An international confirmatory study of the prognostic value of early PET/CT in diffuse large B-cell lymphoma: comparison between Deauville criteria and ΔSUVmax

医学 核医学 弥漫性大B细胞淋巴瘤 标准摄取值 淋巴瘤 卡帕 内科学 放射科 正电子发射断层摄影术 数学 几何学
作者
Emmanuel Itti,Michel Meignan,Alina Berriolo-Riedinger,Alberto Biggi,Amanda F. Cashen,Pierre Véra,Hervé Tilly,Barry A. Siegel,Andrea Gallamini,Olivier Casasnovas,Corinne Haïoun
出处
期刊:European Journal of Nuclear Medicine and Molecular Imaging [Springer Science+Business Media]
卷期号:40 (9): 1312-1320 被引量:239
标识
DOI:10.1007/s00259-013-2435-6
摘要

The role of interim PET/CT in guiding therapeutic strategies in diffuse large B-cell lymphoma (DLBCL) is debated, mainly because interpretation rules vary among centres. This study aimed to explore the reproducibility and confirm the prognostic value of early PET/CT using the Deauville criteria and ΔSUVmax. This international confirmatory study retrospectively evaluated 114 patients with newly diagnosed DLBCL treated with a rituximab-containing regimen. All patients underwent 18F-FDG PET/CT at baseline (PET0) and after two cycles (PET2), with no therapy change based on the latter. Scans were interpreted by three observers using the Deauville five-point scale and ΔSUVmax between PET0 and PET2 was calculated. Interpretations were evaluated for interobserver agreement and for progression-free survival (PFS) prediction. Median follow-up was 39 months. Early PET/CT was predictive of outcome when interpreted with the Deauville criteria and ΔSUVmax. Using the five-point scale, the overall kappa value was 0.66 with the reference background set in the liver (score ≥4) and interobserver agreement was even better using a 66 % ΔSUVmax cut-off (κ = 0.83). Moreover, the prognostic value of interim PET was slightly inferior when using a Deauville score ≥4 than when using a 66 % ΔSUVmax cut-off: for the Deauville score the 3-year PFS estimate was 59 % (45–73 %) in PET2-positive patients vs. 81 % (71–91 %) in PET2-negative patients (P = 0.003); for the 66 % ΔSUVmax cut-off the 3-year PFS estimate was 44 % (23–65 %) in PET2-positive patients vs. 79 % (70–88 %) in PET2-negative patients (P = 0.0002). Although the Deauville criteria are valid for assessing the prognostic value of early PET/CT in DLBCL, computation of the ΔSUVmax leads to better performance and interobserver reproducibility, and should be preferred when a baseline scan is available.
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