Seventy FDG-PET/CT cases in which nuclear medicine physicians suspected lymphoma: How reliable are we?

Document Type : Original Article

Authors

1 Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan

2 Department of Oral and Maxillofacial Radiology, Tokyo Medical and Dental University, Tokyo, Japan

3 Department of Medical Informatics, Tokyo Medical and Dental University, Tokyo, Japan

Abstract

Objective(s): To validate the reliability of nuclear medicine physicians in diagnosing lymphoma using positron emission tomography/computed tomography using 2-deoxy-2-[18F]fluoro-D-glucose (FDG-PET/CT) and to determine findings that reliably suggest lymphoma.
Methods: Seventy patients suspected of having lymphoma using FDG-PET/CT were enrolled in this retrospective study. Two nuclear medicine physicians read all the interpretation reports and graded the degree of suspicion by consensus (3: definitely suspicious, 2: probably suspicious, and 1: possibly suspicious). The following factors were also investigated for each patient: maximum standardized uptake value (SUVmax) of the lesions, serum level of soluble interleukin-2 receptor (sIL-2R), and the presence of splenic FDG uptake higher than that of the liver.
Results: The study group consisted of 34 lymphomas, 18 other malignancies, and 18 benign lesions according to histopathological diagnosis. No patient with a Grade 1 degree of suspicion was diagnosed as lymphoma. SUVmax and the serum level of sIL2-R could not distinguish lymphoma from other diseases. Of the 11 patients who presented with elevated splenic FDG uptake, 10 were diagnosed as having lymphoma.
Conclusion: When the degree of suspicion by nuclear medicine physicians is low, the possibility of lymphoma is also low. On the other hand, elevated splenic FDG uptake may suggest lymphoma.

 

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  1. Thomas AG, Vaidhyanath R, Kirke R, Rajesh A. Extranodal lymphoma from head to toe: part 1, the head and spine. Am J Roentgenol. 2011;197(2):350-6.
  2. Thomas AG, Vaidhyanath R, Kirke R, Rajesh A. Extranodal lymphoma from head to toe: part 2, the trunk and extremities. Am J Roentgenol. 2011;197(2):357-64.
  3. Barrington SF, Mikhaeel NG, Kostakoglu L, Meignan M, Hutchings M, Mueller SP, et al. Role of imaging in the staging and response assessment of lymphoma: consensus of the international conference on malignant lymphomas imaging working group. J Clin Oncol. 2014;32(27):3048-58.
  4. Cheson BD, Fisher RI, Barrington SF, Cavalli F, Schwartz LH, Zucca E, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Ligano classification. J Clin Oncol. 2014;32(27):3059-68.
  5. Aragon-Ching JB, Akin EA. Positron emission tomography findings in clinical mimics of lymphoma. Ann N Y Acad Sci. 2011;1228:19-28.
  6. Barrington SF, O’Doherty MJ. Limitations of PET for imaging lymphoma. Eur J Nucl Med Mol Imaging. 2003;30(Suppl 1):S117-27.
  7. Li Z, Li X, Song Z, Liu J, Dong M, Shi T, et al. Sarcoidosis misdiagnosed as malignant tumors: a case report. World J Surg Oncol. 2015;13:333.
  8. Ito K, Morooka M, Kubota K. Kikuchi disease: 18F-FDG positron emission tomography/computed tomography of lymph node uptake. Jpn J Radiol. 2010;28(1):15-9.
  9. Sathekge M, Maes A, Van de Wiele C. FDG-PET imaging in HIV infection and tuberculosis. Semin Nucl Med. 2013;43(5):349-66.
  10. Nakatani K, Nakamoto Y, Togashi K. Utility of FDG PET/CT in IgG4-related systemic disease. Clin Radiol. 2012;67(4):297-305.
  11. Elboga U, Narin Y, Urhan M, Sahin E. FDG PET/CT appearance of multicentric Castleman’s disease mimicking lymphoma. Rev Esp Med Nucl Imagen Mol. 2012;31(3):142-4.
  12. Salaun PY, Gastinne T, Bodet-Milin C, Campion L, Cambefort P, Moreau A, et al. Analysis of 18F-FDG PET diffuse bone marrow uptake and splenic uptake in staging of Hodgkin’s lymphoma: a reflection of disease infiltration or just inflammation? Eur J Nucl Med Mol Imaging. 2009;36(11):1813-21.
  13. Bien E, Balcerska A. Serum soluble interleukin 2 receptor alpha in human cancer of adults and children: a review. Biomarkers. 2008;13(1):1-26.
  14. Liu Y. Clinical significance of diffusely increased splenic uptake on FDG-PET. Nucl Med Commun. 2009;30(10):763-9.