Isik Emine Göknur, Kuyumcu Serkan, Kebudi Rejin, Sanli Yasemin, Karakas Zeynep, Cakir Fatma Betul, Unal Seher Nilgün
Department of Nuclear Medicine, Istanbul Faculty of Medicine, Millet cad. ÇAPA, 34093, Istanbul, Turkey.
Division of Pediatric Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey.
Ann Nucl Med. 2017 Nov;31(9):660-668. doi: 10.1007/s12149-017-1196-x. Epub 2017 Jul 24.
Minimizing side effects by using response-adopted therapy strategies plays an important role in the management of pediatric Hodgkin lymphoma (HL); however, the criteria for the definition of adequate or inadequate response are controversial. The aim of this study is to compare different methods of interpretation of F-FDG-PET/CT (PET) in the prediction of disease outcome in order to determine the optimum method in this regard.
Baseline, interim and post-treatment PET scans of 72 children were interpreted according to revised International Harmonization Project criteria (IHP) and Deauville criteria. Cut-off values for changes in interim and post-treatment FDG uptake (ΔSUV) in the prediction of progression-free survival (PFS) were measured using ROC analysis. Quantitative and visual data were compared with each other in the prediction of PFS.
Mean interim and post-treatment ΔSUV of the primary lesions were 77.4 ± 19.5 and 68.8 ± 30.4% and respective cut-off values were 82 and 73%. However, only post-treatment ΔSUV yielded statistically significant results in the prediction of 3-year PFS (p = 0.043). Interim ΔSUV was further analyzed according to the values reported in the literature (66 and 77%) yet statistically significant results were not reached (p = 0.604 and 0.431). For interim evaluation, IHP criteria was correlated to Deauville criteria (p = 0.002 and p = 0.001) and ΔSUV (p = 0.03), whereas for post-treatment evaluation, significant correlation with ΔSUV (p = 0.04) but marginally significant (p = 0.055 and p = 0.058) correlation with Deauville criteria were achieved. Overall, 1, 3 and 5-year PFS were 95.7 ± 0.2, 89.6 ± 0.4 and 80.8 ± 0.7%, respectively. All methods demonstrated comparable performance in the prediction of 3-year PFS; however, interim PET using Deauville criteria and post-treatment PET using IHP criteria were statistically significant. All methods demonstrated high negative-predictive value but substantially low positive-predictive value.
Deauville criteria are superior to other methods in the prediction of pediatric HL outcome using interim PET data. On the other hand, quantitative evaluation and visual evaluation by IHP can be used reliably at the end of the treatment. In this regard, we report the optimal cut-off value of SUV reduction as 73%.
采用反应适应性治疗策略将副作用降至最低在儿童霍奇金淋巴瘤（HL）的管理中起着重要作用；然而，反应充分或不充分的定义标准存在争议。本研究的目的是比较F-FDG-PET/CT（PET）不同的解读方法在预测疾病转归方面的差异，以确定这方面的最佳方法。
根据修订后的国际协调项目标准（IHP）和多维尔标准对72例儿童的基线、中期和治疗后PET扫描进行解读。使用ROC分析测量中期和治疗后FDG摄取变化（ΔSUV）在预测无进展生存期（PFS）时的截断值。在预测PFS时，将定量和视觉数据相互比较。
原发灶的平均中期和治疗后ΔSUV分别为77.4±19.5%和68.8±30.4%，各自的截断值分别为82%和73%。然而，只有治疗后ΔSUV在预测3年PFS方面产生了统计学显著结果（p = 0.043）。根据文献报道的值（66%和77%）对中期ΔSUV进行进一步分析，但未达到统计学显著结果（p = 0.604和0.431）。对于中期评估，IHP标准与多维尔标准相关（p = 0.002和p = 0.001）以及与ΔSUV相关（p = 0.03），而对于治疗后评估，与ΔSUV有显著相关性（p = 0.04），但与多维尔标准的相关性为边缘显著（p = 0.055和p = 0.058）。总体而言，1年、3年和5年PFS分别为95.7±0.2%、89.6±0.4%和80.8±0.7%。所有方法在预测3年PFS方面表现相当；然而，使用多维尔标准的中期PET和使用IHP标准的治疗后PET具有统计学显著性。所有方法均显示出高阴性预测值，但阳性预测值极低。
在使用中期PET数据预测儿童HL转归方面，多维尔标准优于其他方法。另一方面，IHP的定量评估和视觉评估在治疗结束时可可靠使用。在这方面，我们报告SUV降低的最佳截断值为73%。
