Use Of Fluorodeoxyglucose Positron Emission Tomography Research Articles

Utility of fluoro-deoxy-glucose positron emission tomography (FDG-PET) to predict a pelvic lymph node involvement (LNI) in patients (pts) with muscle-invasive bladder cancer (MIBC) enrolled in neoadjuvant therapy trials.

527 Background: FDG-PET is reported to have limited utility in pts with MIBC. However, standard computed tomography (CT) imaging can often underestimate disease extent, and its role in predicting a pathological pelvic lymph node involvement (LNI) is very limited. Previous findings from PURE-01 trial reported a potential use of FDG-PET to exclude the few pts with T2-4N0M0 and pelvic LN uptake from neoadjuvant trials with immune-checkpoint inhibitors (ICI; PMID: 33071107). The aim of this study was to extend these findings to a wider range of experimental therapies. Methods: We collected the data of pts with clinical stage T2-4N0-1M0 MIBC included in past and ongoing neoadjuvant trials sponsored by our center, including single agent or combination of immune-checkpoint inhibitors (ICI), ICI+chemotherapy (ChT), standard ChT and sacituzumab govitecan. All pts had predominant urothelial carcinoma (UC) histology and were staged with standard thorax-abdomen CT scan and with PET/CT scan during screening and after treatment, before radical cystectomy (RC). PET/CT images were evaluated qualitatively for increased or abnormal areas of FDG uptake with corresponding anatomic alterations in CT slices. All pts underwent templated pelvic lymph node dissection (LND) with packeted node submission. Multivariable logistic regression analyses (MVA) for pathological LNI prediction were run, including cT-stage and the presence of variant histologies (VH). Results: A total of 149 pts (298 PET scans) were identified, treated between 02/2017 and 08/2023. 112 pts (75.2%) received ICI, 26 (17.4%) ICI+ChT, 11 (7.4%) the remaining therapies. 36 pts (24%) had a VH, 72 (48%) a cT3-4 stage, and 12 (8.1%) a cN1 stage. In total, 20 (13%) and 16 (11%) pts had PET+ pre- and post-therapy, respectively. The accuracy of FDG-PET and CT scan in predicting LNI in overall pts was similar, both pre-therapy (85.3% and 86.7%) and post therapy (86.7%, 84.6%), the only exceptions being a lower accuracy of PET to predict presacral LNI (76.6%, 78.8% pre- and post-therapy) and in VH pre-therapy (84.3% vs 90.9% PET vs CT). A pre-therapy FDG uptake significantly predicted a pathological LNI in MVA (OR: 17.8, 95%CI: 4.18-94.86, p<0.001, AUC: 0.89), with consistent results in T2-4N0M0 cohort (OR: 18.17, 95%CI: 4.15-99.25, p<0.001, AUC: 0.84). Conclusions: Despite the proportion of FDG-PET positive pts was modest in T2-4N0-1M0 MIBC, we were able to confirm that these pts were predicted to be poor responders to neoadjuvant therapies regardless of the type of treatment. FDG-PET had lower prediction ability of LNI in presacral LN region and in pts with a VH. This information should be critically considered for patient selection in neoadjuvant therapy trials.

