title: Qualitative visual trichotomous assessment improves the value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in predicting the prognosis of diffuse large B-cell lymphoma.
abstract: BACKGROUND
  Fluorine-18 fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) is a powerful tool for monitoring the response of diffuse large B-cell lymphoma (DLBCL) to therapy, but the criteria to interpret PET/CT results remain under debate. We investigated the value of post-treatment PET/CT in predicting the prognosis of DLBCL patients when interpreted according to qualitative visual trichotomous assessment (QVTA) criteria compared with the Deauville criteria.
  
  
  METHODS
  In this retrospective study, final PET/CT scans of DLBCL patients treated with rituximab-based regimens between October 2005 and November 2010 were interpreted using the Deauville and QVTA criteria. Survival curves were estimated using Kaplan-Meier analysis and compared using the log-rank test.
  
  
  RESULTS
  A total of 253 patients were enrolled. The interpretation according to the Deauville criteria revealed that 181 patients had negative PET/CT scan results and 72 had positive results. The 3 year overall survival (OS) rate was significantly higher in patients with negative scan results than in those with positive results (91.6% vs. 57.5%, P<0.001). The 72 patients with positive scan results according to the Deauville criteria were divided into two groups by the interpretation according to the QVTA criteria: 29 had indeterminate results, and 43 had positive results. The 3 year OS rate was significantly higher in patients with indeterminate scan results than in those with positive results (91.2% vs. 33.5%, P<0.001) but was similar between patients with negative and indeterminate scan results (91.6% vs. 91.2%, P=0.921).
  
  
  CONCLUSIONS
  Compared with the Deauville criteria, using the QVTA criteria for interpreting post-treatment PET/CT scans of DLBCL patients is likely to reduce the number of false positive results. The QVTA criteria are feasible for therapeutic outcome evaluation and can be used to guide risk-adapted therapy.
authors.affiliation: Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, P. R. China. zhangx2@sysucc.org.cn.|Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. zhangx2@sysucc.org.cn.
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, P. R. China. fanwei@sysucc.org.cn.|Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. fanwei@sysucc.org.cn.
authors.forename: Wei
authors.initials: W
authors.lastname: Fan
authors.affiliation: Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, P. R. China. huyy@sysucc.org.cn.|Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. huyy@sysucc.org.cn.
authors.forename: Ying-Ying
authors.initials: YY
authors.lastname: Hu
authors.affiliation: Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, P. R. China. lizhm@sysucc.org.cn.|Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. lizhm@sysucc.org.cn.
authors.forename: Zhi-Ming
authors.initials: ZM
authors.lastname: Li
authors.affiliation: Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, P. R. China. xiazhj@sysucc.org.cn.|Department of Hematological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. xiazhj@sysucc.org.cn.
authors.forename: Zhong-Jun
authors.initials: ZJ
authors.lastname: Xia
authors.affiliation: Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, P. R. China. linxp@sysucc.org.cn.|Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. linxp@sysucc.org.cn.
authors.forename: Xiao-Ping
authors.initials: XP
authors.lastname: Lin
authors.affiliation: Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, P. R. China. zhangyr@sysucc.org.cn.|Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. zhangyr@sysucc.org.cn.
authors.forename: Ya-Rui
authors.initials: YR
authors.lastname: Zhang
authors.affiliation: Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, P. R. China. liangpy@sysucc.org.cn.|Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. liangpy@sysucc.org.cn.
authors.forename: Pei-Yan
authors.initials: PY
authors.lastname: Liang
authors.affiliation: Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, P. R. China. liyuanh@sysucc.org.cn.|Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China. liyuanh@sysucc.org.cn.
authors.forename: Yuan-Hua
authors.initials: YH
authors.lastname: Li
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived; D006801:Humans; D053208:Kaplan-Meier Estimate; D016393:Lymphoma, B-Cell; D016403:Lymphoma, Large B-Cell, Diffuse; D008722:Methods; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011379:Prognosis; D012189:Retrospective Studies; D000069283:Rituximab; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab