TY - JOUR
T1 - An international confirmatory study of the prognostic value of early PET/CT in diffuse large B-cell lymphoma
T2 - Comparison between Deauville criteria and ΔsUVmax
AU - Itti, Emmanuel
AU - Meignan, Michel
AU - Berriolo-Riedinger, Alina
AU - Biggi, Alberto
AU - Cashen, Amanda F.
AU - Véra, Pierre
AU - Tilly, Hervé
AU - Siegel, Barry A.
AU - Gallamini, Andrea
AU - Casasnovas, René Olivier
AU - Haioun, Corinne
PY - 2013/9
Y1 - 2013/9
N2 - Purpose: The 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. Methods: This 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. Results: Median 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). Conclusion: Although 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.
AB - Purpose: The 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. Methods: This 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. Results: Median 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). Conclusion: Although 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.
KW - Deauville scale
KW - Diffuse large B-cell lymphoma
KW - Interobserver agreement
KW - Outcome prediction
KW - PET/CT
KW - SUV
UR - http://www.scopus.com/inward/record.url?scp=84881665184&partnerID=8YFLogxK
U2 - 10.1007/s00259-013-2435-6
DO - 10.1007/s00259-013-2435-6
M3 - Article
C2 - 23649463
AN - SCOPUS:84881665184
SN - 1619-7070
VL - 40
SP - 1312
EP - 1320
JO - European Journal of Nuclear Medicine and Molecular Imaging
JF - European Journal of Nuclear Medicine and Molecular Imaging
IS - 9
ER -