Journal Article

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

Véra, Pierre, Tilly, Hervé, Itti, Emmanuel, Gallamini, Andrea, Cashen, Amanda F., Haioun, Corinne, Siegel, Barry A., Casasnovas, René-Olivier, Meignan, Michel, Berriolo-Riedinger, Alina, Biggi, Alberto

2013

Overview

Purpose 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. Methods This international confirmatory study retrospectively evaluated 114 patients with newly diagnosed DLBCL treated with a rituximab-containing regimen. All patients underwent 18 F-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. Results 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). Conclusion 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.

• Publisher: Springer Berlin Heidelberg
• Subject: Adult / Aged / Aged, 80 and over / Cardiology / Data Interpretation, Statistical / Female / Fluorodeoxyglucose F18 / Follow-Up Studies / Humans / Imaging / Lymphoma, Large B-Cell, Diffuse - diagnosis / Male / Medicine / Medicine & Public Health / Middle Aged / Multimodal Imaging / Nuclear Medicine / Observer Variation / Oncology / Original Article / Orthopedics / Positron-Emission Tomography / Predictive Value of Tests / Radiology / Radiopharmaceuticals / Tomography, X-Ray Computed