False-Positive [18F]fluorodeoxyglucose-avid lymph nodes on positron emission tomography-computed tomography after allogeneic but not autologous stem-cell transplantation in patients with lymphoma Journal Article


Authors: Ulaner, G. A.; Lilienstein, J.; Gonen, M.; Maragulia, J.; Moskowitz, C. H.; Zelenetz, A. D.
Article Title: False-Positive [18F]fluorodeoxyglucose-avid lymph nodes on positron emission tomography-computed tomography after allogeneic but not autologous stem-cell transplantation in patients with lymphoma
Abstract: Determine the clinical significance of [(18)F]fluorodeoxyglucose (FDG)-avid lesions in patients with lymphoma treated with stem-cell transplantation. All patients who underwent stem-cell transplantation for lymphoma at Memorial Sloan-Kettering Cancer Center between January 2005 and December 2009 and had post-transplantation FDG positron emission tomography/computed tomography (PET/CT) examinations were included. PET/CT examinations were evaluated for FDG-avid lesions suggestive of disease. Clinical records, biopsy results, and subsequent imaging examinations were evaluated for malignancy. Two hundred fifty-one patients were identified, 107 with allogeneic and 144 with autologous stem-cell transplantation. Of allogeneic stem-cell transplantation recipients, 50 had FDG-avid lesions suggestive of lymphoma, defined as FDG-avidity greater than liver background. However, only 29 of these 50 demonstrated lymphoma on biopsy, whereas biopsy attempts were benign in the other 21 patients. Sensitivity analysis determined that a 1.5-cm short axis nodal measurement distinguished patients with malignant from nonmalignant biopsies. In 21 of 22 patients with FDG-avid lymph nodes ≤ 1.5 cm, biopsy attempts were benign. In the absence of treatment, these nodes either resolved or were stable on repeat imaging. Disease-free survival of patients with FDG-avid ≤ 1.5 cm lymph nodes was comparable with patients without FDG-avid lesions. In comparison, autologous stem-cell transplantation patients rarely demonstrated FDG-avid lesions suggestive of disease without malignant pathology. Twenty percent (21 of 107) of patients with an allogeneic stem-cell transplantation demonstrated FDG-avid lymph nodes up to 1.5 cm in short axis on PET/CT, which did not represent active lymphoma. After allogeneic stem-cell transplantation of patients with lymphoma, benign FDG-avid ≤ 1.5 cm lymph nodes can mimic malignancy.
Keywords: adolescent; adult; child; aged; disease-free survival; middle aged; retrospective studies; transplantation, homologous; disease free survival; positron emission tomography; methodology; lymph nodes; laboratory diagnosis; sensitivity and specificity; radiopharmaceuticals; metabolism; computer assisted tomography; mantle cell lymphoma; recurrence; tomography, x-ray computed; hematopoietic stem cell transplantation; pathology; retrospective study; t cell lymphoma; lymphoma, t-cell; diagnostic agent; lymph node; lymphoma; fluorodeoxyglucose f 18; fluorodeoxyglucose f18; positron-emission tomography; radiopharmaceutical agent; scintiscanning; recurrent disease; radiography; large cell lymphoma; lymphoma, large b-cell, diffuse; false positive reactions; follicular lymphoma; lymphoma, follicular; transplantation, autologous; allotransplantation; lymphoma, mantle-cell; autotransplantation; humans; human; male; female; article
Journal Title: Journal of Clinical Oncology
Volume: 32
Issue: 1
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2014-01-01
Start Page: 51
End Page: 56
Language: English
PUBMED: 24248697
PROVIDER: scopus
DOI: 10.1200/JCO.2013.50.8044
DOI/URL:
Notes: Export Date: 2 April 2014 -- Source: Scopus
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MSK Authors
  1. Gary Ulaner
    84 Ulaner
  2. Craig Moskowitz
    372 Moskowitz
  3. Mithat Gonen
    701 Gonen
  4. Andrew D Zelenetz
    550 Zelenetz