PO-04-050 ROLE OF FDG-PET CT IN GUIDING THERAPY FOR RELAPSING AND REMITTING MYOCARDITIS

Fluorodeoxyglucose (FDG)-positron emission tomography (PET) scan is considered as a goal standard test for the diagnosis of myocarditis. Low intensity FDG uptake of the lateral wall without perfusion abnormalities is considered to be a variant of normal. It is imperative to correlate myocardial and pericardial abnormality revealed by myocardial FDG uptake with the signs and symptoms of myocardial disease, as it tends to be overlooked. However, recognition of possible underlying disease will support further patient management to avoid complications due to the disease. While the utility of FDG PET in the diagnosis of myocarditis and initiation of therapy is well documented, there is no consensus in the preferred strategy for monitoring the response to therapy. To present a case highlighting the utilization of FDG PET in guiding the therapy for relapsing/remitting myocarditis. N/A A 55yo male presented with new onset HF with LVEF of 15-20% at the time of index presentation. He underwent cardiac catheterization which showed non-obstructive CAD. He was diagnosed with NICM and was discharged home on GDMT with a wearable external defibrillator. His outpatient work-up with FDG PET imaging showed normal perfusion with FDG uptake involving the proximal, mid inferolateral, and lateral region with a SUV-max of 3.4. Biopsy was determined to be too high-risk and was therefore not pursued. He was diagnosed with chronic idiopathic myocarditis with possible isolated cardiac sarcoidosis and started on methotrexate (MTX). Prednisone was considered but decided against due to comorbid diabetes. His follow up FDG PET in 6 months reported an increase in the SUV max to 4.2 and involvement of lateral base in addition to the mid-inferolateral region [Figure 1(a),(b)]. Due to lack of improvement, the patient was switched from MTX to mycophenolate. Repeat 6 month follow up FDG PET showed resolution of myocarditis with SUV-max of 2.6 [Figure 1(c),(d)] and patient was taken off immunosuppressive therapy. Six-month follow-up FDG PET was unchanged and was thus reassuring. One year later, the patient relapsed with focal FDG uptake of entire lateral and mid and basal inferolateral walls with an SUV max of 11.2 on imaging [Figure 1(e),(f)]. The patient was consequently restarted on mycophenolate therapy. This case highlights the relapsing and remitting clinical course of a patient with FDG-PET uptake in myocardium which was treated with immunosuppressive therapy with serial FDG-PET guidance.

Role of fluorodeoxyglucose-positron emission tomography in predicting the pathological response and prognosis after neoadjuvant chemoradiotherapy for locally advanced non-small-cell lung cancer.

OBJECTIVESThe present study compared the utility of fluorodeoxyglucose-positron emission tomography (FDG-PET) and computed tomography (CT) for predicting the pathological response and prognosis following neoadjuvant therapy for locally advanced non-small-cell lung cancer (NSCLC).METHODSThis retrospective analysis included 72 patients in whom adjacent structures showed involvement and/or cN2 NSCLC who received induction chemoradiotherapy (ICRT) and subsequent surgery at our hospital from 2008 to 2019. FDG-PET and CT were performed in all patients before and after ICRT using the same scanner with similar techniques. We calculated the reduction in the maximum standardized uptake value in FDG-PET (ΔSUVmax) and tumour size on CT (ΔCT-size) before and after ICRT and investigated the relationship between the pathological response and prognosis.RESULTSThe disease response was classified as a major pathological response in 43 patients, and a minor response in 29 patients. ΔSUVmax 60% and ΔCT-size 30% were identified as the optimal cut-off values for predicting a major pathological response. ΔSUVmax was superior to ΔCT-size in terms of sensitivity, specificity, positive predictive value and negative predictive value. Furthermore, ΔSUVmax was superior to ΔCT-size for predicting the prognosis.CONCLUSIONSBased on the results of the present study, FDG-PET appeared to have greater utility than CT in predicting the pathological response following ICRT and the postoperative prognosis in patients with locally advanced NSCLC.

Heart and Lung Transplant for Mixed Connective Tissue Disease: Implications for Pre-Transplant Testing

<h3>Introduction</h3> We present a case of end-stage lung disease secondary to mixed connective tissue disease (MCTD) with concomitant myocarditis. <h3>Case Report</h3> The patient is a 37-year-old male initially diagnosed with interstitial lung disease due to MCTD at age 30. He was started on hydroxychloroquine (HCQ) at age 32 and later switched to mycophenolate mofetil (MMF). At that time, his left ventricular ejection fraction (LVEF) was 30%. His LVEF improved to 47% while on MMF and carvedilol but his pulmonary status worsened, and eventually he was placed on the lung transplant list. He was returned to HCQ due to progression while on MMF. A follow-up echocardiogram performed one year later for clinical decline revealed a LVEF of 15%. HCQ was discontinued for concern of cardiac toxicity and MMF was resumed. Repeat echocardiograms revealed improved LVEF although prohibitive for lung transplant alone. He was approved for heart and lung transplant, and soon thereafter, underwent successful transplant. Explant of lungs revealed extensive interstitial fibrosis with moderate chronic inflammation. Explant of heart revealed patchy lymphocytic myocarditis with myocyte damage and areas of fibrosis with myocyte hypertrophy. <h3>Summary</h3> MCTD is an autoimmune process that has a variety of end-organ manifestations, variably affecting the cardiovascular system and subsequently portending a poorer prognosis. Albeit rare, myocarditis is a known complication of MCTD. Because symptoms are insidious, we emphasize the importance of high clinical suspicion for myocarditis in patients with known MCTD. Diagnosis of myocarditis is made by biopsy, although imaging may be suggestive. The use of fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging may be of value due to its ability to localize inflammation in the form of increased myocardial FDG uptake. In patients presenting with unexplained systolic dysfunction in the setting of MCTD, FDG-PET may be a screening tool and if myocardial inflammation is noted, there may be a role for increased immunosuppression. While this strategy was not employed in our patient, his improvement in LVEF while on MMF compared to HCQ and explant histology suggest a process that may have responded to escalation of immunosuppression. This has further implications as decision regarding single versus multi-organ transplant may be affected by medical therapy response.

