title: Thoracic positron emission tomography using 18F-fluorodeoxyglucose for the evaluation of residual mediastinal Hodgkin disease.
abstract: Residual mediastinal masses are frequently observed in patients with Hodgkin disease (HD) after completed therapy, and the discrimination between active tumor tissue and fibrotic residues remains a clinical challenge. We studied the diagnostic value of metabolic imaging by 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in detecting active mediastinal disease and predicting relapse. Twenty-eight HD patients with a residual mediastinal mass of at least 2 cm after initial therapy or after salvage chemotherapy were prospectively assigned to 29 examinations with FDG PET and were evaluated as 29 "subjects." Patients were monitored for at least 1 year after examination and observed for signs of relapse. Median follow-up was 28 months (range, 16 to 68 months). A PET-negative mediastinal tumor was observed in 19 subjects, of whom 16 stayed in remission and 3 relapsed. Progression or relapse occurred in 6 of 10 subjects with a positive PET, whereas 4 subjects remained in remission. The negative predictive value (negative PET result and remission) at 1 year was 95%, and the positive predictive value (positive PET result and relapse) was 60%. The disease-free survival for PET-negative and PET-positive patients at 1 year was 95% and 40%, respectively. The difference was statistically significant. A negative FDG PET indicates that an HD patient with a residual mediastinal mass is unlikely to relapse before 1 year, if ever. On the other hand, a positive PET result indicates a significantly higher risk of relapse and demands further diagnostic procedures and a closer follow-up.
authors.affiliation: Department of Internal Medicine I, University of Cologne, Germany. martin.weihrauch@uni-koeln.de
authors.forename: M R
authors.initials: MR
authors.lastname: Weihrauch
authors.forename: D
authors.initials: D
authors.lastname: Re
authors.forename: K
authors.initials: K
authors.lastname: Scheidhauer
authors.forename: S
authors.initials: S
authors.lastname: Ansén
authors.forename: M
authors.initials: M
authors.lastname: Dietlein
authors.forename: S
authors.initials: S
authors.lastname: Bischoff
authors.forename: H
authors.initials: H
authors.lastname: Bohlen
authors.forename: J
authors.initials: J
authors.lastname: Wolf
authors.forename: H
authors.initials: H
authors.lastname: Schicha
authors.forename: V
authors.initials: V
authors.lastname: Diehl
authors.forename: H
authors.initials: H
authors.lastname: Tesch
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D002330:Carmustine / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003606:Dacarbazine / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D003937:Diagnosis, Differential; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005188:False Negative Reactions; D005189:False Positive Reactions; D005355:Fibrosis; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D006801:Humans; D015993:Life Tables; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D008558:Melphalan / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D011237:Predictive Value of Tests; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D018714:Radiotherapy, Adjuvant; D012074:Remission Induction; D016879:Salvage Therapy; D014055:Tomography, Emission-Computed; D014182:Transplantation, Autologous; D014747:Vinblastine / Q000008:administration & dosage; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D019275:Radiopharmaceuticals; D003561:Cytarabine; D019788:Fluorodeoxyglucose F18; D001761:Bleomycin; D011344:Procarbazine; D014750:Vincristine; D014747:Vinblastine; D005047:Etoposide; D003606:Dacarbazine; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D008558:Melphalan; D002330:Carmustine; D011241:Prednisone