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Blood, 15 November 2001, Vol. 98, No. 10, pp. 2930-2934
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Thoracic positron emission tomography using
18F-fluorodeoxyglucose for the evaluation of residual
mediastinal Hodgkin disease
Martin R. Weihrauch,
Daniel Re,
Klemens Scheidhauer,
Sascha Ansén,
Markus Dietlein,
Stefanie Bischoff,
Heribert Bohlen,
Jürgen Wolf,
Harald Schicha,
Volker Diehl, and
Hans Tesch
From the Department of Internal Medicine I and
Department of Nuclear Medicine, University of Cologne,
Germany; Axiogenesis GmbH, Cologne, Germany; and
Department of Internal Medicine, Klinikum der Stadt
Villingen-Schwenningen, Germany.
Residual mediastinal masses are frequently observed in patients
with Hodgkin disease (HD) after completed therapy, and the discrimination between active tumor tissue and fibrotic residues remains a clinical challenge. We studied the diagnostic value of
metabolic imaging by 18F-fluorodeoxyglucose (FDG) positron
emission tomography (PET) in detecting active mediastinal disease and
predicting relapse. Twenty-eight HD patients with a residual
mediastinal mass of at least 2 cm after initial therapy or after
salvage chemotherapy were prospectively assigned to 29 examinations
with FDG PET and were evaluated as 29 "subjects." Patients were
monitored for at least 1 year after examination and observed for signs
of relapse. Median follow-up was 28 months (range, 16 to 68 months). A
PET-negative mediastinal tumor was observed in 19 subjects, of whom 16 stayed in remission and 3 relapsed. Progression or relapse occurred in 6 of 10 subjects with a positive PET, whereas 4 subjects remained in
remission. The negative predictive value (negative PET result and
remission) at 1 year was 95%, and the positive predictive value
(positive PET result and relapse) was 60%. The disease-free survival
for PET-negative and PET-positive patients at 1 year was 95% and 40%,
respectively. The difference was statistically significant. A negative
FDG PET indicates that an HD patient with a residual mediastinal mass
is unlikely to relapse before 1 year, if ever. On the other hand, a
positive PET result indicates a significantly higher risk of relapse
and demands further diagnostic procedures and a closer follow-up.
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