The "Ant-farm"-like Appearance of Restricted Lower Limb Vasculitis on Fluorodeoxyglucose-positron Emission Tomography.

Restricted lower limb vasculitis is a type of localized muscle vasculitis limited to the lower limbs. The usefulness of fluorodeoxyglucose-positron emission tomography (FDG-PET) for the diagnosis of this entity has not yet been reported. We herein report three patients with a fever and persistent lower limb pain. FDG-PET revealed linear and patchy FDG uptakes in their lower limbs. Combined with magnetic resonance imaging and histological findings, they were diagnosed with lower limb vasculitis. Linear and patchy FDG uptakes are considered to reflect the presence of muscle vasculitis. The characteristic “ant-farm”-like FDG-PET images can be a diagnostic clue for the currently overlooked vasculitis.

The usefulness of fluorodeoxyglucose-positron emission tomography as a preoperative diagnostic tool for thymic epithelial tumors.

To investigate the usefulness of 18F-fluorodeoxy glucose-positron emission tomography (18F-FDG PET) for the preoperative imaging diagnosis of malignant grade in thymic epithelial tumors (TETs) and the correlation between the maximum standardized uptake value (SUVmax) and tumor size in TETs. We retrospectively investigated 51 patients with TETs performed 18F-FDG PET. The SUVmax was compared between thymic carcinomas and thymomas. We also evaluated the difference in the SUVmax limited to small TETs. In addition, the correlation between the SUVmax and the tumor size was evaluated. The mean SUVmax of thymic carcinomas (n=12) and thymomas (n=39) was 5.71±2.6 and 3.08±1.4, respectively. The SUVmax of thymic carcinomas was significantly higher than that of thymomas (P<0.001). The mean SUVmax of these small thymic carcinomas (n=3) and thymomas (n=13) was 2.97±0.24 and 1.79±0.47, respectively. The SUVmax of the small thymic carcinomas was significantly higher than that of the thymomas (P=0.001). We found a positive correlation between the SUVmax and the maximum tumor size of TETs (correlation coefficient: 0.632, P<0.001). 18F-FDG PET might be useful for evaluating the preoperative malignancy of TETs. Of note, the maximum tumor size should be considered when performing assessments by 18F-FDG PET.

Evaluation of Fluorodeoxyglucose Positron Emission Tomography Scanning in the Neoadjuvant Therapy Paradigm in Pancreatic Ductal Adenocarcinoma.

Little data exist on the utility of fluorodeoxyglucose positron emission tomography (FDG-PET) in operable pancreatic ductal adenocarcinoma (PDAC) treated with neoadjuvant (NA) therapy. Consecutively treated patients with potentially operable PDAC were recruited from a quaternary referral center between 2015 and 2018. Data were collated on demographic, clinical, radiological, treatment, and disease-free and overall survival (OS) outcome measures, correlated with FDG-PET findings. Of 115 patients recruited, 61% were deemed upfront operable (n = 70), 33% borderline (n = 38), and 6% (n = 7) locally advanced. Ninety-five (83%) received NA chemotherapy with 23 (24%) sequential radiotherapy. Sixty-nine (73%) treated with NA were resected, 37 (54%) attained an R0 resection, 43 (62%) had N1 disease with median tumor viability of 50%. The median OS in the entire cohort was 30.48 months and in those who received NA chemotherapy followed by resection 37.98 months. Twelve percent (n = 13) were upstaged during NA therapy by PET. Preoperative standardized uptake value maximum of less than 5 versus 5 or greater after NA predicted for improved OS, 42.95 months versus 26.05 months, P = 0.02. In this real-world cohort study of PDAC, the utility of FDG-PET in informing the patient treatment pathway was meaningfully demonstrated.

