Celal ACAR, Vildan ÖZKOCAMAN, Ali Tayyar AKPINAR, Fahir ÖZKALEMKAŞ

Agresif B hücreli Hodgkin Dışı ve Hodgkin Lenfomada İlk Basamak Tedavi Yanıtının FDG-PET/BT ile Değerlendirilmesinde Rezidüel SUVmax

Bu çalışmada; lenfomada ilk basamak tedavi sonrasında Flor-18 fluorodeoksiglukoz pozitron emisyon tomografisinin (FDG-PET/BT) rezidüel SUVmax değerine göre duyarlılık ve özgünlüğünün geriye dönük olarak klinik takip veya biyopsi sonuçları doğrultusunda belirlenmesi amaçlandı. Çalışmaya Ocak 2004-Mayıs 2012 tarihleri arasında takip edilen, 18 yaş üzeri, agresif B hücreli Hodgkin dışı lenfoma (Yüksek dereceli sınıflandırılamamış B hücreli lenfoma, diffüz büyük B hücreli lenfoma [DBBHL], mantle hücreli lenfoma, Burkitt lenfoma) ve Hodgkin lenfoma (klasik ve nodüler predominant) tanılı 69 hasta dahil edildi. Tedavi sonu FDG-PET/BT’ leri değerlendirilen hastaların ortanca takip süresi 40 ay olup ortalama yaş 49,7 ± 15,5 yıl olarak hesaplandı. Klinik takipte standart tedavi sonrası 23 Hodgkin lenfoma olgusunun sadece birinde, 46 Hodgkin dışı lenfoma olgusunun 10’ unda (%21) relaps gözlendi. Hodgkin dışı lenfomalı 7 olgu (%15) ise tedaviye dirençli idi. Hastaların ortanca relaps süresi 20 ay idi. Rezidü SUVmax > 3,5 kabul edildiğinde duyarlılık, özgüllük, olumlu öngörü, olumsuz öngörü, doğruluk oranları sırası ile %66,6, %94,1, %80, %88,9, %87 olarak hesaplandı. Sonuç olarak; Gallamini kriterleri ile benzer şekilde tedavi sonu FDG-PET/BT’ deki en yüksek doğruluğa sahip rezidüel SUVmax sınır değerinin >3,5 olduğu saptandı. ROC analizlerinde ise SUVmax >4 değerinin %96 özgüllüğe sahip olduğu ve görsel değerlendirmenin şüpheli olduğu lenfomalarda bu sınır değerin anlamlı olabileceği düşünüldü.

Anahtar Kelimeler:

Lenfoma, tedavi sonu FDG-PET/BT, rezidüel SUVmax, yanıt değerlendirme

Residual SUVmax in FDG-PET/CT Evaluation after First-Line Treatment in Aggressive B-Cell Non-Hodgkin's and Hodgkin's Lymphoma

The purpose of this study was to assess the sensitivity and specificity of fluorine-18 fluorodeoxyglucose positron emission tomography/ computed tomography (FDG-PET/CT) according to the residual SUVmax value in patients with lymphoma after firstline therapy using clinical follow-up or the biopsy results, retrospectively. Total 69 patients diagnosed with aggressive B-cell non-Hodgkin's lymphoma (high grade unclassified B-cell lymphoma, diffuse large B-cell lymphoma [DLBCL], mantle-cell lymphoma, Burkitt's lymphoma) and Hodgkin's lymphoma (classic and nodular predominant) who were clinically followed up between January 2004 - May 2012 and older than 18 were included in the study. The median follow-up time was 40 months and the mean age was 49.7 ± 15.5 years in patients whose end-of-treatment FDG-PET / CT were assessed. Only one of the 23 patients with Hodgkin's lymphoma and 10 (21%) of the 46 non-Hodgkin's lymphoma patients were relapsed after the standard therapy in clinical follow-up. 7 (15%) non-Hodgkin's lymphoma patients were resistant to the therapy. Median time to relapse of the patients was 20 months. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates were calculated as 66.6%, 94.1%, 80%, 88.9%, 87%, respectively when the residual SUVmax cut-off value > 3.5 was accepted. In conclusion; residual SUVmax cut-off value > 3,5 has the highest accuracy in the end-of-treatment FDG-PET/CT similar to the Gallamini criteria. It was thought that SUVmax cut-off value > 4 which has 96% specificity in ROC analyzes also could be used in lymphomas which has a suspicious visual assessment.

Keywords:

Lymphoma, end-of-treatment FDG-PET/CT, residual SUVmax, response evaluation,

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