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


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Article Info

DATE

2013-05-07

AUTHORS

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

ABSTRACT

PurposeThe 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.MethodsThis international confirmatory study retrospectively evaluated 114 patients with newly diagnosed DLBCL treated with a rituximab-containing regimen. All patients underwent 18F-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.ResultsMedian 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).ConclusionAlthough 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. More... »

PAGES

1312-1320

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00259-013-2435-6

DOI

http://dx.doi.org/10.1007/s00259-013-2435-6

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1025772213

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/23649463


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29 schema:description PurposeThe 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.MethodsThis international confirmatory study retrospectively evaluated 114 patients with newly diagnosed DLBCL treated with a rituximab-containing regimen. All patients underwent 18F-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.ResultsMedian 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).ConclusionAlthough 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.
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36 schema:keywords CT
37 ConclusionAlthough
38 DLBCL
39 Deauville
40 Deauville criteria
41 Deauville score
42 MethodsThis international confirmatory study
43 PET
44 PET/CT
45 PET0
46 PET2
47 PET2-negative patients
48 PET2-positive patients
49 PFS estimates
50 ResultsMedian
51 agreement
52 background
53 baseline
54 baseline scan
55 better performance
56 cell lymphoma
57 center
58 changes
59 comparison
60 computation
61 confirmatory studies
62 criteria
63 cut
64 cycle
65 diffuse
66 early PET/CT
67 estimates
68 five-point scale
69 interim PET
70 interim PET/CT
71 international confirmatory study
72 interobserver agreement
73 interobserver reproducibility
74 interpretation
75 interpretation rules
76 kappa values
77 liver
78 lymphoma
79 months
80 observer
81 outcomes
82 overall kappa value
83 patients
84 performance
85 prediction
86 prognostic value
87 progression-free survival prediction
88 reference background
89 regimen
90 reproducibility
91 rituximab-containing regimen
92 role
93 rules
94 scale
95 scans
96 scores
97 strategies
98 study
99 survival prediction
100 therapeutic strategies
101 therapy changes
102 values
103 ΔSUVmax
104 ΔSUVmax cut
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