PET/CT, CTC were undetectable at three different time points. Interestingly, two out of these three patients were triple negative. Disease progression was confirmed by biopsy in two of these patients. Conclusions: Our data suggest positive correlation between PET/CT scan and CTC. However, CTC had poor sensitivity and negative predictive value to detect progressive metastatic disease. Normal CTC values have to be interpreted cautiously in patients with MBC. We are now planning to investigate the utility of these tests, prospectively, in a large cohort of MBC patients. No significant financial relationships to disclose.

The role of PET-CT in the follow-up of patients with urothelial cancer diagnosis.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 291-291 ◽  
Author(s):  
G. Jankilevich ◽  
F. Ogresta ◽  
L. Gennari ◽  
A. Ominetti ◽  
M. Bermudez ◽  
...  
Keyword(s):  
Ct Scan ◽  
Sensitivity And Specificity ◽  
Cancer Diagnosis ◽  
Urothelial Cancer ◽  
Great Benefit ◽  
Pet Ct ◽  
Urothelial Tumors ◽  
Increased Sensitivity ◽  
Suspected Recurrence

291 Background: Positron emission tomography (PET) is an imaging technique whose principle is the detection of metabolic activity of tumor cells but in urology its use had been restricted due to urinary excretion of the radiotracer and overlap with urological structures, the use of hybrid PET (PET-CT) would allow its use for monitoring patients with urothelial tumors. Methods: Between 2007 and 2010 we performed PET-TC images in consecutive patients with suspected recurrences in CT scan or MRI. All patients had renal, bladder and uretral cancer and were treated with urothelial cancer diagnosis. We evaluate the usefulness of FDG PET-CT and its impact on behavior therapy in suspected recurrence in patients with urothelial carcinoma, compared with conventional studies. Results: 17 patients were studied for suspected recurrence. All patients had positive images previously on CT scan and MRI; positive PET-TC was observed in 14 and 3 studies were negative. The positive PET-CT showed more number of lesions and change the medical and surgical strategy. Of the three studies negative on PET- CT none had recurrence and remain disease free. PET/CT is in a great benefit to the detection recurrence in the follow up of patients with urothelial cancer diagnosis. These results showed an increased sensitivity and specificity over previous work with conventional PET technology. In the series studied, the implementation of PET-CT (FDG) in the follow up of patients with urothelial tumors were an useful tool. Conclusions: PET/CT is in a great benefit to the detection recurrence in the follow up of patients with urothelial cancer diagnosis. These results showed an increased sensitivity and specificity over previous work with conventional PET technology. In the series studied, the implementation of PET-CT (FDG) in the follow up of patients with urothelial tumors were an useful tool. However, multicenter studies and more patients are required to define its role. No significant financial relationships to disclose.

scholarly journals Imaging analysis of 13 rare cases of renal collecting (Bellini) duct carcinoma patients in northern China: a case series and literature review.

2021 ◽  
Author(s):  
Zhehao Lyu ◽  
Lili Liu ◽  
Huimin Li ◽  
Haibo Wang ◽  
Qi Liu ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Ct Scan ◽  
Clinical Manifestations ◽  
Northern China ◽  
Renal Tumors ◽  
Imaging Features ◽  
Duct Carcinoma ◽  
Pet Ct ◽  
Bellini Duct Carcinoma ◽  
Mass Type

