A functional dynamic scoring model to elucidate the significance of post-induction interim fluorine-18-fluorodeoxyglucose positron emission tomography findings in patients with Hodgkin's lymphoma.
BACKGROUND
The findings of interim fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET/CT) predict progression-free survival of patients with Hodgkin's lymphoma. Historically, the assessment was based on a static all-or-none scoring system. However, the clinical significance of any positivity in interim FDG-PET/CT has not been defined.


METHODS
Ninety-six patients with Hodgkin's lymphoma who underwent interim FDG-PET/CT were evaluated using dynamic and visual scores, employing mediastinal or liver blood pool uptake as a comparator. FDG-PET/CT was prospectively defined as positive if any abnormal F(18)FDG uptake was present. In a retrospective analysis dynamic score 0 indicated resolution of all disease sites; score 1 defined a single residual focus; score 2 denoted a reduction in the number of foci; score 3 defined a reduction in intensity with no reduction in number; and score 4 indicated no change in the number and intensity of foci or appearance of new foci.


RESULTS
The dynamic visual score review reduced the number of positive interim studies from 24 to 6 if a score of 2 or less was considered negative, with significantly better specificity (96%) as compared to static visual scores (78%-86%). The 5-year progression-free survival and overall survival rates in patients who had a negative dynamic score were 92% and 97%, respectively; the corresponding figures for patients with positive results were 50% and 67%.


CONCLUSIONS
A dynamic visual score may be a better indicator for tailoring therapy than static visual scoring.
Dann
Eldad J
EJ
Department of Hematology and Bone Marrow Transplantation, Rambam Medical Center and Technion, P.O. Box 9602, Haifa 31096, Israel. e_dann@rambam.health.gov.il
Bar-Shalom
Rachel
R
Tamir
Ada
A
Epelbaum
Ron
R
Avivi
Irit
I
Ben-Shachar
Menachem
M
Gaitini
Diana
D
Rowe
Jacob M
JM
D000293:Adolescent; D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D055815:Young Adult
D019788:Fluorodeoxyglucose F18
Ann Oncol. 2009 Jul;20(7):1270-4
19228806
Leuk Lymphoma. 2009 Aug;50(8):1257-60
19544140
J Clin Oncol. 2007 Aug 20;25(24):3746-52
17646666
J Nucl Med. 2006 Jun;47(6):1059-66
16741317
N Engl J Med. 1998 Nov 19;339(21):1506-14
9819449
J Clin Oncol. 2009 Jun 1;27(16):2739-41
19398565
Nucl Med Commun. 2007 May;28(5):335-54
17414883
Blood. 2007 Feb 1;109(3):905-9
17018856
Haematologica. 2006 Apr;91(4):475-81
16585014
Blood. 2006 Jan 1;107(1):52-9
16150944
J Clin Oncol. 2007 Feb 10;25(5):579-86
17242396
Ann Oncol. 2005 Jul;16(7):1160-8
15939713
J Clin Oncol. 2009 Apr 10;27(11):1906-14
19273713
J Clin Oncol. 2007 Feb 10;25(5):571-8
17242397
J Clin Oncol. 2006 Jul 1;24(19):3128-35
16754934