title: Surveillance imaging of Hodgkin lymphoma patients in first remission: a clinical and economic analysis.
abstract: BACKGROUND
  The majority of patients with Hodgkin lymphoma (HL) achieve disease remission after primary therapy. To the best of the authors' knowledge, no consensus exists for postremission surveillance imaging.
  
  
  METHODS
  Retrospectively analyzed were 192 adult patients with classic HL in first remission. Events were defined as recurrent HL or secondary malignancies. Primary outcome was positive predictive value (PPV) of surveillance positron emission tomography/computed tomography (PET/CT) and CT scans in event detection. Secondary outcomes were costs and radiation exposures of surveillance scans.
  
  
  RESULTS
  Sixteen events (12 recurrent HL cases and 4 secondary malignancies) were detected during a median follow-up of 31 months. The PPV of surveillance PET/CT was 22.9% compared with 28.6% for CT (P=.73). Factors that were found to significantly improve the PPV of scans in detecting recurrent HL included PET and CT concordance, involvement of a prior disease site, or the occurrence of a radiographic abnormality within 12 months. There were too few events to determine whether event detection by PET/CT versus CT or the presence of symptoms at the time of event detection affected overall outcomes. The cost to detect a single event was approximately $100,000. Radiation exposure to detect a single event was 146.6 millisieverts per patient for each of 9 patients.
  
  
  CONCLUSIONS
  For patients with HL in first disease remission, surveillance radiography appears to be expensive, with limited clinical impact. Surveillance CT is generally adequate.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02114, USA.
authors.forename: Alfred Ian
authors.initials: AI
authors.lastname: Lee
authors.forename: Dan S
authors.initials: DS
authors.lastname: Zuckerman
authors.forename: Annick D
authors.initials: AD
authors.lastname: Van den Abbeele
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Aquino
authors.forename: Diane
authors.initials: D
authors.lastname: Crowley
authors.forename: Christiana
authors.initials: C
authors.lastname: Toomey
authors.forename: Ann S
authors.initials: AS
authors.lastname: Lacasce
authors.forename: Yang
authors.initials: Y
authors.lastname: Feng
authors.forename: Donna S
authors.initials: DS
authors.lastname: Neuberg
authors.forename: Ephraim P
authors.initials: EP
authors.lastname: Hochberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019788:Fluorodeoxyglucose F18; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019788:Fluorodeoxyglucose F18