Abstract Background: Collecting (Bellini) duct carcinoma (CDC) is a highly malignant and rare kidney tumor. We report our 12-year experience with CDC and the results of a retrospective analysis of patients and tumor characteristics, clinical manifestations, and imaging features by computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)/CT.Methods: Retrospective examination of tumors between January 2007 and December 2019 identified 13 cases of CDC from three medical centers in northern China. All 13 patients underwent CT scan, among which eight underwent dynamic enhanced CT scan, two underwent PET/CT scan, and one underwent magnetic resonance cholangiopancreatography (MRCP) examination. The lesions were divided into nephritis type and mass type according to the morphology of the tumors.Results: The study group included ten men and three women with an average age of 64.23 ± 10.74 years. The clinical manifestations were gross hematuria, flank pain, and waist discomfort. The mean tumor size was 8.48 ± 2.48 cm. Of the 13 cases, six (46.2%) were cortical-medullary involved type and seven (53.8%) were cortex-medullary-pelvis involved type. Eleven (84.6%) cases were nephritis type and two (15.4%) were mass type. The lesions appeared solid or complex solid and cystic on CT and MRI. The parenchymal area of the tumors showed isodensity or slightly higher density on unenhanced CT scan in the 13 cases. PET/CT in two cases showed increased radioactivity intake. Evidence of intra-abdominal metastatic disease was present on CT in nine (69.2%) cases.Conclusions: The imaging characteristics of CDC differ from those of other renal cell carcinomas. In renal tumors located in the junction zone of the renal cortex and medulla that show unclear borders, slight enhancement, and metastases in the early stage, a diagnosis of CDC needs to be considered. PET/CT provides crucial information for the diagnosis of CDC, as well as for designing treatment strategies including surgery.

Talimogene laherparepvec with systemic immunotherapy in melanoma: A real-world experience.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21549-e21549
Author(s):  
Tapas Ranjan Behera ◽  
Yanwen Chen ◽  
Jung Min Song ◽  
Steve Shih-lin Huang ◽  
Pauline Funchain ◽  
...  
Keyword(s):  
Overall Survival ◽  
Metastatic Melanoma ◽  
Real World ◽  
Response Rate ◽  
Local Response ◽  
Single Institution ◽  
Talimogene Laherparepvec ◽  
Metastatic Lesions ◽  
Systemic Immunotherapy

e21549 Background: Talimogene laherparepvec (TVEC) is an FDA approved oncolytic herpes virus for intralesional therapy in unresectable metastatic melanoma. Real world data is sparse regarding the efficacy of TVEC in combination with other systemic therapies used in melanoma. We present outcomes of the largest single institution observational study of the off-label use of TVEC in combination with systemic immunotherapy. Methods: Patients with metastatic melanoma receiving TVEC simultaneously with ipilimumab-nivolumab (Ipi/Nivo) or single agent immunotherapy (either nivolumab or pembrolizumab) were evaluated. The demographics, clinicopathological characteristics, responses to injected lesions and remote metastatic lesions were evaluated. Clinical documentation was used to assess improvement in injected lesion size; time points for initial response and best response were identified. Review of imaging by a radiologist was evaluated to assess responses in remote metastatic lesions. Results: A total of 67 patients receiving TVEC from 2016 to 2020 were evaluated, of which 50 remained evaluable after excluding Merkel cell carcinoma, patients on clinical trial, TVEC monotherapy or those on BRAF-MEK inhibitors, and patients lost to follow up. In total, 29 received systemic immunotherapy simultaneously with TVEC and had been followed for at least a year, with a median follow-up time of 34 months (range, 12-56). At the time of analysis, 14 of 29 patients were alive. 6 of the 29 patients had received prior lines of therapy. Four patients received Ipi/Nivo, while 25 patients received monotherapy including 9 on nivolumab and 16 on pembrolizumab. The median number of TVEC doses received was 6 (range, 2-55) with median average TVEC dose being 3.47 ml (0.5-4 ml). Median time to initial local response was 6 weeks, whereas time to best local response was 14 weeks. Overall response rate in the injected target lesions was in 19 (66%), with complete local response (CR) in 12 (41%), partial response (PR) in 7 (24%), and progressive disease (PD) in 8 (28%). The response rate in distant non-injected lesions was 4 out of 16 (25%), 2 of which had previously progressed on prior systemic therapy. Stable disease was observed in 8 (50%) patients, and progression of disease in 4 (25%). The 1-year overall survival rate in patients receiving TVEC with systemic monotherapy was 80%, 95% CI 0.651-0.9730. Progression free survival at 1-year in the monotherapy group was 71.6%, 95% CI 0.557-0.918. Conclusions: This is the largest single institution, real world experience to our knowledge, which assesses the efficacy of TVEC in combination with systemic immunotherapy. Our cohort suggests that TVEC is an effective treatment in combination with systemic immunotherapy, with a better overall survival observed with combination TVEC and anti-PD1 than seen with historical data from clinical trials of anti-PD-1 monotherapy.