European Association of Nuclear Medicine and European Academy of Neurology recommendations for the use of brain 18 F-fluorodeoxyglucose positron emission tomography in neurodegenerative cognitive impairment and dementia: Delphi consensus.

Recommendations for using fluorodeoxyglucose positron emission tomography (FDG-PET) to support the diagnosis of dementing neurodegenerative disorders are sparse and poorly structured. Twenty-one questions on diagnostic issues and on semi-automated analysis to assist visual reading were defined. Literature was reviewed to assess study design, risk of bias, inconsistency, imprecision, indirectness and effect size. Critical outcomes were sensitivity, specificity, accuracy, positive/negative predictive value, area under the receiver operating characteristic curve, and positive/negative likelihood ratio of FDG-PET in detecting the target conditions. Using the Delphi method, an expert panel voted for/against the use of FDG-PET based on published evidence and expert opinion. Of the 1435 papers, 58 papers provided proper quantitative assessment of test performance. The panel agreed on recommending FDG-PET for 14 questions: diagnosing mild cognitive impairment due to Alzheimer's disease (AD), frontotemporal lobar degeneration (FTLD) or dementia with Lewy bodies (DLB); diagnosing atypical AD and pseudo-dementia; differentiating between AD and DLB, FTLD or vascular dementia, between DLB and FTLD, and between Parkinson's disease and progressive supranuclear palsy; suggesting underlying pathophysiology in corticobasal degeneration and progressive primary aphasia, and cortical dysfunction in Parkinson's disease; using semi-automated assessment to assist visual reading. Panellists did not support FDG-PET use for pre-clinical stages of neurodegenerative disorders, for amyotrophic lateral sclerosis and Huntington disease diagnoses, and for amyotrophic lateral sclerosis or Huntington-disease-related cognitive decline. Despite limited formal evidence, panellists deemed FDG-PET useful in the early and differential diagnosis of the main neurodegenerative disorders, and semi-automated assessment helpful to assist visual reading. These decisions are proposed as interim recommendations.

Perfusion SPECT in the differential diagnosis of dementia

Dementia is a syndrome–usually of a chronic or progressive nature–in which there is deterioration in cognitive function beyond what might be expected from normal ageing (WHO). As the world population ages, the number of people afflicted with dementing illnesses will increase. This neurodegenerative disease is one of the major causes of disability and dependency among older people worldwide. Brain single-photon emission computed tomography (SPECT) allows the study of regional cerebral blood flow, providing functional information. Each of the different types of dementia has a distinct blood flow pattern that is revealed with SPECT imaging and which can be used for differential diagnoses. This imaging technique can also be used to differentiate dementia from pseudodementia. The use of SPECT has been recommended in various guidelines to help in differential diagnosis of dementia. The National Institute for Health and Clinical Excellence in the UK recommend the use of SPECT or positron emission tomography (PET) to help differentiate Alzheimer's disease (AD) from frontotemporal dementia and vascular dementia when there is diagnostic doubt (NICE, 2006). The European Federation of the Neurological Societies guidelines for diagnosis also supports the use of FDG-PET (18F fluorodeoxyglucose positron emission tomography) or perfusion SPECT when clarifying a diagnosis of AD. This review describes the utility of perfusion SPECT in differential diagnosis of neurodegenerative dementias.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Is there a role for traditional nuclear medicine imaging in the management of pulmonary carcinoid tumours?

