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      PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study

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          Key Points

          PET-CT is the modern standard for staging Hodgkin lymphoma and can replace contrast enhanced CT in the vast majority of cases. Agreement between expert and local readers is sufficient for the Deauville criteria to assess response in clinical trials and the community.

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          Most cited references44

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          A Coefficient of Agreement for Nominal Scales

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            Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification.

            The purpose of this work was to modernize recommendations for evaluation, staging, and response assessment of patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). A workshop was held at the 11th International Conference on Malignant Lymphoma in Lugano, Switzerland, in June 2011, that included leading hematologists, oncologists, radiation oncologists, pathologists, radiologists, and nuclear medicine physicians, representing major international lymphoma clinical trials groups and cancer centers. Clinical and imaging subcommittees presented their conclusions at a subsequent workshop at the 12th International Conference on Malignant Lymphoma, leading to revised criteria for staging and of the International Working Group Guidelines of 2007 for response. As a result, fluorodeoxyglucose (FDG) positron emission tomography (PET)–computed tomography (CT) was formally incorporated into standard staging for FDG-avid lymphomas. A modification of the Ann Arbor descriptive terminology will be used for anatomic distribution of disease extent, but the suffixes A or B for symptoms will only be included for HL. A bone marrow biopsy is no longer indicated for the routine staging of HL and most diffuse large B-cell lymphomas. However, regardless of stage, general practice is to treat patients based on limited (stages I and II, nonbulky) or advanced (stage III or IV) disease, with stage II bulky disease considered as limited or advanced disease based on histology and a number of prognostic factors. PET-CT will be used to assess response in FDG-avid histologies using the 5-point scale. The product of the perpendicular diameters of a single node can be used to identify progressive disease. Routine surveillance scans are discouraged. These recommendations should improve evaluation of patients with lymphoma and enhance the ability to compare outcomes of clinical trials.
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              FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0

              The purpose of these guidelines is to assist physicians in recommending, performing, interpreting and reporting the results of FDG PET/CT for oncological imaging of adult patients. PET is a quantitative imaging technique and therefore requires a common quality control (QC)/quality assurance (QA) procedure to maintain the accuracy and precision of quantitation. Repeatability and reproducibility are two essential requirements for any quantitative measurement and/or imaging biomarker. Repeatability relates to the uncertainty in obtaining the same result in the same patient when he or she is examined more than once on the same system. However, imaging biomarkers should also have adequate reproducibility, i.e. the ability to yield the same result in the same patient when that patient is examined on different systems and at different imaging sites. Adequate repeatability and reproducibility are essential for the clinical management of patients and the use of FDG PET/CT within multicentre trials. A common standardised imaging procedure will help promote the appropriate use of FDG PET/CT imaging and increase the value of publications and, therefore, their contribution to evidence-based medicine. Moreover, consistency in numerical values between platforms and institutes that acquire the data will potentially enhance the role of semiquantitative and quantitative image interpretation. Precision and accuracy are additionally important as FDG PET/CT is used to evaluate tumour response as well as for diagnosis, prognosis and staging. Therefore both the previous and these new guidelines specifically aim to achieve standardised uptake value harmonisation in multicentre settings.
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                Author and article information

                Journal
                Blood
                American Society of Hematology
                0006-4971
                1528-0020
                March 24 2016
                March 24 2016
                : 127
                : 12
                : 1531-1538
                Affiliations
                [1 ]PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King’s College London, King’s Health Partners, St. Thomas’ Hospital, London, United Kingdom;
                [2 ]Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom;
                [3 ]Department of Nuclear Medicine, University of Modena and Reggio Emilia, Modena, Italy;
                [4 ]Department of Molecular Imaging (PET-CT), Royal Prince Alfred Hospital, Sydney, Australia;
                [5 ]Sydney Medical School, University of Sydney, Sydney, Australia;
                [6 ]Department of Medical Imaging and Physiology and
                [7 ]Department of Oncology and Radiation Physics, Skane University Hospital, Lund University, Lund, Sweden;
                [8 ]Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark;
                [9 ]Department of Radiology, Guy's and St. Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom;
                [10 ]Oncology Unit, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy;
                [11 ]The University of Manchester and the Christie NHS Foundation Trust, Manchester, United Kingdom;
                [12 ]Concord, Repatriation General Hospital, Sydney, Australia;
                [13 ]Department of Oncology, Norwegian Radium Hospital, Oslo, Norway;
                [14 ]Haematology, Auckland City Hospital, Auckland, New Zealand;
                [15 ]Department of Genetics and Pathology, Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden;
                [16 ]Haematology, Aarhus University, Aarhus, Denmark; and
                [17 ]Cancer Research UK Centre, University of Southampton, Southampton, United Kingdom
                Article
                10.1182/blood-2015-11-679407
                26747247
                faa1d74a-0238-4411-8f14-4ab6abf86804
                © 2016
                History

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