Limited benefit of additional contrast-enhanced CT to end-of-treatment PET/CT evaluation in patients with follicular lymphoma

Abstract Despite follicular lymphoma (FL) is frequently characterized by a moderate increase of glucose metabolism, PET/CT examinations provides valuable information for staging and response assessment of the disease. The aim of the study was to assess and compare the diagnostic performance of PET/l...

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Autores principales:	Gaetano Paone, Mariana Raditchkova-Sarnelli, Teresa Ruberto-Macchi, Marco Cuzzocrea, Emanuele Zucca, Luca Ceriani, Luca Giovanella
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/8347340d625b42e5b72a349754e0ed01
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spelling	oai:doaj.org-article:8347340d625b42e5b72a349754e0ed012021-12-02T18:49:53ZLimited benefit of additional contrast-enhanced CT to end-of-treatment PET/CT evaluation in patients with follicular lymphoma10.1038/s41598-021-98081-x2045-2322https://doaj.org/article/8347340d625b42e5b72a349754e0ed012021-09-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-98081-xhttps://doaj.org/toc/2045-2322Abstract Despite follicular lymphoma (FL) is frequently characterized by a moderate increase of glucose metabolism, PET/CT examinations provides valuable information for staging and response assessment of the disease. The aim of the study was to assess and compare the diagnostic performance of PET/ldCT and PET/ceCT, respectively, in evaluating FL patients at the end of treatment. Fifty FL consecutive patients who underwent end-of-therapy PET/CT with both ldCT and ceCT were analyzed. Two blinded observers independently assessed PET/ldCT and PET/ceCT applying the Deauville score (DS) and Lugano classification criteria. PET imaging obtained after the end-of-treatment (EoT) was classified as showing PET and ce-CT matched response (concordant imaging group, CIG) or PET and ce-CT unmatched response (discordant imaging group, DIG). Relapse rate and Event-Free Survival (EFS) were compared between CIG and DIG patients. Overall, no differences in metabolic response classification were observed between PET/ldCT and PET/ceCT. In 13 (26%) patients PET/ceCT identified additional FDG-negative nodal lesions in mesenteric, retroperitoneal and iliac regions. However, in all cases, final DS remained unchanged and the additional results did not modify the following therapeutic decision. Among patients, who obtained complete metabolic response a comparable rate of relapse was registered in DIG 3/13 (23%) and CIG subgroups 5/20 (25%) [p = 0.899]. In all 3 DIG cohort patients who relapsed the recurrent disease involved also, but not exclusively, PET negative lymph nodes detected by ceCT. In overall population metabolic response defined by PET/ldCT predicted EFS [76% (group of patients with metabolic response) vs 35% (group of patients with residual disease), p = 0.0013] significantly better than ceCT-Based response assessment [75% (group of patients with complete response) vs 53% (group of patients with residual disease), p = 0.06]. Our study demonstrates a negligible diagnostic and predictive value of ceCT performed in addition to standard 18FDG PET/ldCT for EoT response evaluation in FLs. PET/ldCT should be performed as first-line imaging procedure, also in patients with prevalent abdominal and pelvic involvement, limiting the acquisition of ceCT in selected cases. This tailored approach would contribute to avoid useless radiation exposure and preserve renal function of patients.Gaetano PaoneMariana Raditchkova-SarnelliTeresa Ruberto-MacchiMarco CuzzocreaEmanuele ZuccaLuca CerianiLuca GiovanellaNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Gaetano Paone Mariana Raditchkova-Sarnelli Teresa Ruberto-Macchi Marco Cuzzocrea Emanuele Zucca Luca Ceriani Luca Giovanella Limited benefit of additional contrast-enhanced CT to end-of-treatment PET/CT evaluation in patients with follicular lymphoma
