Comparison of fluorine-18 fluorodeoxyglucose positron emission tomography and Ga-67 scintigraphy in evaluation of lymphoma

Authors

  • Lale Kostakoglu M.D.,

    Corresponding author
    1. Division of Nuclear Medicine, Department of Radiology, Weill Medical College of Cornell University, New York, New York
    • The New York Presbyterian Hospital, Weill Cornell Medical Center, 525 East 68th Street, Starr: 221, New York NY 10021,
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    • Fax: (212) 746-9010

  • John P. Leonard M.D.,

    1. Division Hematology and Oncology, Department of Medicine, Weill Medical College of Cornell University, New York, New York
    2. Center for Lymphoma and Myeloma, The New York Presbyterian Hospital, New York, New York
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  • Ichiei Kuji M.D.,

    1. Division of Nuclear Medicine, Department of Radiology, Weill Medical College of Cornell University, New York, New York
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  • Morton Coleman M.D.,

    1. Division Hematology and Oncology, Department of Medicine, Weill Medical College of Cornell University, New York, New York
    2. Center for Lymphoma and Myeloma, The New York Presbyterian Hospital, New York, New York
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  • Shankar Vallabhajosula Ph.D.,

    1. Division of Nuclear Medicine, Department of Radiology, Weill Medical College of Cornell University, New York, New York
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  • Stanley J. Goldsmith M.D.

    1. Division of Nuclear Medicine, Department of Radiology, Weill Medical College of Cornell University, New York, New York
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  • This work also was chosen as one of the Highlights of the meeting. Highlights. J Nucl Med 2000;41:22N.

Abstract

BACKGROUND

The accuracy of fluorodeoxyglucose positron emission tomography (FDG-PET; dual-head camera with attenuation correction) and Ga-67 scintigraphy was compared to identify disease sites in patients with Hodgkin disease (HD) and intermediate and high-grade non-Hodgkin lymphoma (NHL) at initial diagnosis or clinical recurrence.

METHODS

Fifty-one contemporaneous FDG-PET and Ga-67 scintigraphies were performed on patients with NHL (35 intermediate grade, 3 high grade) or HD (13 patients). Sites of disease were correlated on a site-by-site basis on FDG-PET and Ga-67 images. Tumor-to-background (T/B) ratios were obtained for both techniques. Discordant FDG-PET and Ga-67 findings were correlated with computed tomography findings or clinical evaluation including repeat FDG-PET scans obtained after therapy.

RESULTS

Fluorodeoxyglucose positron emission tomography was positive at all 158 sites in 51 patients compared with 113 sites in 41 positive studies with Ga-67 scintigraphy (single positron emission computed tomography [SPECT] and/or planar images). In 44 patients who had complete Ga-67 SPECT data on all tumor sites, FDG-PET was positive at 126 sites and Ga-67 SPECT was positive at 81 sites. Ga-67 SPECT failed to demonstrate disease at 45 sites (35.7%). In 10 of 44 patients, Ga-67 SPECT completely failed to detect any disease at 22 of 45 sites (17.5%) and partially identified disease sites at 23 of 45 sites (18.2%) in 11 patients regardless of the tumor site and histology. In these patients, the lesions measured between 0.6 and 14.0 cm by CT. Fluorodeoxyglucose positron emission tomography revealed higher stage disease in 13 patients compared with Ga-67 imaging. Tumor-to-background ratios were statistically different between the two techniques with higher ratios obtained with FDG-PET (P < 0.0001).

CONCLUSIONS

In imaging aggressive lymphoma and HD before therapy, FDG-PET has significantly higher site and patient sensitivity than Ga-67 scintigraphy (100% vs. 71.5% and 100% vs. 80.3%, respectively). The change in disease stage by FDG-PET may result in a change in therapy strategy. Cancer 2002;94:879–88. © 2002 American Cancer Society.

DOI 10.1002/cncr.10336

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