title: Early 18F-FDG PET for prediction of prognosis in patients with diffuse large B-cell lymphoma: SUV-based assessment versus visual analysis.
abstract: The purpose of this study was to assess the prognostic value of early (18)F-FDG PET using standardized uptake value (SUV) compared with visual analysis in patients with diffuse large B-cell lymphoma (DLBCL).
  
  
  METHODS
  Ninety-two patients with newly diagnosed DLBCL underwent (18)F-FDG PET prospectively before and after 2 cycles of chemotherapy (at midtherapy). Maximum SUV (SUVmax) and mean SUV (SUVmean) normalized to body weight and body surface area, as well as tumor-to-normal ratios, were computed on the most intense uptake areas. The SUVs, tumor-to-normal ratios, and their changes over time were compared with visual analysis for predicting event-free survival (EFS) and overall survival, using receiver-operating-characteristic (ROC) analysis. Survival curves were estimated with Kaplan-Meier analysis and compared using the log-rank test.
  
  
  RESULTS
  With visual analysis, the accuracy of early PET to predict EFS was 65.2%. The 2-y estimate for EFS was 51% (95% confidence interval [CI], 34%-68%) in the PET-positive group compared with 79% (95% CI, 68%-90%) in the PET-negative group (P = 0.009). An optimal cutoff value of 65.7% SUVmax reduction from baseline to midtherapy obtained from ROC analysis yielded an accuracy of 76.1% to predict EFS. The 2-y estimate for EFS was 21% (95% CI, 0%-42%) in patients with SUVmax reduction <or= 65.7% compared with 79% (95% CI, 69%-88%) in those with reduction > 65.7% (P < 0.0001). Fourteen patients considered as positive on visual analysis could have been reclassified as good responders.
  
  
  CONCLUSIONS
  SUV-based assessment of therapeutic response during first-line chemotherapy improves the prognostic value of early (18)F-FDG PET compared with visual analysis in DLBCL.
authors.affiliation: Department of Radiology, H. Mondor Hospital, AP-HP/Paris 12 University, Créteil, France.
authors.forename: Chieh
authors.initials: C
authors.lastname: Lin
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Itti
authors.forename: Corinne
authors.initials: C
authors.lastname: Haioun
authors.forename: Yolande
authors.initials: Y
authors.lastname: Petegnief
authors.forename: Alain
authors.initials: A
authors.lastname: Luciani
authors.forename: Jehan
authors.initials: J
authors.lastname: Dupuis
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paone
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Talbot
authors.forename: Alain
authors.initials: A
authors.lastname: Rahmouni
authors.forename: Michel
authors.initials: M
authors.lastname: Meignan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D019788:Fluorodeoxyglucose F18; D005602:France / Q000453:epidemiology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D016393:Lymphoma, B-Cell / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data*; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18