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First published online September 14, 2007
J Nucl Med 2007, doi:10.2967/jnumed.107.042093
© 2007 by Society of Nuclear Medicine
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Early 18F-FDG PET for Prediction of Prognosis in Patients with Diffuse Large B-Cell Lymphoma: SUV-Based Assessment Versus Visual Analysis

Chieh Lin 1, Emmanuel Itti 2, Corinne Haioun 3, Yolande Petegnief 4, Alain Luciani 1, Jehan Dupuis 3, Gaetano Paone 2, Jean-Noël Talbot 4, Alain Rahmouni 1, and Michel Meignan 2*

1 Department of Radiology, H. Mondor Hospital, AP-HP/Paris 12 University, Créteil, France
2 Department of Nuclear Medicine, H. Mondor Hospital, AP-HP/Paris 12 University, Créteil, France
3 Department of Hematology, H. Mondor Hospital, AP-HP/Paris 12 University, Créteil, France
4 Department of Nuclear Medicine, Tenon Hospital, AP-HP/Paris 6 University, Paris, France

* To whom correspondence should be addressed. E-mail: michel.meignan{at}hmn.aphp.fr.


   Abstract

The purpose of this study was to assess the prognostic value of early 18F-FDG PET using standardized uptake value (SUV) compared with visual analysis in patients with diffuse large B-cell lymphoma (DLBCL). Methods: Ninety-two patients with newly diagnosed DLBCL underwent 18F-FDG PET prospectively before and after 2 cycles of chemotherapy (at midtherapy). Maximum SUV (SUVmax) and mean SUV (SUVmean) normalized to body weight and body surface area, as well as tumor-to-normal ratios, were computed on the most intense uptake areas. The SUVs, tumor-to-normal ratios, and their changes over time were compared with visual analysis for predicting event-free survival (EFS) and overall survival, using receiver-operating-characteristic (ROC) analysis. Survival curves were estimated with Kaplan–Meier analysis and compared using the log-rank test. Results: With visual analysis, the accuracy of early PET to predict EFS was 65.2%. The 2-y estimate for EFS was 51% (95% confidence interval [CI], 34%–68%) in the PET-positive group compared with 79% (95% CI, 68%–90%) in the PET-negative group (P = 0.009). An optimal cutoff value of 65.7% SUVmax reduction from baseline to midtherapy obtained from ROC analysis yielded an accuracy of 76.1% to predict EFS. The 2-y estimate for EFS was 21% (95% CI, 0%–42%) in patients with SUVmax reduction ≤ 65.7% compared with 79% (95% CI, 69%–88%) in those with reduction > 65.7% (P < 0.0001). Fourteen patients considered as positive on visual analysis could have been reclassified as good responders. Conclusion: SUV-based assessment of therapeutic response during first-line chemotherapy improves the prognostic value of early 18F-FDG PET compared with visual analysis in DLBCL.

Key Words: early PET, standardized uptake value, lymphoma, prognosis, response




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