The clinical utility of fluorodeoxyglucose-positron emission tomography (FDG-PET) and somatostatin receptor scintigraphy (SRS) in pulmonary carcinoids staging is unclear. This study aims to determine the role of FDG-PET and SRS in detecting hilar-mediastinal lymph node metastasis from these tumours. We retrospectively collected the data of 380 patients who underwent lung resection for primary pulmonary carcinoid in seven centres between 2000 and 2015. Patients without nodal sampling ( n = 78) were excluded. In 302 patients [35% men, median age 58 (interquartile range 47-68) years] the results of preoperative computed tomography (CT) scan, FDG-PET and SRS were analysed and compared to the pathological findings after resection to determine the respective utility of these two nuclear tests. The sensitivity, specificity and negative predictive value in detecting N1 and N2 disease were respectively 33% and 46%, 93% and 90%, 88% and 95% for computed-tomography-scan, 38% and 60%, 93% and 95%, 88% and 95% for FDG-PET, 22% and 33%, 95% and 98%, 84% and 87% for SRS. The diagnostic accuracy for N1 and N2 disease of CT scan was not significantly different from that of FDG-PET ( P = 1.0 and P = 0.37 for N1 and N2 disease respectively) and of SRS ( P = 0.47 and P = 0.35 for N1 and N2 disease respectively). The sensitivity and specificity of these imaging tests were also similar when analysed by typical vs atypical histology. CT scan, FDG-PET and SRS showed similar performance in terms of nodal staging for pulmonary carcinoid. These findings suggest that additional nuclear imaging beyond CT scan is not required as long as a lymphadenectomy or nodal sampling is completed at resection.

Contrast-Enhanced Ultrasound in the Assessment of Patients with Indeterminate Abdominal Findings at Positron Emission Tomography Imaging

Widespread use of fluorodeoxyglucose-positron emission tomography (PET) in cancer imaging may result in a number of indeterminate and false-positive findings. We investigated the role of contrast-enhanced ultrasound (CEUS) as a second-level option after inconclusive PET. We reviewed CEUS images acquired over 4 y, selecting the examinations performed specifically to better assess an unclear PET image. Final diagnosis was confirmed by biopsy, surgery, further imaging or follow-up. Seventy CEUS examinations were performed after a PET scan (44 PET examinations, 19 PET-computer tomography [CT] examinations and 7 PET-CECT examinations). The target organ was the liver in 54 cases, spleen in 12, gallbladder in 2 and pancreas and kidney in one each. In 6 of 70 cases, CEUS was performed because of a negative PET (no uptake) despite an abnormal finding on the CT images of the PET-CT study; CEUS allowed a correct diagnosis in all of these. In 20 of 70 cases, the PET findings were categorized as indeterminate and non-specific (non-specific fluorodeoxyglucose uptake in PET report with no standardized uptake value given); CEUS reached a correct diagnosis in 19 of the 20 cases with one false negative. In 34 of 70 cases, PET was indeterminate, but specific (fluorodeoxyglucose uptake with a standardized uptake value provided); CEUS reached a correct diagnosis in 30 of these 34 cases. In 10 of 70 cases, PET was categorized as determinate but to be investigated because of discrepancy with clinical or imaging findings; CEUS a definitive diagnosis in 9 of 10 cases. CEUS proved to be effective option in the assessment of cancer patients with indeterminate PET findings.

An evidence-based algorithm for the utility of FDG-PET for diagnosing Alzheimer's disease according to presence of medial temporal lobe atrophy.

Imaging biomarkers for Alzheimer's disease include medial temporal lobe atrophy (MTLA) depicted on computed tomography (CT) or magnetic resonance imaging (MRI) and patterns of reduced metabolism on fluorodeoxyglucose positron emission tomography (FDG-PET). To investigate whether MTLA on head CT predicts the diagnostic usefulness of an additional FDG-PET scan. Participants had a clinical diagnosis of Alzheimer's disease (n = 37) or dementia with Lewy bodies (DLB; n = 30) or were similarly aged controls (n = 30). We visually rated MTLA on coronally reconstructed CT scans and, separately and blind to CT ratings, abnormal appearances on FDG-PET scans. Using a pre-defined cut-off of MTLA ⩾5 on the Scheltens (0-8) scale, 0/30 controls, 6/30 DLB and 23/30 Alzheimer's disease had marked MTLA. FDG-PET performed well for diagnosing Alzheimer's disease v DLB in the low-MTLA group (sensitivity/specificity of 71%/79%), but in the high-MTLA group diagnostic performance of FDG-PET was not better than chance. In the presence of a high degree of MTLA, the most likely diagnosis is Alzheimer's disease, and an FDG-PET scan will probably not provide significant diagnostic information. However, in cases without MTLA, if the diagnosis is unclear, an FDG-PET scan may provide additional clinically useful diagnostic information.

The Diagnostic Dilemma of Neurolymphomatosis.

