FDG PET/CT as a diagnostic and prognostic tool for the evaluation of marginal zone lymphoma

Hematol Oncol. 2019 Apr;37(2):168-175. doi: 10.1002/hon.2578. Epub 2019 Mar 18.

Abstract

We evaluated the role of 18-fluoro-2-deoxy-d-glucose positron emission tomography ([18F] FDG-PET) with computed tomography (CT) (PET/CT) as a diagnostic and prognostic tool in newly diagnosed marginal zone lymphoma (MZL) patients. This is a retrospective cohort study of patients with newly diagnosed MZL, treated with immunotherapy, chemotherapy regimens, surgery, or Helicobacter pylori eradication between 2008 and 2016 in a single tertiary center. Only patients who had a pretreatment PET/CT (P-PET/CT) were included. P-PET/CT, interim (I-PET/CT), and end-of-treatment PET/CT (E-PET/CT) studies were reviewed. P-PET/CT results were reported using two methods of evaluation, qualitative and semi quantitative: visual assessment (VAS) and maximal standardized uptake value (SUVmax), and I-PET and E-PET results were reported by Deauville 5-point score (DS) evaluation as well. Avidity of PET/CT was defined as abnormal uptake in any of these methods. The primary outcome was the prognostic role of P-PET/CT, I-PET/CT, and E-PET/CT on progression-free survival (PFS) and overall survival (OS). Data of 196 patients with MZL were identified, 110 of which had P-PET/CT and were included in this analysis. Median age was 67 years (range 18-93). The median follow-up period was 63 months (range 3-278). The median OS and PFS for the whole cohort were 63 (interquartile range 39-85) and 60 (interquartile range 37-76) months, respectively. The avidity of PET at baseline for the whole cohort was 70% (77/110 patients), for MALT lymphoma, 62.5% (40/64 patients), for NMZL, 76.4% (13/17 patients), and for SMZL, 82.7% (24/29 patients). When adjusted for IPI, sex, and comorbidities, positive E-PET/CT was associated with reduced PFS with a hazard ratio (HR) of 3.4 (95% CI, 1.27-9.14, P = 0.02). Positive E-PET/CT did not correlate with OS. However, there were only three events. P-PET/CT was not predictive of PFS or OS. Our study demonstrates that above 70% of MZL are FDG avid. Positive E-PET/CT is a strong prognostic factor for PFS.

Keywords: FDG-PET/CT; SUV; marginal zone lymphoma; prediction; prognosis.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Disease-Free Survival
  • Female
  • Glucose-6-Phosphate / administration & dosage
  • Glucose-6-Phosphate / analogs & derivatives*
  • Helicobacter Infections* / diagnostic imaging
  • Helicobacter Infections* / mortality
  • Helicobacter Infections* / therapy
  • Helicobacter pylori*
  • Humans
  • Lymphoma, B-Cell, Marginal Zone* / diagnostic imaging
  • Lymphoma, B-Cell, Marginal Zone* / mortality
  • Lymphoma, B-Cell, Marginal Zone* / therapy
  • Male
  • Middle Aged
  • Positron-Emission Tomography*
  • Predictive Value of Tests
  • Retrospective Studies
  • Survival Rate

Substances

  • 2-fluoro-2-deoxyglucose-6-phosphate
  • Glucose-6-Phosphate