title: Limited utility of surveillance imaging for detecting disease relapse in patients with non-Hodgkin lymphoma in first complete remission.
abstract: BACKGROUND
  Surveillance imaging with computed tomography (CT) or positron emission tomography with CT (PET/CT) is commonly used in practice in patients with non-Hodgkin lymphoma (NHL) who are in remission after front-line therapies. We aimed to determine the utility of routine imaging for detecting first relapse in patients with NHL in complete remission (CR) after first-line therapies.
  
  
  METHODS
  We retrospectively analyzed patients with NHL who achieved CR after first-line therapies and then subsequently had disease relapse. We evaluated whether the relapse was detected solely by surveillance CT or PET/CT or by patient-reported symptoms or physical examination findings, or both. Subgroup analysis was performed on baseline histologic type (indolent vs. aggressive NHL). Data were also collected to determine the cost of surveillance PET/CT and the number of additional diagnostic imaging procedures, invasive procedures, and iatrogenic complications directly resulting from an abnormality detected on a surveillance scan.
  
  
  RESULTS
  One hundred sixty-three patients with first relapse of NHL between January 1, 2000 and December 31, 2010 were included. The majority of the relapses were detected by patient-reported symptoms or physical examination, or both, as opposed to surveillance imaging (77.9% [n = 127] vs. 22.1% [n = 36]; P < .0001). There was no overall survival difference between the 2 groups (P = .66). Patient-reported symptoms led to the detection of the majority of relapses in aggressive (85.7% [n = 72] vs. 14.3% [n = 12]; P < .0001) as well as indolent NHL (69.6% [n = 55] vs. 30.4% [n = 24]; P = .0007). Surveillance PET/CT contributed to more than 75% of follow-up health care costs in the first 2 years of monitoring for relapse. The surveillance imaging group had 1 reported case of iatrogenic pneumothorax.
  
  
  CONCLUSIONS
  Our retrospective analysis suggests that there is a limited role for surveillance imaging by CT or PET/CT in detecting first relapse in NHL. There was no difference in survival outcomes between the 2 groups in our study.
authors.affiliation: Myeloma and Lymphoma Service, West Virginia University, Morgantown, WV.
authors.forename: Quoc
authors.initials: Q
authors.lastname: Truong
authors.affiliation: Myeloma and Lymphoma Service, West Virginia University, Morgantown, WV.
authors.forename: Nilay
authors.initials: N
authors.lastname: Shah
authors.affiliation: Department of Internal Medicine, West Virginia University, Morgantown, WV.
authors.forename: Mark
authors.initials: M
authors.lastname: Knestrick
authors.affiliation: Myeloma and Lymphoma Service, West Virginia University, Morgantown, WV.
authors.forename: Brendan
authors.initials: B
authors.lastname: Curley
authors.affiliation: Department of Statistics, West Virginia University, Morgantown, WV.
authors.forename: Yanqing
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Myeloma and Lymphoma Service, West Virginia University, Morgantown, WV; Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, WV.
authors.forename: Michael
authors.initials: M
authors.lastname: Craig
authors.affiliation: Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, WV. Electronic address: mehdi.hamadani@gmail.com.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Hamadani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis* / Q000191:economics / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000191:economics / Q000473:pathology*; D049268:Positron-Emission Tomography / Q000191:economics / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000379:methods; D055815:Young Adult
keywords: Imaging; Non-Hodgkin lymphoma; PET/CT; Relapse