Does FDG-PET/CT Obviate the Need for Standard Diagnostic Contrast-Enhanced CT in Patients with Lymphoma?.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2329-2329
Author(s):  
Rebecca L. Elstrom ◽  
Richard K.J. Brown
Keyword(s):  
Ct Scan ◽  
Fdg Pet ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Enhanced Ct ◽  
Fdg Pet Ct ◽  
Lymphoma Therapy ◽  
Diagnostic Ct

Abstract Background and Significance: Positron emission tomography using 18-fluoro-2-deoxyglucose (FDG-PET) is useful in the staging and follow up of patients with lymphoma, and has been shown in several studies to be more accurate than computed tomography (CT). These studies have, however, demonstrated a continued role for CT in staging and restaging of lymphoma, and the two modalities are complementary. Increasingly, FDG-PET is performed in conjunction with a low radiation dose, non-contrast CT scan for attenuation correction and localization of lesions. Currently, many patients undergo both FDG-PET/CT and standard diagnostic, contrast enhanced CT, at a significant cost both financially and in terms of radiation exposure. In this study, we evaluated the clinical utility of performing both studies in patients with lymphoma. Study Design and Methods: We retrospectively identified patients with lymphoma who had undergone both FDG-PET/CT and diagnostic, contrast-enhanced CT (a scan pair) for either staging or restaging following treatment. Patients were included if the two imaging studies were performed within 6 weeks of each other with no intervening anti-lymphoma therapy. We compared the results of the two studies, identifying findings that were detected in either FDG-PET/CT or diagnostic CT scan but not both. Discrepancies were considered clinically significant if they were determined to be related either to lymphoma or another disease process which potentially required intervention. Results: Eighty-nine scan pairs which met the criteria were identified in 75 patients. Sixty-one scan pairs were performed for staging, and 28 were performed for treatment follow up. FDG-PET/CT detected additional potentially clinically relevant lesions over CT in 30 patients, of which 11 demonstrated increased clinical stage. Lymphoma therapy was changed based on FDG-PET/CT findings in 2 patients, and in one patient an occult rectal cancer was detected. In contrast, diagnostic CT detected 5 potentially clinically relevant findings, including 2 incidental findings (one definite and one possible venous thrombosis), and 3 patients with splenic lesions. Of the patients with splenic lesions, one was found on follow up to be definitely not related to lymphoma, and the nature of the splenic lesions in the other two patients remained indeterminate. No patient had a change of stage or lymphoma therapy based on diagnostic CT scan, and one patient was treated with anticoagulation based on CT findings. In the subgroup of scan pairs performed for follow up, diagnostic CT added clinically relevant information in none of the patients. Conclusion: In our series of patients, diagnostic contrast-enhanced CT scan did not contribute to staging or restaging of lymphoma when performed concurrently with FDG-PET/CT. Two clinically important incidental findings were detected by CT alone, of which one led to intervention.

