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Journal of Nuclear Medicine

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OtherClinical Investigations (Human)

Interim positron emission tomography in diffuse large B-cell lymphoma

Lars Kurch, Huettmann Andreas, Thomas Walther Georgi, Jan Rekowski, Osama Sabri, Christine Schmitz, Regine Kluge, Ulrich Duehrsen and Dirk Hasenclever
Journal of Nuclear Medicine November 2020, jnumed.120.255034; DOI: https://doi.org/10.2967/jnumed.120.255034
Lars Kurch
1 Universitaetsklinikum Leipzig, Klinik und Poliklinik fuer Nuklearmedizin, Germany;
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Huettmann Andreas
2 Universitaetsklinikum Essen, Klinik fuer Haemetologie, Germany;
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Thomas Walther Georgi
1 Universitaetsklinikum Leipzig, Klinik und Poliklinik fuer Nuklearmedizin, Germany;
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Jan Rekowski
3 Universitaetsklinikum Essen, Institut fuer Medizinische Informatik, Biometrie und Epidemiologie, Germany;
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Osama Sabri
1 Universitaetsklinikum Leipzig, Klinik und Poliklinik fuer Nuklearmedizin, Germany;
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Christine Schmitz
4 Universitaetsklinikum Essen, Klinik fuer Haematologie, Germany;
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Regine Kluge
1 Universitaetsklinikum Leipzig, Klinik und Poliklinik fuer Nuklearmedizin, Germany;
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Ulrich Duehrsen
4 Universitaetsklinikum Essen, Klinik fuer Haematologie, Germany;
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Dirk Hasenclever
5 Universitaet Leipzig, Institut fuer Medizinische Informatik, Statistik und Epidemiologie, Germany
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Abstract

Rationale: In diffuse large B-cell lymphoma, early assessment of treatment response by 18-fluorodeoxyglucose positron emission tomography (PET) may trigger treatment modification. Reliable identification of good and poor responders is important. We compared three competing methods of interim PET evaluation. Methods: Images from 449 patients participating in the ‘Positron Emission Tomography-Guided Therapy of Aggressive Non-Hodgkin Lymphomas’ trial were re-analyzed by applying the visual Deauville score and the standardized uptake value (SUV)-based qPET and ΔSUVmax scales to interim PET scans performed after two cycles of chemotherapy. qPET relates residual lymphoma 18-fluorodeoxyglucose uptake to physiological liver uptake, converting the ordinal Deauville scale into a continuous scale and permitting a direct comparison with the continuous ΔSUVmax scale, which is based on SUVmax changes between baseline and interim scans. Positive and negative predictive values were calculated for progression-free survival. Results: Using established thresholds to distinguish between good and poor responders (visual Deauville score 1-3 vs. 4-5; ΔSUVmax >66% vs. ΔSUVmax ≤66%), the positive predictive value was significantly lower with Deauville than ΔSUVmax (38.4% versus 56.6%; P = 0.03). qPET and ΔSUVmax were strongly correlated on the log scale (Pearson’s r=0.75). When plotted along corresponding percentiles, the positive predictive value curves for qPET and ΔSUVmax were superimposable, with low values up to the 85th percentile and a steep rise thereafter. The recommended threshold of 66% SUVmax reduction for the identification of poor responders was equivalent to qPET=2.26 corresponding to score 5 on the visual Deauville scale. The negative predictive value curves were also superimposable, but remained flat between 80% and 70%. Conclusion: Continuous scales are better suited for interim PET-based outcome prediction than the ordinal Deauville scale. qPET and ΔSUVmax essentially carry the same information. The proportion of poor risk patients identified is less than 15%.

  • Oncology: Lymphoma
  • PET/CT
  • Statistical Analysis
  • Other
  • DLBCL
  • Deauville score
  • delta SUVmax
  • interim PET
  • qPET
  • Copyright © 2020 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

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Journal of Nuclear Medicine: 62 (2)
Journal of Nuclear Medicine
Vol. 62, Issue 2
February 1, 2021
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Interim positron emission tomography in diffuse large B-cell lymphoma
Lars Kurch, Huettmann Andreas, Thomas Walther Georgi, Jan Rekowski, Osama Sabri, Christine Schmitz, Regine Kluge, Ulrich Duehrsen, Dirk Hasenclever
Journal of Nuclear Medicine Nov 2020, jnumed.120.255034; DOI: 10.2967/jnumed.120.255034

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Interim positron emission tomography in diffuse large B-cell lymphoma
Lars Kurch, Huettmann Andreas, Thomas Walther Georgi, Jan Rekowski, Osama Sabri, Christine Schmitz, Regine Kluge, Ulrich Duehrsen, Dirk Hasenclever
Journal of Nuclear Medicine Nov 2020, jnumed.120.255034; DOI: 10.2967/jnumed.120.255034
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Keywords

  • Oncology: Lymphoma
  • PET/CT
  • Statistical Analysis
  • Other
  • DLBCL
  • Deauville score
  • delta SUVmax
  • interim PET
  • qPET
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