PET/CT surveillance in patients with Hodgkin lymphoma in first remission is associated with low positive predictive value and high costs

Tarec Christoffer El-Galaly, Karen Juul Mylam, Peter Brown, Lena Specht, Ilse Christiansen, Lars Munksgaard, Hans Erik Johnsen, Annika Loft, Anne Bukh, Victor Vishwanath Iyer, Anne Lerberg Nielsen, Martin Hutchings

75 Citationer (Scopus)

Abstract

Background. The value of performing post-therapy routine surveillance imaging in patients with Hodgkin lymphoma is controversial. This study evaluates the utility of positron emission tomography / computed tomography using 2-[18F]fluoro-2-deoxyglucose (PET/CT) for this purpose and in situations with suspected lymphoma relapse. Design and Methods. We conducted a multicenter retrospective study. Patients with newly diagnosed Hodgkin lymphoma achieving at least a partial remission on first-line therapy were eligible if they received PET/CT surveillance during follow-up. Two types of surveillance PET/CTs were analyzed; routine PET/CT when patients showed no signs of relapse at referral to PET/CT, and clinically indicated PET/CT when recurrence was suspected. Results. A total of 211 routine and 88 clinically indicated PET/CTs were performed in 161 patients. In ten of 22 patients with Hodgkin lymphoma recurrence, a routine PET/CT was the primary tool for the diagnosis of relapse. Extranodal disease, interim PET positive lesions and PET activity at response evaluation were all associated with a PET/CT diagnosed preclinical relapse. The true positive rates of routine PET/CT vs. clinically indicated PET/CT were 5 and 13%, respectively (p=0.02). The overall positive predictive value and negative predictive value of PET/CT was 28% and 100%, respectively. The estimated cost per routine PET/CT diagnosed relapse was 50.778 USD. Conclusions. A negative PET/CT reliably rules out a relapse. The high false positive rate, however, is an important limitation and a confirmatory biopsy is mandatory for the diagnosis of a relapse. With no proven survival benefit for patients with a pre-clinically diagnosed relapse, the high costs and low positive predictive value make PET/CT unfit for routine surveillance of Hodgkin lymphoma patients.
OriginalsprogEngelsk
TidsskriftHaematologica
Vol/bind2012;97(6):931-6
ISSN0390-6078
DOI
StatusUdgivet - 2012

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