Effect of whole-body (18)F-FDG PET imaging on clinical staging and management of patients with malignant lymphoma

• Published in: The Journal of nuclear medicine (1978) Vol. 42; no. 8; pp. 1139 - 1143
• Main Authors: Schöder, H, Meta, J, Yap, C, Ariannejad, M, Rao, J, Phelps, M E, Valk, P E, Sayre, J, Czernin, J
• Format: Journal Article
• Language: English
• Published: United States Society of Nuclear Medicine 01-08-2001
• Subjects: Adolescent; Adult; Aged; Female; Fluorodeoxyglucose F18; Hodgkin Disease - diagnostic imaging; Hodgkin Disease - surgery; Hodgkin Disease - therapy; Humans; Image Interpretation, Computer-Assisted; Lymphoma - diagnostic imaging; Lymphoma - surgery; Lymphoma - therapy; Lymphoma, Non-Hodgkin - diagnostic imaging; Lymphoma, Non-Hodgkin - surgery; Lymphoma, Non-Hodgkin - therapy; Male; Middle Aged; Neoplasm Staging - methods; Radiopharmaceuticals; Surveys and Questionnaires; Tomography, Emission-Computed; Whole-Body Counting
• ISSN: 0161-5505; 1535-5667

Correct staging is important in selecting the appropriate treatment for lymphoma patients. PET imaging with (18)F-FDG is useful for staging of lymphoma as well as for monitoring of therapy. However, to our knowledge, the clinical impact of PET on staging and management of lymphoma patients has not been reported.
Standardized questionnaires were mailed to referring physicians asking them whether and how the results of PET imaging had influenced clinical staging and management of the disease in their patients. Management changes, when present, were classified as intermodality (e.g., medical to surgical, surgical to radiation, medical to no treatment) or intramodality (e.g., altered medical, surgical, or radiotherapy approach).
The referring physicians returned 52 of 108 questionnaires (48.1%). Physicians indicated that PET led to a change in the clinical stage in 44% of patients: 21% were upstaged and 23% were downstaged. Findings of the PET examination resulted in intermodality changes in management in 42% of patients, in intramodality changes in 10%, and in a combination of the management changes in 10%. Other, not further specified, treatment changes were reported in 6% of patients. PET did not result in any management changes in only 32% of patients.
This survey-based study of referring physicians indicates that FDG PET has a major impact on the management of lymphoma patients, contributing to changes in clinical stage in 44% and changes in treatment in >60% of cases.