title: Surveillance imaging for lymphoma: pros and cons.
abstract: There is no international consensus on the optimal frequency or duration of computed tomography or positron emission tomography scanning for surveillance in patients who achieve complete remission after initial therapy for lymphoma. Although some clinical practice guidelines suggest periodic imaging is reasonable, others suggest little or no benefit to this practice. From a theoretical perspective, the frequency and duration of surveillance imaging is largely dependent upon the lymphoma subtype. Aggressive lymphomas with a fast growth rate will require surveillance more frequently and for a shorter duration compared to the indolent lymphomas. Historically, relapse has been detected in a majority of patients based upon clinically evident signs and symptoms. Currently, no study has demonstrated an overall survival difference for patients with relapse detected by imaging as opposed to clinical evaluation, although one study did demonstrate a lower second-line International Prognostic Index in patients with relapse detected by surveillance imaging. Enthusiasm for this finding has been tempered by recent studies highlighting the potential long-term risk of secondary malignancies because of ionizing radiation exposure from diagnostic imaging. These factors along with the significant costs associated with diagnostic imaging have contributed to an ongoing debate regarding the relative costs, risks, and benefits of radiographic surveillance. Herein we present perspectives for and against routine surveillance imaging in an effort to facilitate a better understanding of the issues relevant to what is ultimately a clinical decision made by an oncologist and his or her patient.
authors.affiliation: From the: Division of Hospital Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO; Lymphoma Division, Memorial Sloan Kettering Cancer Center, New York, NY; Division of Oncology, Department of Medicine, University of Nebraska; Division of Oncology, Department of Medicine, Washington University School of Medicine; and Division of Hematology/Oncology, St. Louis VA Medical Center, St. Louis, MO.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Lynch
authors.affiliation: From the: Division of Hospital Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO; Lymphoma Division, Memorial Sloan Kettering Cancer Center, New York, NY; Division of Oncology, Department of Medicine, University of Nebraska; Division of Oncology, Department of Medicine, Washington University School of Medicine; and Division of Hematology/Oncology, St. Louis VA Medical Center, St. Louis, MO.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Zelenetz
authors.affiliation: From the: Division of Hospital Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO; Lymphoma Division, Memorial Sloan Kettering Cancer Center, New York, NY; Division of Oncology, Department of Medicine, University of Nebraska; Division of Oncology, Department of Medicine, Washington University School of Medicine; and Division of Hematology/Oncology, St. Louis VA Medical Center, St. Louis, MO.
authors.forename: James O
authors.initials: JO
authors.lastname: Armitage
authors.affiliation: From the: Division of Hospital Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO; Lymphoma Division, Memorial Sloan Kettering Cancer Center, New York, NY; Division of Oncology, Department of Medicine, University of Nebraska; Division of Oncology, Department of Medicine, Washington University School of Medicine; and Division of Hematology/Oncology, St. Louis VA Medical Center, St. Louis, MO.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Carson
mesh_terms: D003952:Diagnostic Imaging / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D017408:Guidelines as Topic; D006801:Humans; D008223:Lymphoma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000628:therapy; D011379:Prognosis; D012074:Remission Induction; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods