Diagnostic and Clinical Impact of Staging F-18-FDG PET/CT in Mantle-Cell Lymphoma: A Two-Center Experience

In an investigation of the utility of staging fluorine-18-fluorodeoxyglucose positron emission tomography/ computed tomography (F-18-FDG PET/CT) in assessing nodal, splenic, bone marrow (BM), and gastrointestinal (GI) involvement compared to CT, BM biopsy, and GI endoscopy in mantle-cell lymphoma, F-18-FDG PET/CT showed high diagnostic performance in nodal and splenic disease. It had good positive predictive value in BM and negative predictive value in GI organs, especially when we excluded all conditions potentially affecting these organs' uptake. F-18-FDG PET/CT altered the management and therapeutic approach in about 20% of cases. Introduction: The diagnostic accuracy of fluorine-(18)efluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT) in staging mantle-cell lymphoma has not yet investigated. The aim of this 2-center retrospective study was to investigate the utility of F-18-FDG PET/CT in assessing nodal, splenic, bone marrow (BM), and gastrointestinal (GI) disease compared to CT, BM, and GI endoscopy; and to assess its clinical impact. Patients and Methods: One hundred twenty-two patients with histologically proven mantle-cell lymphoma were included. PET/CT BM findings were considered positive if isolated/multiple focal uptake in the BM not explained by benign findings and/or diffuse BM uptake higher than liver with/without focal uptakes were present. PET/CT findings were considered positive for GI involvement in the presence of isolated/multiple focal uptake in the GI organ. Results: All patients had positive PET/CT showing the presence of at least one hypermetabolic lesion, with the exception of one case. PET/CT results, compared to CT, detected more nodal and/or splenic lesions in 26 patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET/CT for BM were 52%, 98%, 97%, 65%, and 74%; for GI 64%, 91%, 69%, 90%, and 85%; and for GI excluding diabetic patients, 78%, 92%, 72%, 94%, and 89%. PET/CT permitted upstaging of 21 cases and downstaging of 2. Conclusion: F-18-FDG PET/CT showed excellent detection rate in nodal and splenic disease-a rate better than CT. For BM and GI evaluation, in order to reach good accuracy, the selection of patients and the use of specific criteria for evaluation of these organs seems to be crucial. Moreover, PET/CT altered the management and therapeutic approach in about 20% of patients. (C) 2019 Elsevier Inc. All rights reserved.