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Current status of FDG-PET/CT in staging of adult lymphoma

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Abstract

Staging defines disease location and extent, suggests prognostic information and provides a baseline against which response or disease progression can be compared. Studies in Hodgkin (HL) and non-Hodgkin lymphoma (NHL) generally conclude that PET/CT is more accurate for diagnosing both nodal and extranodal disease than computed tomography (CT), thus having a strong potential impact on the staging of these lymphomas. Due to the high sensitivity and specificity of PET/CT in detecting bone marrow disease in newly diagnosed HL, bone marrow biopsy (BMB) is no longer indicated in HL; in aggressive NHL the detection of bone marrow involvement is still a topic of debate. In patients with a negative PET/CT, BMB is currently suggested to identify discordant histology, but its clinical role need to be further investigated. In indolent lymphoma FDG-PET enables staging the disease and characterization of intensity of glycolytic metabolism and this information provides additional prognostic information. In indolent lymphoma the pattern of marrow involvement is diffuse and PET/CT can be false negative in many cases. The main criteria to interpret staging PET/CT were reviewed. In 2014 were published the updated guidance on the evaluation, staging and response assessment of patients affected by HL and NHL and on the use of PET/CT for staging and response assessment. The guidelines suggest that a reasonable approach would be omit the standard full dose contrast-enhanced CT (ceCT) if not already performed, and perform a low-dose non-enhanced PET/CT as a single imaging modality, with ceCT performed selectively determined by PET/CT findings.

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Authors and Affiliations

  1. Nuclear Medicine Service, Santa Croce and Carle Hospital, Cuneo, Italy

    Alberto Biggi

  2. Nuclear Medicine Unit, San Gerardo Hospital, University of Milano Bicocca, Monza, Italy

    Luca Guerra

  3. Centre for Molecular Imaging, Peter Mac Callum Cancer Centre and University of Melbourne, Melbourne, Australia

    Michael S. Hofman

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  1. Alberto Biggi
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  2. Luca Guerra
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Biggi, A., Guerra, L. & Hofman, M.S. Current status of FDG-PET/CT in staging of adult lymphoma. Clin Transl Imaging 3, 253–269 (2015). https://doi.org/10.1007/s40336-015-0127-x

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