Semi-Quantitative Characterization of Post-Transplant Lymphoproliferative Disorder Morphological Subtypes with [18F]FDG PET/CT.

Filipe Montes De Jesus,Olivier Gheysens,Christophe Deroose,Walter Noordzij,Arjan Diepstra,Andor Glaudemans,Thomas Tousseyn,Thomas Kwee,Daan Dierickx,Rudi Dierckx,Vibeke Vergote

doi:10.3390/jcm10020361

Abstract

Background: Post-transplant lymphoproliferative disorder (PTLD) is a complication of organ transplantation classified according to the WHO as nondestructive, polymorphic, monomorphic, and classic Hodgkin Lymphoma subtypes. In this retrospective study, we investigated the potential of semi-quantitative 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) PET/computed tomography (CT)-based parameters to differentiate between the PTLD morphological subtypes. Methods: 96 patients with histopathologically confirmed PTLD and baseline [18F]FDG PET/CT between 2009 and 2019 were included. Extracted semi-quantitative measurements included: Maximum, peak, and mean standardized uptake value (SUVmax, SUVpeak, and SUVmean). Results: Median SUVs were highest for monomorphic PTLD followed by polymorphic and nondestructive subtypes. The median SUVpeak at the biopsy site was significantly higher in monomorphic PTLD (17.8, interquartile range (IQR):16) than in polymorphic subtypes (9.8, IQR:13.4) and nondestructive (4.1, IQR:6.1) (p = 0.04 and p ≤ 0.01, respectively). An SUVpeak ≥ 24.8 was always indicative of a monomorphic PTLD in our dataset. Nevertheless, there was a considerable overlap in SUV across the different morphologies. Conclusion: The median SUVpeak at the biopsy site was significantly higher in monomorphic PTLD than polymorphic and nondestructive subtypes. However, due to significant SUV overlap across the different subtypes, these values may only serve as an indication of PTLD morphology, and SUV-based parameters cannot replace histopathological classification.

Highlights

Post-transplant lymphoproliferative disorder (PTLD) is a complication of hematopoietic stem cell (HSCT) and solid organ transplantation associated with high morbidity and mortality [1,2,3,4]
Five patients without histopathological PTLD confirmation according to the World Health Organization (WHO) 2017 classification were excluded: Three diagnoses based on cytology, one indolent lymphoma, and one unclear diagnosis due to necrosis
Results for classic Hodgkin Lymphoma PTLD patients were included without statistical analysis as our cohort only included three cases

Summary

Introduction

Post-transplant lymphoproliferative disorder (PTLD) is a complication of hematopoietic stem cell (HSCT) and solid organ transplantation associated with high morbidity and mortality [1,2,3,4] These lymphoid and/or plasmacytic proliferations comprise a broad morphological spectrum, ranging from Epstein–Barr virus drive hyperplasia to malignant monoclonal proliferations, histologically indistinguishable from B-cell (or less commonly T/NK-cell) lymphomas in immunocompetent patients [5]. Post-transplant lymphoproliferative disorder (PTLD) is a complication of organ transplantation classified according to the WHO as nondestructive, polymorphic, monomorphic, and classic Hodgkin Lymphoma subtypes. In this retrospective study, we investigated the potential of semi-quantitative 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) PET/computed tomography (CT)-based parameters to differentiate between the PTLD morphological subtypes. Due to significant SUV overlap across the different subtypes, these values may only serve as an indication of PTLD morphology, and SUV-based parameters cannot replace histopathological classification

Results

Discussion

Conclusion