description	Abstract Despite follicular lymphoma (FL) is frequently characterized by a moderate increase of glucose metabolism, PET/CT examinations provides valuable information for staging and response assessment of the disease. The aim of the study was to assess and compare the diagnostic performance of PET/ldCT and PET/ceCT, respectively, in evaluating FL patients at the end of treatment. Fifty FL consecutive patients who underwent end-of-therapy PET/CT with both ldCT and ceCT were analyzed. Two blinded observers independently assessed PET/ldCT and PET/ceCT applying the Deauville score (DS) and Lugano classification criteria. PET imaging obtained after the end-of-treatment (EoT) was classified as showing PET and ce-CT matched response (concordant imaging group, CIG) or PET and ce-CT unmatched response (discordant imaging group, DIG). Relapse rate and Event-Free Survival (EFS) were compared between CIG and DIG patients. Overall, no differences in metabolic response classification were observed between PET/ldCT and PET/ceCT. In 13 (26%) patients PET/ceCT identified additional FDG-negative nodal lesions in mesenteric, retroperitoneal and iliac regions. However, in all cases, final DS remained unchanged and the additional results did not modify the following therapeutic decision. Among patients, who obtained complete metabolic response a comparable rate of relapse was registered in DIG 3/13 (23%) and CIG subgroups 5/20 (25%) [p = 0.899]. In all 3 DIG cohort patients who relapsed the recurrent disease involved also, but not exclusively, PET negative lymph nodes detected by ceCT. In overall population metabolic response defined by PET/ldCT predicted EFS [76% (group of patients with metabolic response) vs 35% (group of patients with residual disease), p = 0.0013] significantly better than ceCT-Based response assessment [75% (group of patients with complete response) vs 53% (group of patients with residual disease), p = 0.06]. Our study demonstrates a negligible diagnostic and predictive value of ceCT performed in addition to standard 18FDG PET/ldCT for EoT response evaluation in FLs. PET/ldCT should be performed as first-line imaging procedure, also in patients with prevalent abdominal and pelvic involvement, limiting the acquisition of ceCT in selected cases. This tailored approach would contribute to avoid useless radiation exposure and preserve renal function of patients.
format	article
author	Gaetano Paone Mariana Raditchkova-Sarnelli Teresa Ruberto-Macchi Marco Cuzzocrea Emanuele Zucca Luca Ceriani Luca Giovanella
author_facet	Gaetano Paone Mariana Raditchkova-Sarnelli Teresa Ruberto-Macchi Marco Cuzzocrea Emanuele Zucca Luca Ceriani Luca Giovanella
author_sort	Gaetano Paone
title	Limited benefit of additional contrast-enhanced CT to end-of-treatment PET/CT evaluation in patients with follicular lymphoma
title_short	Limited benefit of additional contrast-enhanced CT to end-of-treatment PET/CT evaluation in patients with follicular lymphoma
title_full	Limited benefit of additional contrast-enhanced CT to end-of-treatment PET/CT evaluation in patients with follicular lymphoma
title_fullStr	Limited benefit of additional contrast-enhanced CT to end-of-treatment PET/CT evaluation in patients with follicular lymphoma
title_full_unstemmed	Limited benefit of additional contrast-enhanced CT to end-of-treatment PET/CT evaluation in patients with follicular lymphoma
title_sort	limited benefit of additional contrast-enhanced ct to end-of-treatment pet/ct evaluation in patients with follicular lymphoma
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/8347340d625b42e5b72a349754e0ed01
work_keys_str_mv	AT gaetanopaone limitedbenefitofadditionalcontrastenhancedcttoendoftreatmentpetctevaluationinpatientswithfollicularlymphoma AT marianaraditchkovasarnelli limitedbenefitofadditionalcontrastenhancedcttoendoftreatmentpetctevaluationinpatientswithfollicularlymphoma AT teresarubertomacchi limitedbenefitofadditionalcontrastenhancedcttoendoftreatmentpetctevaluationinpatientswithfollicularlymphoma AT marcocuzzocrea limitedbenefitofadditionalcontrastenhancedcttoendoftreatmentpetctevaluationinpatientswithfollicularlymphoma AT emanuelezucca limitedbenefitofadditionalcontrastenhancedcttoendoftreatmentpetctevaluationinpatientswithfollicularlymphoma AT lucaceriani limitedbenefitofadditionalcontrastenhancedcttoendoftreatmentpetctevaluationinpatientswithfollicularlymphoma AT lucagiovanella limitedbenefitofadditionalcontrastenhancedcttoendoftreatmentpetctevaluationinpatientswithfollicularlymphoma
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Limited benefit of additional contrast-enhanced CT to end-of-treatment PET/CT evaluation in patients with follicular lymphoma

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