Originally published as JCO Early Release 10.1200/JCO.2008.16.0861 on March 9 2009

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Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography for Interim Response Assessment of Advanced-Stage Hodgkin's Lymphoma and Diffuse Large B-Cell Lymphoma: A Systematic Review

From the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Clinical Research Center for Blood Diseases, National Hospital Organization Nagoya Medical Center; Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Nuclear Medicine, François Baclesse Center, Caen; Department of Nuclear Medicine, University of Angers, Angers, France; and the Department of Oncology and Haematology, Copenhagen University Hospital, Copenhagen, Denmark.

Corresponding author: Teruhiko Terasawa, MD, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #63, Boston, MA 02111; e-mail: tterasawa{at}tuftsmedicalcenter.org.

Purpose To systematically review the prognostic accuracy of fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) for interim response assessment of patients with untreated advanced-stage Hodgkin's lymphoma (HL) or diffuse large B-cell lymphoma (DLBCL).

Methods MEDLINE, EMBASE, SCOPUS, and Biologic Abstracts were searched for relevant studies. Two assessors independently reviewed studies for inclusion and extracted data. Relevant unpublished data were requested from the investigators if unavailable from publications. A meta-analysis of the prognostic accuracy was performed.

Results Thirteen studies involving 360 advanced-stage HL patients and 311 DLBCL patients met our inclusion criteria. Advanced-stage HL studies included few unfavorable-risk patients. DLBCL studies were heterogeneous. FDG-PET had an overall sensitivity of 0.81 (95% CI, 0.72 to 0.89) and a specificity of 0.97 (95% CI, 0.94 to 0.99) for advanced-stage HL, and a sensitivity of 0.78 (95% CI, 0.64 to 0.87) and a specificity of 0.87 (95% CI, 0.75 to 0.93) for DLBCL. Meta-regression and subgroup analyses did not identify factors that affect prognostic accuracy.

Conclusion For low- to intermediate-risk advanced-stage HL, FDG-PET performed after a few cycles of standard chemotherapy seems to be a reliable prognostic test to identify poor responders, warranting prospective studies to assess PET-based treatment strategies. For DLBCL, no reliable conclusions can be drawn due to heterogeneity. Interim PET remains an unproven test for routine clinical practice. Its use should be reserved for research settings where treatment regimens and imaging conditions are standardized.

Supported by Banyu Life Science Foundation International (H19) and the Ministry of Health, Labor, and Welfare, Japan (15–2).

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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