Lymphoma- PET-CT - initial staging and response assessment

Aikaterini Tavernaraki, Myrsini Stassinopoulou, Ilias Tsaousidis, Aspasia Papailiou, Christos Papadogeorgopoulos, Konstantinos Deliveliotis


The most common primary hematopoietic malignancy is lymphoma. Proper initial staging and therapy response is important. Staging defines disease location and extent and is important because it provides a baseline evaluation and allows comparison among studies. PET-CT is preferred for the staging of FDG-avid lymphomas, and a CT scan is preferred in non-avid types. Response assessment is also important in lymphoma patients. PET-CT should be used for response assessment in FDG-avid types, both for early assessment during therapy, known as interim, and at end of treatment. A scale was suggested as the standard reporting tool, and these so-called Deauville criteria have been widely used using the 5-point scale. In this pictorial essay, we present several cases of lymphoma patients to understand how to evaluate initial examination-staging and interim or end therapy response assessment according to Deauville criteria.


PET CT, lymphoma, response assessment, Deauville criteria.

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Okada M, Sato N, Ishii K, et al. FDG PET/CT versus CT, MR imaging, and 67Ga scintigraphy in the posttherapy evaluation of malignant lymphoma. RadioGraphics 30:939–57, 2010.

Meignan M, Gallamini A, Haioun C: Report on the First International Workshop on Interim-PETScan in Lymphoma. Leuk Lymphoma 50:1257-1260, 2009.

Elstrom R, Guan L, Baker G, et al: Utility of FDG-PET scanning in lymphoma by WHO classification.Blood 101:3875-3876, 2003

Tsukamoto N, Kojima M, Hasegawa M, et al: The usefulness of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) and a comparison of (18)F-FDG-pet with (67)gallium scintigraphy in the evaluation of lymphoma: Relation to histologic subtypes based on the World Health Organization classification. Cancer 110:652-659, 2007.

Weiler-Sage M, Bushelev O, Epelbaum R, et al: (18)F-FDG avidity in lymphoma readdressed: A study of 766 patients. J Nucl Med 51:25-30,2010.

Cheson BD, Fisher RI, Barrington SF, et al; Australasian Leukaemia and Lymphoma Group; Eastern Cooperative Oncology Group; European Mantle Cell Lymphoma Consortium; Italian Lymphoma Foundation; European Organisation for Research; Treatment of Cancer/Dutch Hemato-Oncology Group; Grupo Español de Médula Ósea; German High-Grade Lymphoma Study Group; German Hodgkin’s Study Group; Japanese Lymphoma Study Group; Lymphoma Study Association; NCIC Clinical Trials Group; Nordic Lymphoma Study Group; Southwest Oncology Group; United Kingdom National Cancer Research Institute. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014 Sep 20;32(27):3059-68.

Sally F. Barrington, N. George Mikhaeel, Lale Kostakoglu, et al. Role of Imaging in the Staging and Response Assessment of Lymphoma: Consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J Clin Oncol 32:3048-3058, 2014.

El-Galaly TC, d’Amore F, Mylam KJ, et al: Routine bone marrow biopsy has little or no therapeutic consequence for positron emission tomography/computed tomography–staged treatment-naïve patients with Hodgkin lymphoma. J Clin Oncol 30:4508-4514, 2012

Luminari S, Biasoli I, Arcaini L, et al: The use of FDG-PET in the initial staging of 142 patients with follicular lymphoma: A retrospective study from the FOLL05 randomized trial of the Fondazione Italiana Linfomi. Ann Oncol 24:2108-2112, 2013

Richardson SE, Sudak J, Warbey V, et al: Routine bone marrow biopsy is not necessary for the staging of patients with classical Hodgkin lymphoma in the 18F- fluoro-2-deoxyglucose positron emission tomography era. Leuk Lymphoma 53:381-385, 2012

Chen YK, Yeh CL, Tsui CC, et al: F-18 FDG PET for evaluation of bone marrow involvement in non-Hodgkin lymphoma: A meta-analysis. Clin Nucl Med 36:553-559, 2011

O’Doherty MJ, Barrington SF, Campbell M, et al: PET scanning and the human immunodeficiency virus-positive patient. J Nucl Med 38:1575-1583, 1997

Cheson BD, Horning SJ, Coiffier B, et al: Report of an International Workshop to standardize response criteria for non-Hodgkin’s lymphomas: NCI Sponsored International Working Group. J Clin Oncol 17:1244-1253, 1999

Cronin C, Sword R, Truong M, et al. Clinical utility of PET/CT in lymphoma. AJR 194:91–103, 2010.

Juweid ME, Stroobants S, Hoekstra OS, et al: Use of positron emission tomography for response assessment of lymphoma: Consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J Clin Oncol 25:571-578, 2007

Cheson BD, Pfister B, Juweid ME, et al: Revised response criteria for malignant lymphoma. J Clin Oncol 25:579-586, 2007

Juweid ME, Stroobants S, Hoekstra OS, et al: Use of positron emission tomography for response assessment of lymphoma: Consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J Clin Oncol 25:571-578, 2007

Biggi A, Gallamini A, Chauvie S, et al: International validation study for interim PET in ABVD-treated, advanced-stage Hodgkin lymphoma: Interpretation criteria and concordance rate among reviewers. J Nucl Med 54:683-690, 2013

Dupuis J, Berriolo-Riedinger A, Julian A, et al: Impact of [18F]fluorodeoxyglucose positron emission tomography response evaluation in patients with high-tumor burden follicular lymphoma treated with immunochemotherapy: A prospective study from the Groupe d’Etudes des Lymphomes de l’Adulte and GOELAMS. J Clin Oncol 30:4317-4322, 2012

Itti E MM, Berriolo-Riedinger A, Biggi A, et al: An international validation study of the prognostic role of interim FDG PET/CT in diffuse large B-cell lymphoma. Eur J Nucl Med Mol Imaging 40:1312-1320, 2013

Cheson, B.D.; Ansell, S.; Schwartz, L.; Gordon, L.I.; Advani, R.; Jacene, H.A.; Hoos, A.; Barrington, S.F.; Armand, P. Refinement of the Lugano Classification lymphoma response criteria in the era of immunomodulatory therapy. Blood 2016, 128, 2489–2496

Wolchok JD, Hoos A, O’Day S, et al. Guidelines for the evaluation of immune therapy activity in solid tumors: immune-related response criteria. Clin Cancer Res. 2009; 15:7412–7420



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