Clinical Symptom Or Sign-Directed Surveillance Can Be More Useful In Detecting Relapse Compared To Routine Imaging In Patients With Diffuse Large B-Cell Lymphoma In Remission

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2914-2914
Author(s):  
Junshik Hong ◽  
Ji Hyun Kim ◽  
Jinny Park ◽  
Jae Hoon Lee
Keyword(s):  
Ct Scan ◽  
Fdg Pet ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Disease Relapse ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Positive Results

Abstract Background For patients with aggressive lymphoma in complete remission (CR) after primary therapy, efficient detection of relapse with maintenance of performance status is important because there is the second chance for cure by salvage therapy. Contrary to initial staging workup, treatment, and its response evaluation, there is ambiguity in the field of surveillance of patients with lymphoma in CR: intervals of outpatient department (OPD) follow-up, lists of required laboratory tests, and especially routing imaging by computed tomography (CT) scan or 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), have not been firmly standardized according to experts and guidelines. Despite a lack of evidence, routine imaging (RI) with CT or FDG-PET/CT has been widely adopted. The aim of the current study was to analyze the patterns and outcomes of OPD surveillance and to evaluate the role of RI and unplanned early OPD visits in patients with diffuse large B-cell lymphoma (DLBCL) in remission. Methods Patients 1) diagnosed as DLBCL according to 2008 WHO criteria, 2) age °Ã 20 years, 3) achieved CR according to 2007 Revised Criteria after receiving R-CHOP immunochemotherapy with or without following radiotherapy or high dose therapy, and 4) had °Ã 1 OPD visit for the surveillance of relapse, were included. The institutional policy of OPD visits in patients with DLBCL in CR was as follows: OPD visit every 2 to 3 months for the first 2 years, then every 4 to 6 months for the next 3 years, and annually thereafter. History taking, physical examination, and checking complete blood cell count were performed routinely during each visit. Every single OPD visit was reviewed and classified with regard to whether or not it was planned. If an OPD visit was scheduled during the last OPD visit for purpose of surveillance of asymptomatic patients, the visit was classified as a 'planned OPD visit'. An 'unplanned early visit' was defined as any OPD visit earlier than the appointed next visit decided by the patient because of any abnormal symptom or sign. RI was defined as a CT or FDG-PET/CT scheduled by a physician at least 2 months prior to actual scanning for routine surveillance of lymphoma, i.e., without any symptom or sign of relapse. There was no specific institutional policy of RI, and three physicians (Hong J, Park J, and Lee JH) decided whether or not to perform RI during the next visit with consideration of the patient's opinion. Result One hundred and six patients diagnosed between May 2004 and February 2012, satisfied the inclusion criteria. During a median follow-up duration of 38.1 months, 15 patients (14.2%) experienced disease relapse. A total of 856 OPD visits (median 6, range 1-25) were analyzed from the 106 patients; 501 visits were planned OPD visits with RI, 322 visits were planned visits without RI, and 33 visits (33/856 = 3.9%) were unplanned early visits (Fig. 1). RI showed a perfect sensitivity and negative predictive value but low positive predictive value due to frequent false-positive results (Fig. 2). Six of seven patients who underwent routine CT scan and 17 of 21 patients who underwent a surveillance FDG-PET/CT received unnecessary further evaluations, even including biopsy with general anesthesia. Compared to enhanced CT scan, FDG-PET/CT showed a higher rate of false positive results [7/407 (13.7%) for CT vs. 23/165 (13.7%) for FDG-PET/CT]. Unplanned early visits of patients showed a strong association with disease relapse compared to planned OPD visits; one third of the unplanned early visits were due to disease relapse (Fig 3). Due to the small number of patients, it was impossible to determine whether RI can prolong the survival of relapsed patients with DLBCL, although there appeared to be no significant difference between the groups. Conclusions Considering limited diagnostic values in addition to the risk of radiation exposure, financial cost, and anxiety of the patients, RI appears not to be an ideal strategy for surveillance in patients with DLBCL who achieved a CR in the rituximab era. Clinical symptom or sign-directed surveillance can be more useful in detecting relapse compared to RI, at least in patients with DLBCL in remission. It should be emphasized that patients should be encouraged to visit the hospital earlier if they experience any discomfort. Disclosures: Off Label Use: lenalidomide in newly diagnosed myeloma.

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