Neurolymphomatosis (NL) defined as infiltration of the central nervous system or the peripheral nervous system (PNS) by malignant lymphoma cells is a rare clinical entity. However, the increasing use of fluorodeoxyglucose positron-emission tomography (FDG-PET) and magnetic resonance imaging in evaluating PNS disorders is resulting in; this condition being recognized more frequently. Here; we report five NL patients and review the current literature. We report five patients with non-Hodgkin's lymphoma (NHL) and NL, all of whom were men aged 47–69 years. The clinical presentation varied from symmetrical peripheral neuropathy to mononeuropathy. Peripheral neuropathy was the presenting manifestation of a systemic lymphoma in two patients (40%). Neuroimaging as well as whole-body FDG-PET helped in determining the correct diagnosis in all of the patients. NL is an unusual presentation of NHL resulting from infiltration of the PNS by malignant lymphomatous cells. While evaluating peripheral neuropathy, a high degree of suspicion of NL is required since the presenting symptoms vary, conventional radiology has only modest sensitivity, and a pathological diagnosis is often difficult. FDG-PET helps in the early diagnosis and treatment of this condition.

Utility of18fluoro-deoxyglucose positron emission tomography for prognosis and response assessments in a phase 2 study of romidepsin in patients with relapsed or refractory peripheral T-cell lymphoma

For patients with peripheral T-cell lymphoma (PTCL), the value of (18)fluoro-deoxyglucose positron emission tomography (FDG-PET) scans for assessing prognosis and response to treatment remains unclear. The utility of FDG-PET, in addition to conventional radiology, was examined as a planned exploratory end point in the pivotal phase 2 trial of romidepsin for the treatment of relapsed/refractory PTCL. Patients received romidepsin at a dose of 14 mg/m(2) on days 1, 8, and 15 of 28-day cycles. The primary end point was the rate of confirmed/unconfirmed complete response (CR/CRu) as assessed by International Workshop Criteria (IWC) using conventional radiology. For the exploratory PET end point, patients with at least baseline FDG-PET scans were assessed by IWC + PET criteria. Of 130 patients, 110 had baseline FDG-PET scans, and 105 were PET positive at baseline. The use of IWC + PET criteria increased the objective response rate to 30% compared with 26% by conventional radiology. Durations of response were well differentiated by both conventional radiology response criteria [CR/CRu versus partial response (PR), P = 0.0001] and PET status (negative versus positive, P < 0.0001). Patients who achieved CR/CRu had prolonged progression-free survival (PFS, median 25.9 months) compared with other response groups (P = 0.0007). Patients who achieved PR or stable disease (SD) had similar PFS (median 7.2 and 6.3 months, respectively, P = 0.6427). When grouping PR and SD patients by PET status, patients with PET-negative versus PET-positive disease had a median PFS of 18.2 versus 7.1 months (P = 0.0923). Routine use of FDG-PET does not obviate conventional staging, but may aid in determining prognosis and refine response assessments for patients with PTCL, particularly for those who do not achieve CR/CRu by conventional staging. The optimal way to incorporate FDG-PET scans for patients with PTCL remains to be determined. NCT00426764.

Visual and statistical analysis of ¹⁸F-FDG PET in primary progressive aphasia.

Diagnosing progressive primary aphasia (PPA) and its variants is of great clinical importance, and fluorodeoxyglucose (FDG) positron emission tomography (PET) may be a useful diagnostic technique. The purpose of this study was to evaluate interobserver variability in the interpretation of FDG PET images in PPA as well as the diagnostic sensitivity and specificity of the technique. We also aimed to compare visual and statistical analyses of these images. There were 10 raters who analysed 44 FDG PET scans from 33 PPA patients and 11 controls. Five raters analysed the images visually, while the other five used maps created using Statistical Parametric Mapping software. Two spatial normalization procedures were performed: global mean normalization and cerebellar normalization. Clinical diagnosis was considered the gold standard. Inter-rater concordance was moderate for visual analysis (Fleiss' kappa 0.568) and substantial for statistical analysis (kappa 0.756-0.881). Agreement was good for all three variants of PPA except for the nonfluent/agrammatic variant studied with visual analysis. The sensitivity and specificity of each rater's diagnosis of PPA was high, averaging 87.8 and 89.9% for visual analysis and 96.9 and 90.9% for statistical analysis using global mean normalization, respectively. In cerebellar normalization, sensitivity was 88.9% and specificity 100%. FDG PET demonstrated high diagnostic accuracy for the diagnosis of PPA and its variants. Inter-rater concordance was higher for statistical analysis, especially for the nonfluent/agrammatic variant. These data support the use of FDG PET to evaluate patients with PPA and show that statistical analysis methods are particularly useful for identifying the nonfluent/agrammatic variant of PPA.

