open access

Vol 22, No 1 (2019)
Research paper
Submitted: 2018-11-18
Accepted: 2018-12-27
Published online: 2019-01-31
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Productivity of 18F-FDG-PET/CT Diagnostic Tool in the Management of Pediatric Lymphoblastic Lymphoma

Ahmed Elhussein1, Mohamed Fawzy2, Hany Abdel Rahman2, Walid Omar3, Elshaymaa Mohamed Hussein4
DOI: 10.5603/NMR.2019.0004
·
Pubmed: 31482539
·
Nucl. Med. Rev 2019;22(1):23-28.
Affiliations
  1. Consultant of pediatric oncology, Children’s Cancer Hospital Egypt (CCHE 57357)., seket elemam street, Cairo, Egypt
  2. Professor of pediatric oncology, National Cancer Institute (NCI), Cairo University and Children’s Cancer Hospital Egypt (CCHE/57357)., seket el emam, cairo, Egypt
  3. Professor of nuclear medicine, National Cancer Institute (NCI), Cairo University., cairo, Egypt
  4. consultant of nuclear medicine, department of nuclear medicine andradiation oncology, faculty of medicine, cairo university, cairo, Egypt

open access

Vol 22, No 1 (2019)
Original articles
Submitted: 2018-11-18
Accepted: 2018-12-27
Published online: 2019-01-31

Abstract

BACKGROUND: Lymphoblastic lymphoma (LL) comprises approximately 20% of childhood non-Hodgkin lymphoma (NHL); however, few studies had investigated the role of 18F-FDG-PET/CT in pediatric LL patients. We aim in this study to assess the role of 18F-FDG-PET/CT in the initial staging of newly diagnosed pediatric patients with LL as well as in the assessment of response after induction chemotherapy.

PATIENTS AND METHODS: A prospective study enrolled biopsy proven newly diagnosed pediatric LL patients presenting in the Children Cancer Hospital Egypt (CCHE) during the period from October 2014 to October 2016. 18F-FDG-PET/CT was done initially before therapy and after induction chemotherapy in all patients. The patients were followed until the end of April 2018 (mean 23.5 months).

RESULTS: All lymphoma involvement lesions (n = 43) were FDG avid and the intensity of nodal FDG uptake was variable. Two patients (11%) had bone marrow (BM) involvement by < 25% blast cells with corresponding positive BM focal uptake in 18F-FDG-PET/CT (SUVmax = 4 and 4.5). Evaluation post induction phase; CT detected 8 residual lesions in 8 patients (44.4%), while 18F-FDG-PET/CT detected only 3 Deauville-positive residual lesions in 3 patients (16.6%). No intensification of therapy was done in all post-induction positive patients. Repeated 18F-FDG-PET/CT at week 18 for post-induction patients revealed cleared all Deauville-positive residual lesions. On the other hand, repeated CT at week 18 detected regression but still residual in 4/8 (50%) post-induction CT lesions with clearance of the rest (50%).

CONCLUSION: In initial staging, 18F-FDG-PET/CT is a useful tool for disease extent evaluation of pediatric LL. Moreover, it could provide a diagnostic hint for BM involvement. 18F-FDG-PET/CT done after induction therapy has a good negative predictive value with higher specificity than CT alone, but is not an indication for treatment intensification due to false positive results. However, larger sample size is required for better conclusion.

Abstract

BACKGROUND: Lymphoblastic lymphoma (LL) comprises approximately 20% of childhood non-Hodgkin lymphoma (NHL); however, few studies had investigated the role of 18F-FDG-PET/CT in pediatric LL patients. We aim in this study to assess the role of 18F-FDG-PET/CT in the initial staging of newly diagnosed pediatric patients with LL as well as in the assessment of response after induction chemotherapy.

PATIENTS AND METHODS: A prospective study enrolled biopsy proven newly diagnosed pediatric LL patients presenting in the Children Cancer Hospital Egypt (CCHE) during the period from October 2014 to October 2016. 18F-FDG-PET/CT was done initially before therapy and after induction chemotherapy in all patients. The patients were followed until the end of April 2018 (mean 23.5 months).

RESULTS: All lymphoma involvement lesions (n = 43) were FDG avid and the intensity of nodal FDG uptake was variable. Two patients (11%) had bone marrow (BM) involvement by < 25% blast cells with corresponding positive BM focal uptake in 18F-FDG-PET/CT (SUVmax = 4 and 4.5). Evaluation post induction phase; CT detected 8 residual lesions in 8 patients (44.4%), while 18F-FDG-PET/CT detected only 3 Deauville-positive residual lesions in 3 patients (16.6%). No intensification of therapy was done in all post-induction positive patients. Repeated 18F-FDG-PET/CT at week 18 for post-induction patients revealed cleared all Deauville-positive residual lesions. On the other hand, repeated CT at week 18 detected regression but still residual in 4/8 (50%) post-induction CT lesions with clearance of the rest (50%).

CONCLUSION: In initial staging, 18F-FDG-PET/CT is a useful tool for disease extent evaluation of pediatric LL. Moreover, it could provide a diagnostic hint for BM involvement. 18F-FDG-PET/CT done after induction therapy has a good negative predictive value with higher specificity than CT alone, but is not an indication for treatment intensification due to false positive results. However, larger sample size is required for better conclusion.

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Keywords

Pediatric lymphoblastic lymphoma, 18F-FDG-PET/CT, CCHE.

About this article
Title

Productivity of 18F-FDG-PET/CT Diagnostic Tool in the Management of Pediatric Lymphoblastic Lymphoma

Journal

Nuclear Medicine Review

Issue

Vol 22, No 1 (2019)

Article type

Research paper

Pages

23-28

Published online

2019-01-31

Page views

1051

Article views/downloads

891

DOI

10.5603/NMR.2019.0004

Pubmed

31482539

Bibliographic record

Nucl. Med. Rev 2019;22(1):23-28.

Keywords

Pediatric lymphoblastic lymphoma
18F-FDG-PET/CT
CCHE.

Authors

Ahmed Elhussein
Mohamed Fawzy
Hany Abdel Rahman
Walid Omar
Elshaymaa Mohamed Hussein

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