title: Surveillance Scans in Lymphoma: Friend or Foe?
abstract: Advancements in the treatment of lymphoma over the last few decades have allowed more patients to achieve a remission after the completion of therapy. Due to the improvement in response rates, methods to detect recurrence early and accurately during follow-up, especially in patients with potential curable aggressive lymphomas, are a key. Observation has always involved close clinical follow-up with the use of physical exams and routine labs, but rapid changes in technology have allowed CT scans, PET scans, and MRIs to become an integral part of managing patients with lymphoma. While the utility of scans in initial staging and immediately after completion of therapy is well established, the use of these imaging modalities for monitoring recurrence in lymphoma patients is still controversial. Patient advocacy groups and other regulatory committees have questioned the frequency and in some cases even the need for these tests in patients without evidence of active disease given the concern for radiation-associated health risks. Additionally, the extent to which this form of testing impacts the psyche of our patients is not completely known. Given the numerous questions raised about the benefits, safety, and cost-effectiveness of CT imaging, firm guidelines are needed at this time in standard practice and within our clinical trials to limit the use of surveillance imaging. Such efforts are expected to improve the utility of these scans in asymptomatic patients, reduce healthcare costs, and reduce patient exposure to radiation.
authors.affiliation: Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA. tycelp@med.umich.edu.
authors.forename: Tycel
authors.initials: T
authors.lastname: Phillips
authors.affiliation: Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Mercer
mesh_terms: D003362:Cost-Benefit Analysis; D003952:Diagnostic Imaging / Q000009:adverse effects* / Q000191:economics / Q000379:methods*; D055088:Early Detection of Cancer; D006801:Humans; D008223:Lymphoma / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008403:Mass Screening; D009017:Morbidity; D009026:Mortality; D049268:Positron-Emission Tomography / Q000009:adverse effects / Q000191:economics / Q000379:methods; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000191:economics / Q000379:methods
keywords: C PET; CT; DLBCL; Hodgkin; Lymphoma; Non-Hodgkin; Survival