Authors: Emmanuel Itti Michel Meignan Alina BerrioloRiedinger Alberto Biggi Amanda F Cashen Pierre Véra Hervé Tilly Barry A Siegel Andrea Gallamini RenéOlivier Casasnovas Corinne Haioun
Publish Date: 2013/05/07
Volume: 40, Issue: 9, Pages: 1312-1320
Abstract
The role of interim PET/CT in guiding therapeutic strategies in diffuse large Bcell lymphoma DLBCL is debated mainly because interpretation rules vary among centres This study aimed to explore the reproducibility and confirm the prognostic value of early PET/CT using the Deauville criteria and ΔSUVmaxThis international confirmatory study retrospectively evaluated 114 patients with newly diagnosed DLBCL treated with a rituximabcontaining regimen All patients underwent 18FFDG PET/CT at baseline PET0 and after two cycles PET2 with no therapy change based on the latter Scans were interpreted by three observers using the Deauville fivepoint scale and ΔSUVmax between PET0 and PET2 was calculated Interpretations were evaluated for interobserver agreement and for progressionfree survival PFS predictionMedian followup was 39 months Early PET/CT was predictive of outcome when interpreted with the Deauville criteria and ΔSUVmax Using the fivepoint scale the overall kappa value was 066 with the reference background set in the liver score ≥4 and interobserver agreement was even better using a 66 ΔSUVmax cutoff κ = 083 Moreover the prognostic value of interim PET was slightly inferior when using a Deauville score ≥4 than when using a 66 ΔSUVmax cutoff for the Deauville score the 3year PFS estimate was 59 45–73 in PET2positive patients vs 81 71–91 in PET2negative patients P = 0003 for the 66 ΔSUVmax cutoff the 3year PFS estimate was 44 23–65 in PET2positive patients vs 79 70–88 in PET2negative patients P = 00002Although the Deauville criteria are valid for assessing the prognostic value of early PET/CT in DLBCL computation of the ΔSUVmax leads to better performance and interobserver reproducibility and should be preferred when a baseline scan is availableWe address special thanks to Romain Ricci Jennifer Frye Stéphane Chauvie and Anna Cavallo for their help with data collection We are indebted to Jérôme Fortineau and Pierre Thervet of Keosys France who kindly provided the central review platform
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