Staging in childhood lymphoma

Summary

Aim: The clinical value of positron emission tomography using fluorine-18 fluoro-deoxy-glucose (FDG-PET) in the staging of adult lymphoma has been shown in many studies. However, there are only few data regarding childhood lymphoma. The purpose of this retrospective study was to compare the staging of childhood lymphoma using FDG-PET and the established computed tomography (CT). Method: Whole-body FDG-PET was performed in 25 children with histologically proven Hodgkin ´s disease (n = 18) and non-Hodgkin´s lymphoma (n = 7) using a dedicated PET. The findings were compared with the CT results. Both examinations, FDG-PET and CT, were assessed by two experienced physicians. In each patient, 30 regions were analysed (22 nodal, 8 extranodal). Each region was assessed using a fivevalue scale (definitely/probably positive, equivocal, probably/definitely negative). Results: 662 regions (470 nodal, 192 extranodal) were compared. 91 regions (81 nodal, 10 extranodal; 14%) were concordant positive and 517 regions (347 nodal, 170 extranodal; 78%) were concordant negative. In 47 regions, 48 discordant findings (7%) were described: 27 findings (22 nodal, 5 extranodal) were positive using FDG-PET and negative using CT whereas 21 findings (17 nodal, 4 extranodal) were positive using CT and negative using PET. A total of 7 regions (1%) were judged equivocal in one imaging modality (1 FDG-PET, 6 CT). Using FDG-PET as compared to CT, resulted in a higher staging in 4 of 25 patients and in a lower staging in 2 of 25 patients. Conclusion: Staging of childhood lymphoma using FDGPET shows differences compared with CT resulting in a different staging in 6 of 25 patients. Prospective studies are required to evaluate the impact of these discrepancies on the clinical management of pediatric patients.

Zusammenfassung

Der klinische Nutzen der FDG-PET hinsichtlich des Stagings und der Therapiekontrolle bei adulten Patienten mit Lymphomerkrankung konnte in einer Vielzahl von Studien gezeigt werden. Im Kindesalter gibt es hierzu nur wenige Daten. Ziel dieser retrospektiven Studie ist der Vergleich der Ganzkörper-FDG-PET und der CT beim Staging des M. Hodgkin (HD) und der Non-Hodgkin- Lymphome (NHL) im Kindesalter. Methode: Bei 25 pädiatrischen Patienten mit histologisch gesicherten Lymphomen (18 HD, 7 NHL) erfolgten FDG-PET-Untersuchungen in Ganzkörpertechnik. Die FDG-PET-Aufnahmen wurden im Vergleich zu denen mit CT von je zwei erfahrenen Untersuchern hinsichtlich der Erkennung von Lymphommanifestationen analysiert. Zum Vergleich wurde eine Einteilung in 30 Regionen pro Patient (22 nodal, 8 extranodal) vorgenommen. Die FDG-PET und die CT wurden in jeder Region jeweils mit einer 5-Wert-Skala (sicher/wahrscheinlich positiv, unbestimmt, wahrscheinlich/ sicher negativ) beurteilt. Ergebnisse: Insgesamt wurden 662 Regionen (470 nodal, 192 extranodal) analysiert. 91 Regionen (81 nodal, 10 extranodal; 14%) wurden konkordant positiv und 517 Regionen (347 nodal, 170 extranodal; 78%) konkordant negativ befundet. In 47 Regionen wurden 48 Läsionen diskordant bewertet (7%): 27 Läsionen (22 nodal, 5 extranodal) waren positiv in der FDG-PET und negativ in der CT, 21 Läsionen (17 nodal, 4 extranodal) hingegen negativ in der FDG-PET und positiv in der CT. 7 Regionen (1%) wurden mit einer der beiden bildgebenden Methoden als unbestimmt eingestuft (1 FDG-PET, 6 CT). Im Vergleich zur CT ergibt sich in der FDG-PET bei 4 von 25 Patienten ein höheres Staging und bei 2 von 25 Patienten ein niedrigeres Staging. Schlussfolgerung: Mit der FDG-PET ergeben sich im Vergleich zur CT bei Lymphomen im Kindesalter Unterschiede, die bei 6 von 25 Patienten zu einem anderen Staging führen. Prospektive Studien mit Validierung der diskrepanten Befunde werden benötigt.

