FDG PET Imaging for Lymphoma

PET/CT is approved by Medicare for use in staging, restaging and detecting recurrence in Hodgkins and Non-Hodgkins lymphoma.

PET/CT has also been shown to be an accurate tool for measuring response to therapy after the first cycle (Spaepen et al, 2001).

1.Spaepen etal. Prognostic value of PET with FDG after first line chemotherapy in NHL: Is FDG a valid alternative to conventional diagnostic modalities? Journal of Clinical Oncology, Vol 19, No 2 2001 414-419.

2004 Lymphoma Statistics*

Estimated New Cases

  • Non Hodgkin’s Disease 7,880
  • Hodgkin’s Disease 54,370

Estimated New Deaths

  • Non Hodgkin’s Disease 1,320
  • Hodgkin’s Disease 19,410

*All cancer statistics obtained from the American Cancer Society’s Cancer Facts and Figures available at www.cancer.org

Lymphoma & FDG PET Imaging Statistics**

Table 1: Utility of PET Imaging in Diagnosis of Lymphoma (N=11)

  PET CT
Sensitivity 100% N/A

Table 2: Utility of PET Imaging in Lymphoma Diagnosis/Staging (N=254)

  PET CT
Sensitivity 92% N/A
Specificity 93% N/A
PPV 62% N/A
NPV 88% 84%

For this patient population there was a 5% change in the physician managed the patient’s disease based upon the results of the PET scan.

Table 3: Utility of PET Imaging in Lymphoma Staging (N=1796)

  PET CT
Sensitivity 90% 81%
Specificity 93% 69%
PPV 74% 48%
NPV 91% 87%
Accuracy 88% 64%

For this patient population there was a 21% change in the way the physician managed the patient’s disease based upon the results of the PET scan.

Table 4: Utility of PET Imaging in Lymphoma Recurrence (N=581)

  PET CT
Sensitivity 87% 92%
Specificity 93% 10%
PPV 66% 37%
NPV 90% 81%
Accuracy 88% 63%

For this patient population there was a 10% change in the way the physician managed the patient’s disease based upon the results of the PET scan.

Table 5: Utility of PET Imaging in Lymphoma Monitoring (N=279)

  PET CT
Sensitivity 90% N/A
Specificity 93% N/A
PPV 88% N/A
NPV 94% N/A
Accuracy 69% N/A

** Reprinted by permission of the Society of Nuclear Medicine from: Gambhir, Sanjiv S., Czernin, Johannes, Schwimmer, Judy, Silverman, Daniel H.S., Coleman, R. Edward, Phelps, Michael E. “A Tabulated Summary of the FDG PET Literature” J Nucl Med 2001 42: 1-93.

Case Study
Patient: 13yo male with diffuse large cell lymphoma. PET/CT was used to assess response to the first cycle of therapy.

Results: PET/CT demonstrated that the chemotherapy was working. Patient completed chemo and remained disease free 2 years after completion.