To analyze the characteristics of 18FDG-PET/CT image and explore the relevance of the standard uptake value with some prognostic indicators. Subjects and methods: Descriptive, prospective study on 50 patients with a definitive diagnosis of non-Hodgkin lymphoma by 18FDG-PET/CT scans in the Department of Nuclear Medicine, 103 Military Hospital.
Journal of military pharmaco-medicine no6-2019 CHARACTERISTICS OF 18FDG PET/CT IMAGE AND THE CORRELATION BETWEEN STANDARD UPTAKE VALUE AND SOME INDICATORS OF PATIENT WITH NON-HODGKIN LYMPHOMA AT 103 MILITARY HOSPITAL Nguyen Kim Luu1; Ngo Van Dan1; Ngo Vinh Diep1 SUMMARY 18 Objectives: To analyze the characteristics of FDG-PET/CT image and explore the relevance of the standard uptake value with some prognostic indicators Subjects and methods: Descriptive, prospective study on 50 patients with a definitive diagnosis of non-Hodgkin 18 lymphoma by FDG-PET/CT scans in the Department of Nuclear Medicine, 103 Military Hospital Results and conclusion: Standard uptake value index increased in the inguinal node groups (27.2 ± 11.0), abdominal lymph nodes (16.3 ± 8.3), in amydal (18.5 ± 0.7), lower stomach (9.1 ± 6.2) There was a relatively close correlation (r = 0.8) between standard uptake value and cell malignancy and correlation between standard uptake value and international prognosis index risk (r = 0.51) 18 * Keywords: Non-Hodgkin lymphoma; FDG PET/CT; Standard uptake value INTRODUCTION Non-Hodgkin lymphoma (NHL) is a malignant group of lymphocytes, which may manifest in lymph nodes or beyond lymph nodes Following Globocan (2012), NHL is one of the ten most common cancers in Vietnam and many other countries in the world, ranking fifth in terms of incidence and sixth in mortality after lung, breast, liver, stomach and colorectal cancers The disease occurs in all ages, men tend to get sick more than women Diagnosis of NHL based on clinical and subclinical characters Clinical symptoms include enlarged lymph nodes found in the neck, upper arm, armpit, groin Lymphoma can occur in any organ or part of the body When the disease is in advanced stage, there may be signs of compression, invasion of lymph nodes, tumors such as: protrusion; facial paralysis, numbness, paralysis, paralysis due to compression of the spinal cord; intestinal obstruction, gastrointestinal bleeding in the case of gastrointestinal tract tumor Subclinically: Lymph node biopsy to diagnose the disease and classify cell lines Bone marrow biopsy helps determine the invasion of tumor cells into the bone marrow to help classify and predict prognosis Biochemical testing of tumor markers: high blood lactate dehydrogenase (LDH), increased blood beta2-microglobulin has a negative prognosis 103 Military Hospital Corresponding author: Ngo Van Dan (dr.danhvqy@gmail.com) Date received: 07/06/201 Date accepted: 05/08/2019 175 Journal of military pharmaco-medicine no6-2019 There are many methods of image diagnosis such as ultrasound of the neck, armpit, groin, abdomen to detect the number, position, size of lymph nodes and tumors CT, MRI-scans of the chest, abdomen, cranial and spinal cord to assess the size of tumors, lymph nodes, position, degree of invasion 18FDG PET/CT has a high value for detecting lymph node lesions, helping to accurately assess the number, position, size of lymph nodes, external lymphadenopathy to help determine the stage of disease more accurately, follow progress, evaluate treatment response, monitor relapse after treatment In this topic, we set the research problem with the objective of: Assessing the role of 18FDG PET/CT in the diagnosis of lymphadenopathy and the relationship between standard uptake value (SUV) values and malignancy and prognosis index of NHL SUBJECTS AND METHODS Subjects 50 patients with a definitive diagnosis of NHL by histopathology, under inpatient treatment at the Department of Hematology Toxic - Radiology and Occupational Disease and Nuclear Medicine Department and taking 18FDG-PET/CT at the Department of Nuclear Medicine, 103 Military Hospital from June 2016 to August 2018 Methods Descriptive and