Keywords

Paediatrics - lymphoma - Hodgkin - staging

Schlüsselwörter

Pädiatrie - Lymphom - Hodgkin - Staging

• References

• 1 Arita T, Kuramitsu T, Kawamura M. et al. Bronchogenic carcinoma: incidence of metastases to normal sized lymph nodes. Thorax 1995; 50: 1267-9.
• 2 Brink I, Reinhardt MJ, Hoegerle S. et al. Increased metabolic activity in the thymus gland studied with ¹⁸F-FDG PET: age dependency and frequency after chemotherapy. J Nucl Med 2001; 42: 591-5.
• 3 Buchmann I, Reinhardt M, Elsner K. et al. 2-(fluorine-18)fluoro-2-deoxy-D-glucose positron emission tomography in the detection and staging of malignant lymphoma. A bicenter trial. Cancer 2001; 91: 889-99.
• 4 Cohade C, Osman M, Pannu HK. et al. Uptake in supraclavicular area fat (USA-Fat): description on ¹⁸F-FDG PET/CT. J Nucl Med 2003; 44: 170-6.
• 5 Franzius C, Schober O. Assessment of therapy response by FDG PET in pediatric patients. Q J Nucl Med 2003; 47: 41-5.
• 6 Friedberg JW, Chengazi V. PET scans in the staging of lymphoma: current status. Oncologist 2003; 8: 438-47.
• 7 Gross BH, Glazer GM, Orringer MB. et al. Bronchogenic carcinoma metastatic to normalsized lymph nodes: frequency and significance. Radiology 1988; 166: 71-4.
• 8 Hull MC, Morris CG, Pepine CJ. et al. Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of hodgkin lymphoma treated with radiation therapy. JAMA 2003; 290: 2831-7.
• 9 Deutsche Krebsgesellschaft: Kurzgefasste Interdisziplinäre Leitlinien. 3. Auflage, Zuckerschwerdt 2002
• 10 Jabour BA, Choi Y, Hoh CK. et al. Extracranial head and neck: PET imaging with 2-[F-18]fluoro- 2-deoxy-D-glucose and MR imaging correlation. Radiology 1993; 186: 27-35.
• 11 Kostakoglu L, Goldsmith SJ. Fluorine-18 fluorodeoxyglucose positron emission tomography in the staging and follow-up of lymphoma: is it time to shift gears?. Eur J Nucl Med 2000; 27: 1564-78.
• 12 Lardinois D, Weder W, Hany TF. et al. Staging of non-small-cell lung cancer with integrated positron- emission tomography and computed tomography. N Engl J Med 2003; 348: 2500-7.
• 13 Leung W, Sandlund JT, Hudson MM. et al. Second malignancy after treatment of childhood non-Hodgkin lymphoma. Cancer 2001; 92: 1959-66.
• 14 Montravers F, McNamara D, Landman-Parker J. et al. ¹⁸F-FDG in childhood lymphoma: clinical utility and impact on management. Eur J Nucl Med Mol Imaging 2002; 29: 1155-65.
• 15 Ng AK, Bernardo MVP, Weller E. et al. Second malignancy after Hodgkin disease treated with radiation therapy with or without chemotherapy: long-term risks and risk factors. Blood 2002; 100: 1989-96.
• 16 O’Doherty MJ, Macdonald EA, Barrington SF. et al. Positron emission tomography in the management of lymphomas. Clin Oncol (R Coll Radiol) 2002; 14: 415-26.
• 17 Partridge S, Timothy A, O’Doherty MJ. et al. 2-Fluorine-18-fluoro-2-deoxy-D-glucose positron emission tomography in the pretreatment staging of Hodgkin’s disease: influence on patient management in a single institution. Ann Oncol 2000; 11: 1273-9.
• 18 Pastore G, Magnani C, Verdecchia A. et al. Survival of childhood lymphomas in Europe, 1978- 1992: a report from the EUROCARE study. Eur J Cancer 2001; 37: 703-10.
• 19 Piepsz A, Hahn K, Roca I. et al. A radiopharmaceuticals schedule for imaging in paediatrics. Paediatric Task Group European Association Nuclear Medicine. Eur J Nucl Med 1990; 17: 127-9.
• 20 Pond GD, Castellino RA, Horning S. et al. Non- Hodgkin lymphoma: influence of lymphography, CT, and bone marrow biopsy on staging and management. Radiology 1989; 170: 159-64.
• 21 Reske SN, Kotzerke J. FDG-PET for clinical use. Results of the 3rd German Interdisciplinary Consensus Conference, Onko-PET III. 21 July and 19 September 2000. Eur J Nucl Med 2001; 28: 1707-23.
• 22 Reske SN. PET and restaging of malignant lymphoma including residual masses and relapse. Eur J Nucl Med Mol Imaging 2003; 30 (Suppl. 01) S89-96.
• 23 Ries L, Smith M, Gurney J. et al. Cancer Incidence and Survival among Children and Adolescents: United States SEER Program 1975- 1995, National Cancer Institute, SEER Program. NIH Publication; 1999
• 24 Schiepers C, Filmont J, Czernin J. PET for staging of Hodgkin’s disease and non-Hodgkin’s lymphoma. Eur J Nucl Med Mol Imaging 2003; 30 (Suppl. 01) S82-8.
• 25 Schoder H, Larson SM, Yeung HWD. PET/CT in oncology: integration into clinical management of lymphoma, melanoma, and gastrointestinal malignancies. J Nucl Med 2004; 45 (Suppl. 01) 72S-81.
• 26 Spaepen K, Stroobants S, Verhoef G. et al. Positron emission tomography with ¹⁸F-FDG for therapy response monitoring in lymphoma patients. Eur J Nucl Med Mol Imaging 2003; 30 (Suppl. 01) S97-105.
• 27 Talbot JN, Haioun C, Rain JD. et al. ¹⁸F-FDG positron imaging in clinical management of lymphoma patients. Crit Rev Oncol Hematol 2001; 38: 193-221.
• 28 Weihrauch MR, Re D, Bischoff S. et al. Wholebody positron emission tomography using ¹⁸Ffluorodeoxyglucose for initial staging of patients with Hodgkin’s disease. Ann Hematol 2002; 81: 20-5.
• 29 Wickmann L, Luders H, Dorffel W. ¹⁸F-FDGPET- findings in children and adolescents with Hodgkin’s disease: retrospective evaluation of the correlation to other imaging procedures in initial staging and to the predictive value of follow up examinations. Klin Pädiatr 2003; 215: 146-50.
• 30 Yeung HWD, Grewal RK, Gonen M. et al. Patterns of ¹⁸F-FDG uptake in adipose tissue and muscle: a potential source of false-positives for PET. J Nucl Med 2003; 44: 1789-96.