Comparison of positron emission tomography/computed tomography with classical contrast-enhanced computed tomography in the initial staging of Hodgkin lymphoma

Abstract

We compared initial computed tomography (CT) and positron emission tomography (PET)/CT in 96 patients with Hodgkin lymphoma (HL), assessing the role of baseline PET/CT in stage migration and treatment selection. The number of patients with stage I, II, III and IV disease based on CT versus PET/CT was: 5 vs. 7, 49 vs. 37, 28 vs. 22 and 14 vs. 30, respectively. In 33 (34%) patients, PET/CT changed HL stage: 27 (28%) were upstaged and six (6.3%) downstaged. Upstaging was caused by detection of new extranodal involvements (47 sites in 26 patients): bone marrow (10 patients), spleen (five patients) and lung (two patients). In nine patients ≥ 2 further coexisting locations were detected. Downstaging resulted from the absence of fluorodeoxyglucose (¹⁸F-FDG) uptake in enlarged nodes (> 15 mm) in the abdomen and pelvis. PET/CT modified HL stage in 34% of patients leading to treatment modification in the majority. Our results indicate that PET/CT should be mandatory in the initial staging of HL.

Keywords::

• Hodgkin lymphoma
• staging
• PET/CT

Acknowledgements

The authors are deeply grateful to Dr. Alberto Biggi and Dr. Stefan Chauvie from Cuneo PET Center, Italy, for nuclear medicine training of the Polish PET centers before project initiation and Professor Andrea Gallamini for help and constant support.

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