Lopci Egesta, Elia Caterina, Catalfamo Barbara, Burnelli Roberta, De Re Valli, Mussolin Lara, Piccardo Arnoldo, Cistaro Angelina, Borsatti Eugenio, Zucchetta Pietro, Bianchi Maurizio, Buffardi Salvatore, Farruggia Piero, Garaventa Alberto, Sala Alessandra, Vinti Luciana, Mauz-Koerholz Christine, Mascarin Maurizio
Nuclear Medicine Unit, IRCCS-Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy.
AYA and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
J Clin Med. 2022 Oct 21;11(20):6223. doi: 10.3390/jcm11206223.
Rationale: Therapy response evaluation by 18F-fluorodeoxyglucose PET/CT (FDG PET) has become a powerful tool for the discrimination of responders from non-responders in pediatric Hodgkin lymphoma (HL). Recently, volumetric analyses have been regarded as a valuable tool for disease prognostication and biological characterization in cancer. Given the multitude of methods available for volumetric analysis in HL, the AIEOP Hodgkin Lymphoma Study Group has designed a prospective analysis of the Italian cohort enrolled in the EuroNet-PHL-C2 trial. Methods: Primarily, the study aimed to compare the different segmentation techniques used for volumetric assessment in HL patients at baseline (PET1) and during therapy: early (PET2) and late assessment (PET3). Overall, 50 patients and 150 scans were investigated for the current analysis. A dedicated software was used to semi-automatically delineate contours of the lesions by using different threshold methods. More specifically, four methods were applied: (1) fixed 41% threshold of the maximum standardized uptake value (SUVmax) within the respective lymphoma site (V41%), (2) fixed absolute SUV threshold of 2.5 (V2.5); (3) SUVmax(lesion)/SUVmean liver >1.5 (Vliver); (4) adaptive method (AM). All parameters obtained from the different methods were analyzed with respect to response. Results: Among the different methods investigated, the strongest correlation was observed between AM and Vliver (rho > 0.9; p < 0.001 for SUVmean, MTV and TLG at all scan timing), along with V2.5 and AM or Vliver (rho 0.98, p < 0.001 for TLG at baseline; rho > 0.9; p < 0.001 for SUVmean, MTV and TLG at PET2 and PET3, respectively). To determine the best segmentation method, we applied logistic regression and correlated different results with Deauville scores at late evaluation. Logistic regression demonstrated that MTV (metabolic tumor volume) and TLG (total lesion glycolysis) computation according to V2.5 and Vliver significantly correlated to response to treatment (p = 0.01 and 0.04 for MTV and 0.03 and 0.04 for TLG, respectively). SUVmean also resulted in significant correlation as absolute value or variation. Conclusions: The best correlation for volumetric analysis was documented for AM and Vliver, followed by V2.5. The volumetric analyses obtained from V2.5 and Vliver significantly correlated to response to therapy, proving to be preferred thresholds in our pediatric HL cohort.
通过18F-氟脱氧葡萄糖PET/CT（FDG PET）进行治疗反应评估已成为鉴别儿童霍奇金淋巴瘤（HL）反应者与无反应者的有力工具。最近，体积分析已被视为癌症疾病预后和生物学特征分析的有价值工具。鉴于HL体积分析有多种可用方法，AIEOP霍奇金淋巴瘤研究组设计了一项对参加EuroNet-PHL-C2试验的意大利队列的前瞻性分析。方法：主要而言，该研究旨在比较HL患者基线期（PET1）及治疗期间早期（PET2）和晚期评估（PET3）用于体积评估所采用的不同分割技术。总体而言，本次分析共调查了50例患者及150次扫描。使用一款专用软件，通过不同阈值方法半自动勾勒病变轮廓。更具体地说，应用了四种方法：（1）在各自淋巴瘤部位内最大标准化摄取值（SUVmax）的固定41%阈值（V41%）；（2）固定绝对SUV阈值2.5（V2.5）；（3）SUVmax（病变）/SUVmean肝脏>1.5（Vliver）；（4）自适应方法（AM）。对从不同方法获得的所有参数进行反应相关性分析。结果：在所研究的不同方法中，观察到AM与Vliver之间相关性最强（rho>0.9；所有扫描时间点SUVmean、代谢肿瘤体积（MTV）和总病变糖酵解（TLG）的p<0.001），以及V2.5与AM或Vliver之间相关性最强（基线时TLG的rho为0.98，p<0.001；PET2和PET时SUVmean、MTV和TLG的rho>0.9；p<0.001）。为确定最佳分割方法，我们应用逻辑回归并将不同结果与晚期评估时的Deauville评分相关联。逻辑回归表明，根据V2.5和Vliver计算的MTV和TLG与治疗反应显著相关（MTV分别为p = 0.01和0.04，TLG分别为0.03和0.04）。SUVmean作为绝对值或变化量也显示出显著相关性。结论：记录显示AM与Vliver进行体积分析时相关性最佳，其次是V2.5。从V2.5和Vliver获得的体积分析与治疗反应显著相关，在我们的儿童HL队列中被证明是更优的阈值。