OP0110 The utility of fluorodeoxyglucose-positron emission tomography for IgG4-related disease diagnosed accorgding to comprehensive diagnostic criteria

BackgroundIgG4-related disease (IgG4-RD) is a systemic disease characterized by elevated levels of serum IgG4 (sG4) and mass-forming lesions infiltrated with IgG4-positive (IgG4+) plasma cell. To date in our facilities, IgG4-RD...

Prognostic Impact of Serum Soluble Interleukin-2 Receptor Values Just After Completion of R-CHOP in Diffuse Large B-Cell Lymphoma

Abstract 1591 IntroductionThe use of fluorodeoxyglucose-positron emission tomography (PET) to aid the prognosis of patients with diffuse large B-cell lymphoma (DLBCL) after treatment with rituximab-containing combination chemotherapy was investigated. Several studies report that less than 20 % of patients who are PET-negative and more than 85 % of PET-positive patients will experience lymphoma recurrence. Since therapy for DLBCL recurrence remains a major problem, the ability to accurately predict the risk of relapse in PET-negative DLBCL patients after chemotherapy would be extremely beneficial. In this study we focused on levels of serum soluble interleukin-2 receptor (sIL-2R) since several reports indicate that sIL-2R at the time of diagnosis is closely linked to the prognoses of DLBCL patients. We measured sIL-2R levels in DLBCL patients shortly after R-CHOP therapy and investigated whether there was any correlation with patient prognoses. Patients and MethodsThis was a retrospective pooled analysis of DLBCL patients treated with R-CHOP in our institute. Patients were included if they were under the age of 80, had an International Prognostic Index (IPI) score of more than two, and had received R-CHOP with curative intent. Patients who received salvage chemotherapies due to insufficient responses to R-CHOP were also included. We excluded patients with low IPI scores as their sIL-2R levels at the time of diagnosis were usually in the normal range. Patients were also excluded if R-CHOP could not be continued for reasons other than disease progression. sIL-2R and PET analyses were performed when patients first visited the institute after completing 6–8 cycles of R-CHOP. Patients were divided into three groups: Group A consisted of patients who had completed R-CHOP, were PET-negative and whose sIL-2R levels had returned to normal (<600 mg/dl); Group B consisted of patients who had completed R-CHOP and were PET-negative, but whose sIL-2R levels had remained high (>=600mg/dl); Group C consisted of patients who had switched to salvage therapies as well as those who remained PET-positive after completing R-CHOP. Overall survival (OS) was assessed using the Kaplan-Meier method and the log-rank test was used for comparisons within each group. A multivariate Cox regression analysis was used to adjust for IPI scores. ResultsFrom January, 2006 to January, 2012, a total of 178 DLBCL patients aged less than 80 years were referred to our institution, and 70 of these patients were included in this analysis. The median age of patients was 68 years (range 37–79 years), 96 % had advanced stage DLBCL, and 77 % had elevated lactate dehydrogenase levels. 30% of patients had ECOG performance status (PS) less than 2. The median sIL-2R level at the time of diagnosis was 2676 mg/dl (range 612–48000 mg/dl). The numbers of patients assigned to groups A, B, and C were 28 (40 %), 18 (26 %), and 24 (34 %), respectively. A Fisher’s exact test showed no significant differences in IPI scores between the three groups (p=0.453). A Mann-Whitney test showed no significant differences in sIL-2R levels at the time of diagnosis between the three groups (A; median 2660 mg/dl, range 612–19000 mg/dl, B; 2905 mg/dl, 970–37100 mg/dl, C; 4347 mg/dl, 734–48000 mg/dl). Patients in groups A and B received 6–8 cycles of R-CHOP (median 7 cycles). Patients in group C received 1–4 salvage treatments (median 2 treatments) before or after completion of R-CHOP (median 6 cycles, range 2–8 cycles). After a median follow-up time of 36 months (range 5–60 months), 24 deaths had occurred (including 20 due to lymphoma), and the 3 year OS rate for the entire cohort was 65.5 % [95 % confidence interval (CI), 51.7–76.2 %]. The 3 year unadjusted OS rate of patients in groups A, B, and C was 95.2% [95%CI, 70.7–99.3%], 60.7% [95%CI, 31.3–80.6%] and 30.6% [95%CI, 12.5–51.0%], respectively (log-rank, p<0.001), (group A vs B; hazard ratio (HR), 10.8; 95%CI, 1.33–88.1; p=0.026, group B vs C; HR, 2.24; 95%CI, 0.91–5.54; p=0.079). Multivariate analysis including IPI score, revealed that 3 year OS for patients in group B was significantly inferior to that for patients in group A (HR, 6.26; 95%CI, 1.29–30.4; p=0.023), but was comparable with that for patients in group C. ConclusionDLBCL patients with an IPI score of more than 2 had an increased risk of relapse if their sIL-2R levels failed to return to normal following R-CHOP treatment, even if they completed 6–8 cycles of R-CHOP and were PET-negative. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

