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Value of FDG-PET/CT Examinations in Different Cancers of Children, Focusing on Lymphomas

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Pathology & Oncology Research

Abstract

The aim of the study was to assess sensitivity and specificity of FDG-PET/CT in different forms of childhood cancer. We retrospectively evaluated the results dedicated of 162 FDG-PET/CT examinations of 86 children treated with: Hodgkin lymphoma (HL; n = 31), non-Hodgkin lymphoma (NHL; n = 30) and other high grade solid tumors (n = 25). Patients were admitted and treated in two departments of pediatric hematology and oncology in Hungary. FDG-PET/CT was performed for staging (n = 25) and for posttreatment evaluation (n = 137). Imaging was performed in three FDG-PET/CT Laboratories, using dedicated PET/CT scanners. False positive results were defined as resolution or absence of disease progression over at least 1 year on FDG-PET/CT scans without any intervention. In some cases histopathological evaluation of suspicious lesions was performed. Fals negative results were defined as negative FDG-PET/CT results in case of active malignancy. Positive predictive values (PPV) and negative predictive values (NPV) were calculated. NPV was 100 %. The highest PPV was observed in high grade solid tumors (81 %), followed by HL (65 %) and NHL (61 %). There was a major difference of PPV in different histological types of HL (50 % in HL of mixed-cellularity subtype, 90 % in nodular sclerosing, and 100 % in lymphocyte-rich and lymphocyte depleted HL). We treated one patient with nodular lymphocyte predominant HL, who had 5 false positive FDG-PET/CT results. PPV of T- and B-lineage NHL were similar (60 % and 62 %, respectively). We observed an interesting difference of PPV in different stages of HL and NHL. In HL PPV was higher in early than in advanced disease forms: 66 % in stage II HL and 60 % in stage III HL, whereas there was an inverse relationship between PPV and disease stages in NHL 0 % in stage I and II patients, 67 % in stage III and 100 % in stage IV patients. PPV was lower in males (54 %) than in females (65 %). PPV were 64 % vs. 58 % in patients under vs. over 10 years of age. Negative FDG-PET/CT results during follow-up reliably predict the absence of malignancy. Positive FDG-PET/CT scan results in general have a low PPV. The relatively high PPV in patients with histologically proven high grade solid tumors, advanced stages of NHL and with nodular sclerosing, lymphocyte-rich and lymphocyte depleted subtypes of HL warrant a confirmation by biopsy, whereas the watch-and-wait approach can be used in other forms of childhood cancer patients with a positive FDG-PET/CT result in course of follow-up examinations.

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Acknowledgments

Histopathologic analyses were performed by the coworkers of the 1st Department of Pathology and Experimental Oncology, Semmelweis University, Budapest and of the Department of Pathology, MHSC UD, Debrecen. This work was supported by the grant of the Health Science Council of the Ministry of Education Republic of Hungary (ETT) No. 01-478/2009 and by the “For the leukemic children” foundations. The publication is supported by the TÁMOP- 4.2.2.A-11/1/KONV-2012-0025 project. The project is co-financed by the European Union and the European Social Fund.

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Authors and Affiliations

  1. Department of Pediatric Hematology and Oncology, Institute of Pediatrics, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary

    Edit Bárdi, István Szegedi & Csongor Kiss

  2. 2nd Department of Pediatrics, Semmelweis University Budapest, Budapest, Hungary

    Mónika Csóka, Judit Müller, Karolina Nemes & Gábor Kovács

  3. Department of Nuclear Medicine, Semmelweis University Budapest, Budapest, Hungary

    Tamás Györke

  4. Scanomed LTD, Debrecen, Hungary

    Ildikó Garai & Tamás Györke

  5. Pozitron PET/CT Center, Budapest, Hungary

    Kornélia Kajáry

  6. Department of Pediatric Hematology and Oncology, Markusovszky Teaching Hospital, 5, Markusovszky Street, Szombathely, Hungary, 9700

    Edit Bárdi

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  1. Edit Bárdi
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  2. Mónika Csóka
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  3. Ildikó Garai
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  4. István Szegedi
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  5. Judit Müller
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  7. Kornélia Kajáry
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  8. Karolina Nemes
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  9. Csongor Kiss
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  10. Gábor Kovács
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Correspondence to Edit Bárdi.

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Csongor Kiss and Gábor Kovács contributed equally to the manuscript.

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Bárdi, E., Csóka, M., Garai, I. et al. Value of FDG-PET/CT Examinations in Different Cancers of Children, Focusing on Lymphomas. Pathol. Oncol. Res. 20, 139–143 (2014). https://doi.org/10.1007/s12253-013-9676-3

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  • DOI: https://doi.org/10.1007/s12253-013-9676-3

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