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The majority of lymphomas, including diffuse large B-cell lymphoma (DLBCL), are 18fluoro-deoxyglucose (18F-FDG) avid. 18F-FDG is commonly used for staging of DLBCL, but its quantitative parameters, such as baseline SUVmax and total metabolic tumor volume (MTV), which has been demonstrated as prognostic factors, need defined robust cutoff values before they can be used in routine clinical practice.
A new parameter, 18F-FDG metabolic heterogeneity (also known as textural features), has recently emerged as a promising prognostic tool in solid tumors. However, its use in DLBCL has only been evaluated to a limited extent. Nicolas Aide and colleagues investigated the prognostic value of this new quantitative feature of 18F-FDG-positron emission tomography (PET) in patients with DLBCL treated with first-line immunochemotherapy using 2-year event-free survival (EFS). The results of the study were published in the journal European Radiology.1
Data from patients with newly diagnosed with DLBCL were analyzed retrospectively.18F-FDG-PET studies were reconstructed using an algorithm with point spread function (PSF) modeling. For each patient, the total MTV was recorded and the volume of interest (VOI) structure of the largest target lesion (>10 cc) was used to determine the textural parameters. Data were then randomized to training and validation datasets, with 80% of patients attributed to the training dataset and remaining 20% of patients to the validation dataset. The training dataset was used to define the area under the curve (AUC) and optimal cutoff values for each metric from the 2-year EFS receiver operating characteristic (ROC) curves.
Table 1. Clinical and PET characteristics significantly different between patients according to 2-year EFS status
18F-FDG, 18fluoro-deoxy-glucose; IPIaa, age-adjusted international prognostic index; min, minute; SD, standard deviation *patients with no event at 2 years †patients who experienced an event at 2 years |
||||
Parameter |
Whole population (n = 132) |
2-year EFS 0* (n = 102) |
2-year EFS 1† (n = 30) |
p value |
---|---|---|---|---|
IPIaa, % 0–1 2–3 |
44.7 55.3 |
51.0 49.0 |
23.3 76.7 |
0.01 |
Mean 18F-FDG uptake time (SD), min |
61 (5) |
60 (5) |
62 (4) |
0.05 |
Table 2. PET variables with significant difference based on ROC analysis for 2-year EFS
GLCM, grey level co-occurrence matrix; GLNU, grey-level non-uniformity for zone; GLSZM, grey-level size zone matrix; LZE, long-zone emphasis; LZLGE, long-zone low grey-level emphasis; LZHGE, long-zone high grey-level emphasis; MTV, metabolic tumor volume; ZP, zone percentage |
||
Variable |
Value |
p value |
---|---|---|
Basic MTV total |
> 111.00 |
0.01 |
GLCM Homogeneity Contrast Correlation Dissimilarity |
> 0.55 < 3.76 > 0.60 < 1.39 |
0.04 0.04 0.03 0.04 |
GLDZM LZE LZLGE LZHGE GLNU ZP |
> 24,829.55 > 1873.01 > 1,264,925.92 > 21.19 < 0.08 |
0.01 0.04 0.002 0.02 0.02 |
The results of this study suggest that baseline 18F-FDG PET heterogeneity of the largest lymphoma lesion, in particular LZHGE, is a promising independent predictor of 2 year-EFS in patients with newly diagnosed DLBCL treated with immunochemotherapy. However, those findings need to be further explored and validated in a larger independent cohort of patients.
References
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