MIS3-5 - Fluorodeoxyglucose Positron Emission Tomography for Evaluating Early Response During Neoadjuvant Chemoradiotherapy in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma

ABSTRACT Background To determine whether fluorodeoxyglucose positron emission tomography (FDG-PET) could differentiate between responding and non-responding locally advanced esophageal squamous cell carcinoma (ESCC) early in the course of neoadjuvant chemoradiotherapy (CRT). Methods Patients with T3 or N1M0-1a (AJCC, 6th ed.) ESCC first received a 21-day cycle of induction CT with paclitaxel, cisplatin, 5-FU/leucovorin D 1, 8). This was followed by concurrent paclitaxel, cisplatin CRT (Lin CC et al. Ann Oncol 18: 93; 2007). When the accumulated RT dose reached 40 Gy, the feasibility of esophagectomy was evaluated. In patients for whom esophagectomy was not feasible, CCRT was continued to a dose of 60 Gy. Serial FDG-PETs were carried out before and 14 days after the start of induction CT. Pathologic response (PR) was defined as no or microscopic residual disease. PET response was measured using the standardized uptake value (SUV). Receiver operating characteristic (ROC) analysis was used to evaluate the SUV ability in distinguishing between PR and non-PR. Results Of 65 patients (M:F = 60:5, median age 55, range 39–71) with locally advanced (M0:M1a = 58:7) ESCC enrolled from March 2008 to December 2011, 40 patients underwent esophagectomy and 26 patients were pathologic responders. The median SUV decrease 140 days after the start of therapy was 75.8% for pathologic responders and 30.1% for non-responders (P Conclusions A 35% SUV decrease 14 days after the start of induction CT is significantly associated with PR, but its accuracy in detecting non-responders is too low to justify the clinical use of FDG-PET for early discontinuation of neoadjuvant CRT in patients with locally advanced ESCC.

Guidelines for the investigation and management of mantle cell lymphoma.

The guideline group was selected to be representative of UK-based medical experts and patients representatives. Ovid MEDLINE, EMBASE and NCBI Pubmed were searched systematically for publications in English from 1980 to 2011 using the MeSH subheading 'lymphoma, mantle cell' and 'lymphoma, mantle cell' as a keyword, as well as all subheadings. In addition, all references to mantle cell lymphoma in the World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissue (Swerdlow et al, 2008) and the British Committee for Standards in Haematology (BCSH) Guideline: Best Practice in Lymphoma Diagnosis and Reporting (Parker et al, 2010) have been included. The writing group produced the draft guideline, which was subsequently revised by consensus by members of the Haemato-oncology Task Force of the BCSH. The guideline was then reviewed by a sounding board of approximately 50 UK haematologists, the BCSH and the British Society for Haematology Committee and comments incorporated where appropriate. The 'GRADE' system was used to quote levels and grades of evidence, details of which can be found in Appendix I. The objective of this guideline is to provide healthcare professionals with clear guidance on the investigation and management of patients with mantle cell lymphoma. The guidance may not be appropriate to patients with other lymphoma sub-types and in all cases individual patient circumstances may dictate an alternative approach.

Management of Localized-Stage Follicular Lymphoma: Changing the Paradigm?

Management of Localized-Stage Follicular Lymphoma: Changing the Paradigm?