Interim 18F-FDG PET SUVmax Reduction Is Superior to Visual Analysis in Predicting Outcome Early in Hodgkin Lymphoma Patients

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FIGURE 1.
Receiver-operating-characteristics curve for determining ΔSUVmax PET0–PET2 cutoff value. Marked point corresponds to cutoff point with best Youden index. AUC = area under the curve.
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FIGURE 2.
PFS (A) and TTP (B) according to PET2 results on basis of 5-point scale analysis.
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FIGURE 3.
PFS (A) and TTP (B) according to PET2 results on basis of ΔSUVmax analysis.

TABLE 1

Characteristics of the 59 Patients

Characteristic	Data
Median age at diagnosis (y)	35.5 (16–76)
Sex
Male	40 (68)
Female	19 (32)
Histologic type
Lymphocyte-rich	5 (9)
Mixed cellularity	7 (12)
Nodular sclerosis	45 (76)
Unclassified^*	2 (3)
Ann Arbor stage
I	5 (9)
II	17 (29)
III	10 (17)
IV	27 (46)
Bulky tumor (mass > 10 cm)	9 (15)
International prognosis score
0–2	23 (39)
≥3	36 (61)

↵* Patients with only extranodal biopsy available were defined as having unclassified HL according to World Health Organization 2008 classification.
Data are n followed by percentage in parentheses, except for age.

TABLE 2

Outcome Prediction Using Semiquantitative or Visual Analysis for PET2 Interpretation^*

Parameter	Semiquantitative analysis (ΔSUVmax ≤ 71% vs. > 71%)	Visual analysis (score 1, 2, 3 vs. 4, 5)
Sensitivity	54%	46%
Specificity	94%	84%
Negative predictive value	88%	85%
Positive predictive value	70%	46%
Accuracy	85%	76%

TABLE 3

Outcome of Subsets of Patients Defined by PET2 Results Combining Visual and Semiquantitative Analysis

PET2
Visual analysis	Semiquantitative analysis	n	Treatment failure (progression or relapse)	4-y PFS	4-y TTP
Score 1–3	ΔSUVmax > 71%	43	6 (14%)	82%	86%
Score 1–3	ΔSUVmax ≤ 71%	3	1 (33%)	67%	67%
Score 4–5	ΔSUVmax > 71%	6	0	83%	100%
Score 4–5	ΔSUVmax ≤ 71%	7	6 (86%)	14%	14%