Beyond PET/CT in lymphoma: Does PET/CT has similar diagnostic accuracy in recurrent lymphoma cases in TB-endemic countries.

Muhammad Israr Ahmed, Muhammad Saad Ahmed, Waseem Mehmood Nizamani, Amna Rasul

Abstract


TITLE: Beyond PET/CT in lymphoma: Does PET/CT has similar diagnostic accuracy in recurrent lymphoma cases in TB-endemic countries.

BACKGROUND: Lymphoma includes histologically heterogeneous group of tumors which are derived from the cells of the immune system.

OBJECTIVE: The objective of this study is to determine the diagnostic accuracy of PET/CT in recurrence of lymphoma in treated cases. The PET CT findings were correlated with biopsy and histopathological diagnosis.

METHODS: After ethical committee approval, this study was conducted in the PET/CT suite, Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. The study design was cross sectional and sampling technique was non-probability and purposive. The sample size was 155 (Sample size estimated using 95% confidence level and 8% margin of error with an expected sensitivity value of PET/CT as 85% and specificity value as 95%). Patients of all age and both genders who had PET/CT avid disease on follow up scan after achieving complete response after first line of treatment. The patients who had a positive PET/CT were later discussed in MDT and were referred for biopsy. The biopsy of the patient was then performed in appropriate modality to document the exact histopathology which was gold standard in our study

RESULTS: Histopathology confirmed that a total of 70 patients recurrent disease of lymphoma patients.  PET/CT correctly identified 64/70 of the recurrent cases of lymphoma. Thus the sensitivity of the PET/CT was 91.4%. On the other hand, PET/CT truly identified 37/85 cases without recurrent disease of lymphoma making the specificity as 43.5%. The Overall diagnostic accuracy of the PET/CT was 65.5%. Positive and negative predicative values for a diagnosis of recurrent disease of lymphoma on PET/CT were 57.7% and 86.0% respectively.

 CONCLUSION: We have found 65% diagnostic accuracy of PET/CT for detecting recurrent disease in the Lymphoma patients which is lower than internationally published data i.e. 85%. Possible cause of this would be high burden of infectious diseases (particularly tuberculosis) in our society.

 Key words: PET/CT; recurrent lymphoma; tuberculosis


Full Text:

PDF

References


Kwee TC, Kwee RM, Nievelstein RA Imaging in staging of malignant lymphoma: a systematic review. Blood 2008;111:504–516.

Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 . Lyon, France: International Agency for Research on Cancer, 2010.

Raanani P, Shasha Y, Perry C, Metser U, Naparstek E, Apter S, et al. Is CT scan still necessary for staging in Hodgkin and non-Hodgkin lymphoma patients in the PET/CT era? Ann Oncol. 2006; 17 (1): 117-122.

Yasmin B, Asif B, Sania N, Ashfaq A, Ahmed U, Shahid P, et all. Pakistan - Country Profile of Cancer and Cancer Control 1995-2004. JPMA 2006; 56(3):124-130

Kanwal A, Yasmin B, Shahid P. Small B Cell Non-Hodgkins Lymphoma in Pakistan. J Pak Med Assoc. 2006; 56(1):22-25.

Zeba A,Amjad R,Muhammad A,Asif S. Non-Hodgkin’s Lymphoma in Pakistan: A Clinicopathological Profile of 175 Patients. J Pak Med Assoc. 1999;49(1):11-5.

Paes FM, Kalkanis DG, Sideras PA, Serafini AN. FDG PET/CT of extranodal involvement in NonHodgkin Lymphoma and Hodgkin Disease. RadioGraphics 2010; 30:269–291.

Seam P, Juweid ME, Cheson BD. The role of FDG PET scans in patients with lymphoma. Blood 2007; 110:3507–3516.

Niklaus GS, Christian T, Klaus S, Cathrin W, Michael K, Thomas FH. Hodgkin Disease: Diagnostic Value of FDG PET/CT after First-Line Therapy—Is Biopsy of FDG- avid Lesions Still Needed? Radiology 2007; 244: 257-262.

SEER Cancer Statistics Review, 1975-2009. National Cancer Institute. http://seer.cancer.gov/csr/1975_2009_pops09

American Cancer Society. Cancer Facts & Figures. http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf

Quddus F, Armitage JO. Salvage therapy for Hodgkin's lymphoma.Cancer J. 2009;15(2):161-3.

Yuliya SJ, David JS. The Role of PET in Lymphoma. J Nucl Med. 2006;47:1326-1334.

Pamela S, Malik EJ, Bruce DC. The role of FDG-PET scans in patients with lymphoma. Blood. 2007 110: 3507-3516.

Guay C, Lépine M, Verreault J, Bénard F. Prognostic value of PET using 18F-FDG in Hodgkin's disease for posttreatment evaluation.J Nucl Med. 2003 Aug; 44(8):1225-31.

Cremerius U, Fabry U, Neuerburg J, Zimny M, Osieka R, Buell U. Positron emission tomography with 18F-FDG to detect residual disease after therapy for malignant lymphoma. Nucl Med Commun. 1998;19:1055–1063.

Zijlstra JM, Lindauer-van der Werf G, Hoekstra OS, Hooft L, Riphagen II, Huijgens PC18F-fluoro-deoxyglucose positron emission tomography for post-treatment evaluation of malignant lymphoma: a systematic review. Haematologica 2006;91:522–529.

Javaid A, Hasan R, Zafar A, Ghafoor A, Pathan AJ, Rab A, et al. Prevalence of primary multidrug resistance to anti-tuberculosis drugs in Pakistan. Int J Tuberc Lung Dis. 2008;12(3):326-3.


Refbacks

  • There are currently no refbacks.


© Copyright PJR 2008-