FDG-PET scanning in extranodal marginal zone mucosaassociated lympoid tissue (MALT) lymphoma.

Transcription

1 FDG-PET scanning in extranodal marginal zone mucosaassociated lympoid tissue (MALT) lymphoma. Poster No.: C-3424 Congress: ECR 2010 Type: Scientific Exhibit Topic: Molecular Imaging Authors: K. HAYASAKA 1, M. Koyama 1, T. Yamashita 1, T. Nihashi 2 ; 1 Tokyo/ JP, 2 Nagoya/JP Keywords: MALT, FDG-PET, Diagnosis DOI: /ecr2010/C-3424 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 12

2 Purpose To evaluate the diagnostic accuracy of FDG-PET in patients with extranodal MALT lymphoma and assessed its reliability in clinical staging and monitoring response. Methods and Materials A total of 70 patients of 82 sites with a histological diagnosis of extranodal MALT lymphoma were referred. All informations were obtained from a retrospective review of medical records, PET findings and data. FDG-PET imaging was performed using ECAT EXACT HR 47, ECAT ACCEL, BIOGRAPH DUO LSO (PET/CT), or Aquiduo 16 (PET/CT). Imaging was performed at 60 minutes after the intravenous administration of MBq F18-FDG. Each patient had been fasting for at least 4 hours when imaged, and a normal glucose level was confirmed prior to the PET scan. Regional FDG uptake in the affected area was expressed as standardized uptake value (SUV). Stastical anlysis of defferenced between each site, stage was carried out using SPSS Regression Modes 9.0J. Results Page 2 of 12

3 Seventy patients in this study included 29 men (41.2%) and 41 women(58.8%) with a median age at diagnosis of 64 years (range 33 to 90 y)(figure 1). The sites of MALT were the orbit (n = 34)(Figure 2), stomach (n = 22)(Figure 3), lung (n = 9), intestine (n =4), thyroid(n=3), bone marrow (n =3). head & neck (epipharynx, tonsil, sublingual gland, lip, larynx)(n=6), intestine (rectum, ileum, cecum)(n=4),breast (n=1), esophagus(n=1), liver (n=1)(figure 4). The SUVmax of FDG was <1.5 at 3 sites (orbit, n = 2; lung, n = 1), 1.5~2.5 at 21 sites (orbit,n=14; bone marrow,n=2; lung, stomach, lip and larynx, each one) and >2.5 at 60 sites ( Figure4). Sensitivity in orbital MALT(50.0%) and marrow MALT(33.3%) was lower when compared with non-orbital, non-marrow MALT(89.4%). The stages were # in 51 patients (sensitivity in 74.5%), # in 12 (sensitivity in 66.7%), and # in 7 (sensitivity in 71.5%). Other findings were: high LDH in 4 of the 69 patients (5.7%), high serum interleukin 2 receptor in 35 of 67 (52.2%)(Figure 1), CD20-, n=2 (lung and tonsil), CD5-,CD10-; n=76 (91.6%),CD5-, CD10+; n=2 (orbit)(2.4%), CD5+,CD10-; n=5(orbit)(6%), Bcl2+, n=71(97.3%), Bcl2-, n=2 (2.7%), Bcl6-, n=57(90.5%), Bcl6+, n=6(9.5%)(figure 5). Fifteen patients of gastric MALT were positive for Helicobacter pylori (68.2%) (Figure 1). There was a significant difference between stage 1 nad 4, orbit and stomach (Figure 6 ) Of the 70 studied patients, 23 were followed up FDG-PET, which detected relapse in four of them (Figure 7,8). Images for this section: Page 3 of 12

4 Fig. 1: Patients chracteristics Page 4 of 12

5 Fig. 2: FDG-PET image of a patient (84-year-old woman) affected by orbital MALT lymphoma. A (T1 weighted image), B (T2 weighted image): MRI shows left orbital mass and staging PET (C,D) shows left orbital uptake (SUVmax=5.37) (stage 1E)(C: axial PET image, D: fused PET/CT image) Page 5 of 12

6 Fig. 3: Gastrointestinal fiber scope (A) shows gastric MALT lymphoma (59-year-old man). Staging FDG-PET shows a single uptake(arrow) in the stomach(suvmax=3.19, stage 1E). B:coronal PET image, C:fused PET/CT axial image. Page 6 of 12

7 Fig. 4: SUVmax of stages and sites Page 7 of 12

8 Fig. 5: SUVmax of immunophenotype Page 8 of 12

9 Fig. 6: Stasttiscal analysis between stages and sites. Page 9 of 12

10 Fig. 7: FDG PET image of a patient (44-year-old woman) affected by breast MALT lymphoma. A(coronal image), B(fused PET/CT sagittal image):staging PET shows right breast(suvmax=2.83) and axillay uptake(stage 2E). Page 10 of 12

11 Fig. 8: Breast MALT lymphoma (the same case of Figure 7). One year after chemotherapy and radiotherapy, follow up FDG-PET shows recurrence in the tibia and ischium (C: coronal PET image, D,E: fused PET/CT axial images Page 11 of 12

12 Conclusion The SUVmax of MALT was >1.5 at 79 sites (Sensiyivity 96.3%). We identified FDG avidity in 71.4% of extra-nodal MALT lymphoma but in 50.0% of orbital MALT. Two patients with bone marrow invasion were understaged. However, these results suggested that PET is a useful tool with which to stage, restage after therapy, or monitor disease in patients with extra- nodal MALT lymphoma. References 1. Perry C,et al. Diagnostic accuracy of PET/CT in patients with extranodal marginal zone MALT lymphoma. Eur J Nucl Med Mol Imag 2007;79: Alinari L, et al. 18F-FDG PET in mucosa-associated lymphoid tissue (MALT) lymphoma. Leukemia & Lymphoma 2006; 47: Beal KP, et al. FDG-PET scanning for detection and staging of extranodal marginal zone lymphomas of the MALT type: a report of 42 cases. Ann Oncol 2005; 16: Bae YA, et al. Marginal zone B-cell lymphoma of bronchus-aasociated lymphoid tissue, imaging findings in 21 patients. Chest 2008; 133: Raden L, et al. FDG avidity and PET/CT patterns in primary gastric lymphoma. Eur J Nucl Med Mol Imag 2008; 35: Personal Information Kazumasa Hayasaka, MD,PhD. Director in department of Nuclear Medicine, Japanese Foundation for Cancer Research, Cancer Institute Hospital. Page 12 of 12