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Role of 18F-FLT PET/CT in suspected recurrent or residual lymphoma: final results of a pilot prospective trial

  • Lucia ZanoniEmail author
  • Alessandro Broccoli
  • Alessandro Lambertini
  • Cinzia Pellegrini
  • Vittorio Stefoni
  • Filippo Lodi
  • Cristina Fonti
  • Cristina Nanni
  • Pier Luigi Zinzani
  • Stefano Fanti
Original Article

Abstract

Purpose

To evaluate the role of F-18-Fluorothymidine (FLT) PET/CT in lymphoma patients with suspected recurrent or residual disease.

Methods

Adult lymphoma patients presenting with positive or equivocal F-18-FDG PET/CT at end-treatment or follow-up were prospectively addressed to an additional F-18-FLT-PET/CT. SUV max and tumour-to-background ratios (TBRs) were recorded for the most avid lesion. Biopsy or, when not available, clinical or imaging assessment were employed as standard of reference.

Results

Overall 52 patients were recruited. Histology was available in 20/52 patients (38%), proliferation-index (Ki-67) in 14/20. Disease was excluded in 13/52 patients (25%) (one reactive follicular hyperplasia, five reactive-inflammatory tissues, four reactive nodes, two nodal sarcoid-like and one non-specific peri-caecal finding). FDG and FLT scans were concordant in disease restaging in 34/52 patients (65%), whereas in 18/52 cases (35%) relevant discrepancies were recorded. SUV max and TBR were significantly higher in the disease versus the disease-free group, with both tracers (p = 0.0231 and 0.0219 for FDG; p = 0.0008 and 0.0016 for FLT). FLT-SUVmax demonstrated slightly better performance in discriminating benign from malignant lesions (ROC-AUC: 0.8116 and 0.7949 for FLT-SUV max and TBR; 0.7120 and 0.7140 for FDG). Optimal FLT-SUV max cut-offs were searched: three would lead to 95% sensitivity, 81% accuracy, and 39% specificity, whereas seven led to 100%, 41%, and 56% respectively. No statistically significant correlation was observed between the two FLT indices and Ki-67.

Conclusions

According to our results in a clinical setting of recurrent or residual lymphoma, FLT is not significantly superior to FDG and it is unlikely that it will be employed independently. FLT may be restricted to a few specific cases, as complementary to standard FDG imaging, to confirm a diagnosis or to define a better target to biopsy. However, due to FLT suboptimal performance, many findings would remain inconclusive, requiring further diagnostic procedures and reducing the effectiveness of performing an additional FLT scan.

Keywords

Positron emission tomography Lymphoma F-18-FLT F-18-FDG Relapse 

Notes

Funding

The project was granted by Ministero della Salute, Bando Ricerca Finalizzata 2010.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Local Ethical Committee code: 77/2009/O/Sper.

EudraCT Number 2009-012561-56.

Informed consent

Written informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Lucia Zanoni
    • 1
    Email author
  • Alessandro Broccoli
    • 2
  • Alessandro Lambertini
    • 1
  • Cinzia Pellegrini
    • 2
  • Vittorio Stefoni
    • 2
  • Filippo Lodi
    • 1
  • Cristina Fonti
    • 1
  • Cristina Nanni
    • 1
  • Pier Luigi Zinzani
    • 2
  • Stefano Fanti
    • 1
  1. 1.Nuclear MedicineAzienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-MalpighiBologna (BO)Italy
  2. 2.Hematology “L. e A. Seràgnoli”Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-MalpighiBolognaItaly

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