L hyperfixation dans le suivi des lymphomes représente-t-elle toujours une maladie active?

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1 L hyperfixation dans le suivi des lymphomes représente-t-elle toujours une maladie active? Thierry Vander Borght UCL Mont-Godinne, Belgique

2

3 FDG-PET in Lymphoma: Mont-Godinne Experience 03/ /2002: 199 FDG-PET in lymphomas: 43 initial staging 53 early assessment of treatment response 103 follow-up 90 NHL and 11 HD

4 Case #1: Mrs M.G. 68 years 12/98 Diagnosis: transformed follicular NHL Stage: I R/ CHOP x4 + RT Result: CR1 03/01 jugal tumefaction and cervical nodes Relapse? FDG-PET

5 March 2001 Giant cells

6 Shah & Branstetter. Oncocytoma of the parotid gland: a potential falsepositive finding on FDG PET. AJR 2007;189:W (SUV 6.2) Bilaterally symmetrical increased uptake is usually physiological An asymmetrical uptake, especially when focal, would warrant correlation Nucl Med Commun 2008;29(4):

7

8 CL360517

9 Buchler et al. SM. Haematologica 2007;92:120-1.

10 Retrospective study of patients with nonlung cancer: 103/933 (11%) hilar FDG-avid foci Univariate analysis variables associated with malignancy SUV max (6.6 vs. 3.5 for benign) Impurity = non hilar chest foci (79% vs. 18% for benign) Node size on CT Δ uptake between scans 1 and 2 (2.7 vs. 0.73) Variables associated with benign Symmetry Purity Colorectal primary (75% = benign vs. 34 breast, 49 lymphoma, 37 others) Multivariate analysis SUV max (odds of malignancy by 1.54 for each unit increase in SUV) Purity (odds of malignancy by 0.08 if pure). J Nucl Med 2008;49:

11 Brepoels L, et al. Leuk Lymphoma 2007;48:

12 Cervical thymic hyperplasia after chemotherapy in an adult patient with HL: a potential cause of FP on FDG PET/CT scanning Fallanca et al. Br J Haematol 2008;140:477.

13 Lipomatous Hypertrophy Interatrial Septum 1% at autopsy, 2-8% on echo Increase in size with age Associated with arrhythmias Increased uptake on FDG-PET Mixed fat, brown fat and fibrous tissue on histology Fan et al. Am J Roentgenol 2005;184:

14 MA 62 y-old man A A B C B C A B C

15 Case #2: Mr J.J., 64 years Diagnosis: stage IV (lung) DLBCL 08/00 3 CHOP 10/00

16 6 m. FU Transbronchic biopsy PAS Invasive aspergillosis

17 28-year-old man History of Hodgkin disease in remission Fatigue, pyrexia, and a raised ESR Sheehy N, et al. Clin Nucl Med 2007;32:820-1.

18 Case report #3: Mr B.E. 55 years 1994 Diagnosis: Peripheral T-cell NHL 40 x CD3 Stage: III B Treatment: Result: CR1 ACVBP x4 + conso 2000 Relapse: salvage CT: Edx-Vp16 x1/ VIM2AraC x2 Staging before intensification: CR2?

19 March 2000 At relapse July 2000 Before PBSCT en s é Pr n it o ta M A R P A EN

20 SUV = 4 SUV = 1.8 March 2000 At relapse July 2000 Before PBSCT en s é Pr n it o ta M A R P A EN

21 Transbronchic biopsy and bone biopsy SUV = x September months after PBSCT Non small cell carcinoma

22 Case report #4: Mr G.H. 71 years 1989 Diagnosis: Diffuse large B-cell NHL Stage : III B Treatment: Alt VIM/ACVBP x4 Result: CR Relapse: Clinical stage: I : inguinal lymph node PET stage: III Treatment: CHOP x4 + RTh Result: CR2

23 02/00 Relapse? 04/01 End R/ 05/02 FU

24 02/00 Relapse? DLBCL 04/01 End R/ 20 x HE 05/02 FU M A R P A EN n it o NSCLC ta 20 x HE n e s é Pr

25 Case report #5: Mr D.J. 53 years 1990 Diagnosis: Hodgkin s disease Stage: I Treatment: surgery + Rth Result: CR1 2000: cervical lymph node FDG-PET

26 Epidermoid carcinoma of unknown origin 4 x HE

27 Case report n 6: Mrs C.B. 67 years 1999 Diagnosis: lymphocytic lymphoma Stage: IV R/ chlorambucil CR1 December 2001: FU FDG-PET Rectal villous tumour

28 Tatlidil et al. Radiology 2002;224: /06-02/07: selection of patients with unusual bowel uptake 14% colonic malignancy 38% polyps, gastrointestinal stromal tumour and severe ulcerative colitis Gupta & Olson. RSNA 2008: SSJ21-04

29 CT corrected PET image Ge corrected PET image Subtraction PET image CT transmission image Ge transmission image CT scan Nakamoto et al. Nucl Med Commun 2004;25:

30 Mantle Cell Lymphoma 59-year-old man Fatigue, weight loss Clinical exam: splenomegaly, adenopathies Inguinal node biopsy BMB: cyclin D1 overexpression [t(11;14)] 27/01/2003; HY modified from Lenz G et al. Ann Hematol 2004;83:

31 Summary Initial D/ Time Interval Secondary D/ Non-malignant lesions B-NHL 27 months Sarcoidosis B-NHL 6 months Aspergillosis X = 16.5 months Malignant lesions T-NHL 70 months NSCLC B-NHL 154 months NSCLC Hodgkin 116 months Epidermoid carcinoma B-NHL 31 months Villous tumour B-NHL 63 months SCLC X = 70 months

32 2837 agressive NHL from 02/84 to 01/87 81 second cancers = 66 (17 hematologic; 49 solid [21 lung]) 7-year cumulative incidence = 2.75% Blood. 2004;103:

33 Conclusion These data illustrate the role of FDG-PET in (re)staging of lymphoma Relapse suspected only on FDG-PET imaging requires biopsy as alternative diagnoses are possible Early in the follow-up, persistent abnormal FDG uptake in sites unrelated to the initial staging is highly suspicious for infection, whereas later, new lesion is suspicious of secondary tumour FDG-PET might be a new modality for long-term monitoring of late effects, especially second cancer occurrence

34 Merci pour votre attention

35 Ceci est-il un lymphome? Merci pour votre attention

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