METHODS:
Literature Review and Analysis
Pertinent information from the published literature on the use of PET for response assessment in lymphoma through June 2005 was retrieved and reviewed for creation of this guideline. The subcommittee focused its deliberations on the results of a meta-analysis of FDG-PET for post-treatment evaluation of lymphoma, conducted in part by two of its members (OSH and JMZ) and subsequently published elsewhere.1 Search of the literature did not reveal any other meta-analysis or systematic review of this particular FDG-PET application. In this systematic review, the databases of PubMed (since 1966) and Embase (since 1998) were searched for studies relevant to the use of dedicated FDG-PET in evaluation of first-line therapy of HL and aggressive NHL up to January 2004 without any language restrictions.1 A series of searches were performed using controlled indexing terms (MeSH in MEDLINE and EMTree in Embase) and free text words. The search was augmented by manually reviewing the bibliographies of the identified studies and relevant review articles. Three reviewers (including OSH and JMZ) independently assessed the methodological quality of each study using the criteria list recommended by the Cochrane Methods Working Group on Systematic Review of Screening and Diagnostic Tests. As a valid reference test, histology or a clinico-radiological follow-up of at least 12 months was used and a meta-analysis of the reported sensitivity and specificity of each study was performed. 1
In addition to the above systematic review, subcommittee members identified on lymphoma reponse assessment with FLT in a mouse xenotransplant model more recent articles published in 2005 and 2006, particularly those pertaining to the use of PET/CT and PET imaging during therapy (therapy monitoring).
Process of Consensus Development
The Imaging Subcommittee had one face-to-face meeting followed by numerous e-mail communications. The first meeting defined the charge, identified the issues to be addressed by the guideline and addressed the process of literature review and allocation of writing assignments. A subgroup of panel members then formulated the initial tentative recommendations and supporting evidence, which were then circulated in draft form to all subcommittee members. Each of these had an opportunity to comment on these tentative recommendations and suggest revisions which were subsequently discussed by the panel members. The recommendations were then finalized by the designated panel’s subgroup and circulated to all panel members and to the IHP at large for final review and approval.
REFERENCE
1. Zijlstra JM, van der Werf GL, Hoekstra OS, Hooft L, Riphagen II, Huijgens PC: 18F-fluoro-deoxyglucose positron emission tomography for post-treatment evaluation of malignant lymphoma: a systematic review. Haematologica 91:522-529, 2006.
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