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qPET – a quantitative extension of the Deauville scale to assess response in interim FDG-PET scans in lymphoma

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Abstract

Background

Interim FDG-PET is used for treatment tailoring in lymphoma. Deauville response criteria consist of five ordinal categories based on visual comparison of residual tumor uptake to physiological reference uptakes. However, PET-response is a continuum and visual assessments can be distorted by optical illusions.

Objectives

With a novel semi-automatic quantification tool we eliminate optical illusions and extend the Deauville score to a continuous scale.

Patients and methods

SUVpeak of residual tumors and average uptake of the liver is measured with standardized volumes of interest. The qPET value is the quotient of these measurements. Deauville scores and qPET-values were determined in 898 pediatric Hodgkin’s lymphoma patients after two OEPA chemotherapy cycles.

Results

Deauville categories translate to thresholds on the qPET scale: Categories 3, 4, 5 correspond to qPET values of 0.95, 1.3 and 2.0, respectively. The distribution of qPET values is unimodal with a peak representing metabolically normal responses and a tail of clearly abnormal outliers. In our patients, the peak is at qPET = 0.95 coinciding with the border between Deauville 2 and 3. qPET cut values of 1.3 or 2 (determined by fitting mixture models) select abnormal metabolic responses with high sensitivity, respectively, specificity.

Conclusions

qPET methodology provides semi-automatic quantification for interim FDG-PET response in lymphoma extending ordinal Deauville scoring to a continuous scale. Deauville categories correspond to certain qPET cut values. Thresholds between normal and abnormal response can be derived from the qPET-distribution without need for follow-up data. In our patients, qPET < 1.3 excludes abnormal response with high sensitivity.

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Acknowledgement

The EURO-NET-trial received research support from Deutsche Krebshilfe e.V. - Hermes Medical Solutions AB - Executive Agency for Health and Consumers (EAHC) - Peter-Escher-Stiftung.

Conflicts of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany

    Dirk Hasenclever

  2. Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany

    Lars Kurch, Thomas Georgi, Osama Sabri & Regine Kluge

  3. Department of Pediatrics, University Hospital Halle, Halle, Germany

    Christine Mauz-Körholz & Dieter Körholz

  4. Hermes Medical Solutions AB, Stockholm, Sweden

    Andreas Elsner

  5. Royal Hospital for Sick Children, Edinburgh, Scotland, UK

    Hamish Wallace

  6. Hopital d’Énfants Armand Trousseau, Paris, France

    Judith Landman-Parker

  7. Department of Pediatric Oncology and Hematology, Polish-American Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland

    Angelina Moryl-Bujakowska

  8. Department of Pediatric Hematology and Oncology, Faculty Hospital Motol, Prague, Czech Republic

    Michaela Cepelová

  9. Pediatric Cancer Unit, Astrid Lindgrens Childrens Hospital, Karolinska University Hospital, Stockholm, Sweden

    Jonas Karlén

  10. Department of Pediatric Oncology and Hematology, University Hospital Virgen Macarena Avda, Sevilla, Spain

    Ana Álvarez Fernández-Teijeiro

  11. Department of Pediatric Hematology and Oncology, St. Anna Children’s Hospital, Medical University of Vienna, Vienna, Austria

    Andishe Attarbaschi

  12. Department of Medical Oncology and Radiotherapy, Rikshospitalet – Radiumhospitalet HF, Oslo, Norway

    Alexander Fosså

  13. Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland

    Jane Pears

  14. Clinic of Pediatric Oncology, University Children’s Hospital, Bratislava, Slovakia

    Andrea Hraskova

  15. Department Oncology, University Children’s Hospital, Zurich, Switzerland

    Eva Bergsträsser

  16. Department of Pediatric Oncology/Hematology, MC – Sophia Children’s Hospital, Rotterdam, Netherlands

    Auke Beishuizen

  17. Department of Pediatric Hemato-Oncology, University Hospitals of Leuven, Leuven, Belgium

    Anne Uyttebroeck

  18. Department of Pediatric Oncology and Hematology, H. C. Andersen Children’s Hospital, University of Odense (OUH), Odense, Denmark

    Eckhard Schomerus

Authors
  1. Dirk Hasenclever
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  2. Lars Kurch
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  3. Christine Mauz-Körholz
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  5. Thomas Georgi
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  6. Hamish Wallace
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  7. Judith Landman-Parker
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  8. Angelina Moryl-Bujakowska
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  11. Ana Álvarez Fernández-Teijeiro
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  12. Andishe Attarbaschi
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  13. Alexander Fosså
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  14. Jane Pears
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  15. Andrea Hraskova
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  16. Eva Bergsträsser
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  17. Auke Beishuizen
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  18. Anne Uyttebroeck
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  19. Eckhard Schomerus
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  20. Osama Sabri
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  21. Dieter Körholz
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  22. Regine Kluge
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Corresponding author

Correspondence to Regine Kluge.

Additional information

Dirk Hasenclever and Lars Kurch contributed equally.

Research Support

Deutsche Krebshilfe e.V. (No. 106161)

EAHC – European Agency for Health and Consumers

Peter-Escher-Stiftung für krebskranke Kinder

Hermes Medical Solutions AB

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Hasenclever, D., Kurch, L., Mauz-Körholz, C. et al. qPET – a quantitative extension of the Deauville scale to assess response in interim FDG-PET scans in lymphoma. Eur J Nucl Med Mol Imaging 41, 1301–1308 (2014). https://doi.org/10.1007/s00259-014-2715-9

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  • DOI: https://doi.org/10.1007/s00259-014-2715-9

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