prospective study The patients were evaluated for the International Prognostic Index (IPI) PET/CT Trulight (Philip firm) Drug of radioactive substance 18FDG, dosage: 0.14 - 0.15 mCi/kg body weight On the 18FDG-PET/CT image, there are the largest number of nodes, largest position, size and value SUVs in each group Size, position and SUV value of non-lymph node lesions The results were statistically processed: average size, average SUV by lymph node group, lymph node position, lymph node group Find correlation between SUV value and malignancy and IPI index of disease NHL multiplication RESULTS AND DISCUSSION 50 NHL patients with characteristics: Age from 23 to 87 years, average age was 53.8 ± 17.9 Males: 38 and females: 12; male:female ratio = 3.2:1 Table 1: Characteristics of the research group Characteristics Reason of admission Symptom B 176 No of patients Percentage (%) Large nodes 27 54 Abdominal pain 16 32 Cough, chest pain Others Fever 15 30 Sweating 12 24 Weight loss Journal of military pharmaco-medicine no6-2019 Cell type CD20 B 47 94 T (+) 45 90 (-) 10 Percentage of hospitalized patients with symptoms of large nodes (27/50 = 54%), abdominal pain (16/50 = 32%) due to abdominal metastasis, so patients with nonHodgkin's malignant lymphoma are often given late diagnosis Most patients (47/50 = 94%) were of the invasive B cells, of which 45/50 (90%) had CD20 (+) Table 2: Location of metastatic lymph nodes and tumors in NHL patients Metastatic lymph nodes and tumors Nodes and tumor Nodes Tumors No of patients Percentage (%) Neck 25 50 Abdomen 16 32 Supraclavicular 11 22 Inguinal Armpit node group 23 46 ≥ node group 27 54 Stomach 18 Chest 16 Intestines 14 Breasts, uterus, cervix 10 Amydal Position According to Carlos A.B [1], 18FDG PET/CT can detect metastatic lymphoma in many different organs such as the brain, neck, liver, spleen, muscle and skin In some cases, attention should be paid to avoid false diagnosis due to physiological glucose concentration or inflammation after the patient treated with chemotherapy, radiation therapy However, the high concentration of physiological glucose is usually in the lymph structures in the head and neck areas and is symmetrical, while malignant lymphocytes are often asymmetrical and significantly higher in SUV values By retrospective analysis of some research results, Delbeke, Wu L.M and Chen F.Y [2, 7] showed that 18FDG PET/CT in NHL diagnosis had a sensitivity of 91.6% and specificity of 90.3%, higher than MRI There were some claims that these statistics were over 97% 177 Journal of military pharmaco-medicine no6-2019 Table 3: Lymph node size and 18FDG concentration (SUV) of lymph nodes Position Number Size (mm) SUV Neck 25 25.8 ± 14.4 15.7 ± 8.0 Abdomen 16 18.6 ± 9.2 16.3 ± 8.3 Supraclavicular 11 20.0 ± 10.7 9.5 ± 3.3 p > 0.05 Inguinal 26.0 ± 15.5 27.2 ± 11.0 r = 0.19 Armpit 60 16 23.8 ± 13.8 16.4 ± 7.6 Average p, r The average size of the largest lymph node in each node group was over cm The concentration of glucose SUV increased highly in the inguinal node group (27.2 ± 11.0), abdominal lymph nodes (16.3 ± 8.3), and the overall average was 16.4 ± 7.6 There was no clear correlation between glucose SUV concentration and lymph node size (r = 0.19) Table 4: Metastatic tumor size and 18FDG concentration (SUV) Position Number Size (mm) SUV Stomach 32.6 ± 14.0 9.1 ± 6.2 Intestines 44.3 ± 16.2 12.0 ± 7.0 Chest 15.6 ± 5.2 14.4 ± 6.7 Breasts, uterus, cervix 25.0 ± 8.7 12.3 ± 11.0 Amydal 40.0 ± 7.0 18.5 ± 0.7 33 39.2 ± 14.5 14.6 ± 6.5 Total p < 0.05 The average size of metastatic tumors was 39.2 ± 14.5 mm, the average SUV value of metastatic tumors was 14.6 ± 6.5; lower than the average SUV of the node Disseminated B-cell malignant lymphoma is a type of cell that has a rapid division rate, a strong increase in glucose consumption, therefor the SUV values of lymph nodes and tumors are very high For non-lymphoma tumors, the highest SUV values were found in the amydal (18.5 ± 0.7), the lowest was in the stomach (9.1 ± 6.2) (p < 0.05) Table 5: SUV concentration of lymph nodes according to histology (n = 