2-(Fluorine-18)fluoro-2-deoxy-D-glucose positron emission tomography in the detection and staging of malignant lymphoma - A bicenter trial

BACKGROUND. The authors undertook a prospective evaluation of the clinical value of 2-fluoro [18-]-2-deoxyglucose positron emission tomography (FDG-PE T) in the detection and staging of malignant lymphoma compared with compute d tomography (CT) and bone marrow biopsy (BMMB) METHODS. Fifty-two consecutive patients with untreated malignant lymphoma w ere evaluated prospectively in a bicenter study. FDG-PET, CT, and BMB were performed for investigating lymph node/extranodal manifestations and bone m arrow infiltration. Thirty-three percent of the discrepant results were ver ified by biopsy, magnetic resonance imaging, or clinical follow-up (range, 4-24 month). RESULTS. Altogether, 1297 anatomic regions (lymph nodes, organs, and bone m arrow) were evaluated. FDG-PET and CT scans were compared by reciever opera ting characteristic (ROC) curve analysis. The area under the ROC curve were as follows: lymph nodes, 0.996 (PET) and 0.916 (CT); extranodal, 0.999 (PE T) and 0.916 (CT); supradiaphragmatic, 0.996 (PET) and 0.905 (CT); and infr adiaphragmatic, 0.999 (PET) and 0.952 (CT). in these analyses, FDG-PET was significantly superior to CT (P < 0.05), except in infradiaphragmatic regio ns, in which the two methods produced equivalent results. In detecting bone marrow infiltration, FDG-PET was superior to CT and was equivalent to BMB. In 4 of 52 patients (8%), FDG-PET led to an upstaging and a chance of ther apy. CONCLUSION. Noninvasive FDG-PET is very accurate in the staging of malignan t lymphoma. Compared with standard staging modalities (CT and BMB), PET was significantly superior and led to changes in the therapy regimen for 8% of patients. (C) 2001 American Cancer Society.