The usefulness of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) and a comparison of (18)F-FDG-pet with (67)gallium scintigraphy in the evaluation of lymphoma: relation to histologic subtypes based on the World Health Organization classification.
BACKGROUND
Although studies comparing conventional imaging modalities with (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) for the detection of lymphoma and although the relations between (18)F-FDG-PET and histologic types were reported previously, most studies were not systematic and involved relatively small numbers of patients.


METHODS
Two hundred fifty-five patients with lymphoma had their disease staged using (18)F-FDG-PET, and 191 of those patients also were assessed using gallium-67 scintigraphy ((67)Ga). Disease sites were identified on a site-by-site basis using computed tomography scans and/or magnetic resonance imaging. The results of these conventional imaging modalities were compared with the results from (8)F-FDG-PET and (67)Ga, and correlations between the imaging results and pathologic diagnoses were evaluated by using the World Health Organization classification system.


RESULTS
Of 913 disease sites in 255 patients, (18)F-FDG-PET identified >97% of disease sites of Hodgkin lymphoma (HL) and aggressive and highly aggressive non-Hodgkin lymphoma. For indolent lymphoma, the detection rate of (18)F-FDG-PET was 91% for follicular lymphoma (FL); 82% for extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, irrespective of plasmacytic differentiation; and approximately 50% for small lymphocytic lymphoma (SLL) and splenic marginal zone lymphoma (SMZL). The results from (67)Ga were similar to those from (18)F-FDG-PET for most histologic subtypes. However, the sensitivity of (67)Ga was unexpectedly poor for FL, for mantle cell lymphoma (MCL), and for the nasal type of natural killer/T-cell lymphoma (NK/T-nasal), ranging from 30% to 38%.


CONCLUSIONS
(18)F-FDG-PET was useful for all histologic subtypes of lymphoma other than SLL and SMZL. Compared with (67)Ga, the authors strongly recommend the use of (18)F-FDG-PET in patients with FL, MCL, and NK-nasal.
Tsukamoto
Norifumi
N
Medicine and Clinical Science, Gunma University Graduate School of Medicine, Japan. ntukamot@med.gunma-u.ac.jp
Kojima
Masaru
M
Hasegawa
Masatoshi
M
Oriuchi
Noboru
N
Matsushima
Takafumi
T
Yokohama
Akihiko
A
Saitoh
Takayuki
T
Handa
Hiroshi
H
Endo
Keigo
K
Murakami
Hirokazu
H
D003937:Diagnosis, Differential; D019788:Fluorodeoxyglucose F18; D005710:Gallium Radioisotopes; D006689:Hodgkin Disease / Q000000981:diagnostic imaging*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000000981:diagnostic imaging*; D009367:Neoplasm Staging / Q000379:methods; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed / Q000379:methods*; D014944:World Health Organization
D005710:Gallium Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18