45) Malignancy Number SUV Low 12 7.2 ± 1.8 Medium 25 15.3 ± 6.5 High 16.4 ± 6.8 p, r p < 0.05 r = 0.8 According to histology, NHL is divided into subgroups with low, medium and high malignancy The above results showed a relatively close correlation (r = 0.8) between 178 Journal of military pharmaco-medicine no6-2019 SUV value and cell malignancy According to Carlos A.B [1], the results of 18FDG PET/CT for NHL depend on many factors, one of which is histology SUVs have high values of 16 - 17 in patients with disseminated B-cell NHL or Hodgkin capsule type III; for NHL patients with residential and degree I, II SUVs valued arounded - Table 6: Correlation between SUV and international prognosis index (IPI) prognosis index IPI index No of patients Average SUV - (low risk) 6.8 ± 1.2 (medium-low risk) 13 14.1 ± 8.3 Correlation r = 0.51 (medium-high risk) 16 18.3 ± 7.6 - (high risk) 14 19.1 ± 4.9 Since 1993, before the IPI, the NHL prognosis is based on the Ann Arbor phase [6] But the results of the extra life expectancy are not really accurate, there are many differences compared to reality Therefore, some other risk factors were added such as patient’s age (> 60), elevated LDH, PS (> 1) and number of non-lymph nodes (> 1) The IPI includes the Ann Arbor phase and these factors have become a good tool for oncologists in the progression of NHL patients With IPI from - 1, the rate of 5-year survival time was 73%; while with IPI from - this rate was only 26% Table showed the correlation between SUV and IPI risk index (r = 0.51) SUVs < belong to a low-risk group, had a good prognosis, and NHL patients with SUVs > 14 were at high risk, with poor prognosis node groups Mainly neck lymph nodes (50%), followed by abdominal lymph nodes (32%) and supraclavicular lymph nodes (22%) Metastatic lymphoma was found in 33/50 patients (66%), with 9/50 patients (18%) in the stomach and 16% in the chest, 14% in the intestine, 10% in the breasts, uterus, cervix and 8% in the amydal The concentration of glucose SUV was increased in the inguinal node group (27.2 ± 11.0), abdominal lymph nodes (16.3 ± 8.3), in the amydal (18.5 ± 0.7), the lowest was in the stomach (9.1 ± 6,2) There was a close correlation (r = 0.8) between SUV value and cell malignancy and between SUV and IPI risk index (r = 0.51) SUVs may have prognostic value for NHL patients REFERENCES CONCLUSION Using 18FDG PET/CT image for 50 patients with NHL, 23/50 patients (46%) had node group and 27/50 (57%) ≥ Carlos A.B Current status of PET/CT in the diagnosis and follow-up of lymphomas Rev Bras Hematol Hemoter 2011, 33 (2), pp.140-147 179 Journal of military pharmaco-medicine no6-2019 Delbeke D, Stroobants S, de Kerviler E Expert opinions on positron emission tomography and computed tomography imaging in lymphoma Oncologist 2009, 14 Suppl 2, pp.30-40 Ell P.J, S.S Gambir Nuclear Medicine in Clinical Diagnosis and Treatment Churchill Livingstone 2004 Fueger B.J, Yeom K, Czernin J Comparison of CT, PET, and PET/CT for staging of patients with indolent non-Hodgkin's lymphoma Mol Imaging Biol 2009,11 (4), pp.269-274 180 Kwee T.C, Nievelstein R.A Imaging in staging of malignant lymphoma: A systematic review Blood 2008, 111 (2), pp 504-516 Lu P Staging and classification of lymphoma Semin Nucl Med 2005, 35 (3), pp.160-164 Wu L.M, Chen F.Y, Jiang X.X FDG PET, combined FDG PET/CT and MRI for evaluation of bone marrow infiltration in staging of lymphoma: A systematic review and metaanalysis Eur J Radiol 2010, Dec, ... treatment In this topic, we set the research problem with the objective of: Assessing the role of 18FDG PET/CT in the diagnosis of lymphadenopathy and the relationship between standard uptake value. .. (SUV) values and malignancy and prognosis index of NHL SUBJECTS AND METHODS Subjects 50 patients with a definitive diagnosis of NHL by histopathology, under inpatient treatment at the Department of. .. concentration or inflammation after the patient treated with chemotherapy, radiation therapy However, the high concentration of physiological glucose is usually in the lymph structures in the head and