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. 2017 Oct 3;26(3):83-92.
doi: 10.4274/mirt.48658.

Uptake Patterns of Untreated Primary Gastrointestinal Extranodal Lymphomas on Initial Staging 18F-FDG PET/CT and Metabolic Tumor Parameters

Engin Alagöz  1 , Kürşat Okuyucu  1 , Semra İnce  1 , Murat Kantarcıoğlu  2 , Şükrü Özaydın  3 , Cumhur Heper  4 , Türker Türker  5 , Nuri Arslan  1
Affiliations

Uptake Patterns of Untreated Primary Gastrointestinal Extranodal Lymphomas on Initial Staging 18F-FDG PET/CT and Metabolic Tumor Parameters

Engin Alagöz et al. Mol Imaging Radionucl Ther. .

Abstract
in English, Turkish

Objective: Non-Hodgkin's lymphomas arising from tissues other than primary lymphatic sites are classified as primary extranodal lymphomas (PEL). PELs of the gastrointestinal system (PGISL) originate from the lymphatic tissues within the gastrointestinal tract. The prognostic value of 18F-FDG PET/CT in lymphomas is high in terms of both overall survival (OS) and disease-free survival (DFS). Our aim was to investigate the uptake patterns and properties of low-grade and high-grade PGISL on primary staging 18F-FDG PET/CT, as well as the prognostic significance of metabolic tumor parameters in high grade PGISL.

Methods: Thirty-nine patients with PGISL were enrolled in this retrospective cohort study between 2004-2015. Primary staging 18F-FDG PET/CT have been performed and quantitative parameters of SUVmax, SUVmean, metabolic tumor volume (MTV), total lesion glycolysis (TLG) have been calculated for all patients prior to treatment. Low-grade and high-grade PGISL were compared in terms of metabolic tumor parameters. Cox regression models were performed to determine factors that correlate with DFS in high-grade PGISL.

Results: There were statistically significant differences between high-grade and low-grade PGISL in terms of SUVmax, SUVmean, MTV, TLG, recurrence, mortality, DFS and OS. None of the potential risk factors (sex, age, site, SUVmax, SUVmean, MTV, TLG) for recurrence and metastasis in high grade PGISL was identified as a risk factor on univariate and multivariate Cox regression analysis.

Conclusion: Metabolic tumor parameters are not predictive markers in high-grade PGISL, especially in diffuse large B cell variant and primary gastric lymphoma. The first implications suggest they will not play a role in patient management.

Amaç: Primer lenfatik alanlar dışındaki dokulardan kaynaklanan Non-Hodgkin lenfomalara primer ekstranodal lenfoma (PEL) denmektedir. Gastrointestinal sistemin PEL’i (PGISL) buradaki lenfatik dokulardan köken alır. 18F-FDG PET/BT lenfomalarda genel ve hastalıksız sağkalım açısından yüksek prognostik değere sahiptir. Amacımız düşük grad ve yüksek grad PGISL’de primer evreleme 18F-FDG PET/BT’de tutulum şekillerini, özelliklerini, yüksek grad PGISL’de metabolik tümör parametrelerinin prognostik önemi ile birlikte araştırmaktır. Yöntem: 2004-2015 yılları arasında PGISL (evre 1-2) tanısı konmuş 39 hasta bu retrospektif kohort çalışmaya dahil edildi. Hastalara tedaviden önce primer evreleme 18F-FDG PET/BT çekilmiş ve maksimum standardize uptake değeri (SUVmaks), ortalama standardize uptake değeri (SUVortalama), metabolik tümör hacmi (MTV) ve total lezyon glikolizi (TLG) gibi metabolik tümör parametreleri hesaplanmıştı. Düşük grad ve yüksek grad PGISL metabolik tümör parametreleri açısından karşılaştırıldı. Yüksek grad PGISL’de Cox regresyon modelleri üzerinden hastalıksız sağkalım ile ilişkili faktörler tespit edildi. Bulgular: Düşük grad ve yüksek grad PGISL arasında SUVmaks, SUVortalama, MTV, TLG, nüks, mortalite, genel ve hastalıksız sağkalım açısından istatistiksel olarak anlamlı fark saptanmıştır. Yüksek grad PGISL’de nüks ve metastaza etki eden tüm potansiyel risk faktörlerinin (cinsiyet, yaş, site, SUVmaks, SUVortalama, MTV, TLG) tek ve çok değişkenli Cox regresyon analizinden sonra metabolik tümör parametrelerinin bir risk faktörü olmadığı görülmüştür. Sonuç: Metabolik tümör parametreleri özellikle diffüz büyük B hücreli varyant ve primer gastrik lenfoma başta olmak üzere yüksek grade PGISL’nin prognoz tahmininde faydalı değildir. İlk izlenimler hasta yönetiminde bir rolleri olamayacağı yönündedir. Anahtar kelimeler: 18F-fluorodeoksiglukoz pozitron emisyon tomografi/bilgisayarlı tomografi, metabolik tümör parametreleri, primer gastrointestinal lenfoma.

Keywords: 18; F-fluorodeoxyglucose positron emission tomography/computed tomography; metabolic tumor parameters primary gastrointestinal lymphoma..

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Conflict of interest statement

Conflict of Interest: The authors declared that there is no conflict of interest regarding the publication of this paper.

Figures

Figure 1
Figure 1. The SUVmax, SUVmean, metabolic tumor volume and total lesion glycolysis values of a 58-year old male patient with primary gastric lymphoma diffuse large B-cell variant were 11.5, 5.2, 35 cm3 and 176, respectively, on trans-axial computed tomography (A), positron emission tomography (B), fusion (C) and maximum intensity projection (D) images of baseline 18-fluorodeoxyglucose positron emission tomography (arrows). He responded to treatment and his disease-free survival and overall survival are 92 months
Figure 2
Figure 2. ROC curve of SUVmax, SUVmean, metabolic tumor volume and total lesion glycolysis for high-grade primary extranodal lymphomas of the gastrointestinal system MTV: Metabolic tumor volume, TLG: Total lesion glycolysis
Figure 3
Figure 3. Survival graphic of high-grade primary extranodal lymphomas of the gastrointestinal system diffuse large B-cell variant obtained by univariate Cox regression test. Kaplan-Meier curves of SUVmax with a cut-off value of 18.2 (A), SUVmean with a cut-off value of 12.1 (B), metabolic tumor volume with a cut-off value of 97 cm3 (C), total lesion glycolysis with a cut-off value of 487 (D) for high-grade primary extranodal lymphomas of the gastrointestinal system MTV: Metabolic tumor volume, TLG: Total lesion glycolysis, DFS: Disease-free survival
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