Sains Malaysiana 48(10)(2019): 2239–2248

http://dx.doi.org/10.17576/jsm-2019-4810-20

 

The Value of PET-CT Scan in Determining Remission Status in Lymphoma Patients Involving the Head & Neck Region

(Penilaian Imbasan PET-CT dalam Menentukan Status Sembuh di Bahagian Kepala & Leher Pesakit Limfoma)

 

WAN FARIZA WAN JAMALUDIN*1, FARA RAHIDAH HUSIN2, AINI AB. AZIZ3,4, MOHD RAZIF MOHD YUNUS5, MAWADDAH AZMAN5, KONG MIN HAN5, NORAIDAH MASIR6, MAHDIEH GHODDOOSI6, SEERY ZALIZA AZURA ZAIDER1, NORMI MUSTAPHA7, NOR ASIAH MUHAMAD8 & S FADILAH ABDUL WAHID1

 

1Pusat Terapi Sel, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia

 

2Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia

 

3Department of Nuclear Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia

 

4Department of Radiology, National Heart Institute of Malaysia, 145, Jalan Tun Razak, Bandar Tun Razak, 50400 Kuala Lumpur, Federal Territory, Malaysia

 

5Department of Otorhinolaryngology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia

 

6Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia

 

7Faculty Science & Technology, Open University Malaysia, Jalan Tun Ismail, 50480 Kuala Lumpur, Federal Territory, Malaysia

 

8Non Communicable Disease Section, Ministry of Health, Complex E, Federal Government Administrative Building, 62590 Putrajaya, Federal Territory, Malaysia

 

Diserahkan: 24 Januari 2019/Diterima: 3 September 2019

 

ABSTRACT

In lymphoma, Positron Emission Tomography-Computerized Tomography (PET-CT) provides greater prognostic information than conventional imaging. However, false positivity occurred particularly in the head & neck due to predilection for infection and inflammation. We investigated the association between positive scans in the head & neck at the end of therapy with histology, and its diagnostic and prognostic values. 488 PET-CT were retrospectively assessed in 2012-2016 (40 months). Positive uptakes in the head & neck (five-point scale ≥4) were biopsied. Prevalence of positive scans was 10.9% (53/488). Two positive scans were histologically lymphomatous with mean maximum standardized uptake value (SUVmax) of 9.0±2.69. False positivity (96.2%) was histologically attributed to reactive lymphoid hyperplasia (SUVmax 9.0±3.88). Positive and negative predictive values, sensitivity and specificity were 3.8%, 100%, 100% and 89.5%, respectively. False positivity was associated with age, gender, extra-nodal involvement, Eastern Cooperative Oncology Group score (ECOG), positivity only in the head & neck and its pattern of positivity. No significant predictors were identified. Hodgkin Disease (HD) was more likely to have positivity only in the head & neck compared to Non-Hodgkin Lymphoma (NHL) (p=0.019). 106 patients with negative scans remained negative during study period, hence regarded as true negatives. Positive scans in the head & neck at post therapy yielded high false positivity and should not be routinely performed. HD has higher likelihood of scan positivity only in the head & neck than NHL. The value of PET-CT to detect true lymphomatous relapse in selected high-risk patients remained to be confirmed in future trials.

Keywords: Head & neck; lymphoma; PET-CT

 

ABSTRAK

Dalam limfoma, imbasan Positron Emission Tomography-Computerized Tomography (PET-CT) memberi maklumat prognosis yang lebih mendalam berbanding imbasan konvensional. Namun, keputusan positif palsu berlaku terutama di bahagian kepala & leher kerana tisu limfoid di situ sering terdedah kepada radang dan jangkitan. Kami mengkaji hubung-kait antara imbasan positif di bahagian kepala & leher dengan histologi serta nilainya dalam maklumat diagnostik dan prognostik. 488 imbasan PET-CT setelah rawatan tamat telah dikaji secara retrospektif antara 2012-2016 (40 bulan). Imbasan positif di kepala & leher (skor berskala lima ≥4) dihantar untuk biopsi. Kelaziman imbasan positif ialah 10.9% (53/488). Hanya dua imbasan positif terbukti mengandungi histologi limfoma, dengan bacaan SUVmax 9.0±2.69. Imbasan positif palsu (96.2%) mengandungi histologi limfoid hyperplasia reaktif (SUVmax 9.0±3.88). Nilai ramalan positif dan negatif, kesensitifan dan kekhususan adalah 3.8%, 100%, 100% dan 89.5%. Imbasan positif palsu dikaitkan dengan umur, jantina, penglibatan extra-nodal, ECOG, positif di kepala & leher sahaja, dan corak positif, namun tiada faktor peramal dapat dikenal pasti. Hodgkin Disease (HD) dikenal pasti sebagai peramal untuk mempunyai imbasan positif di kepala & leher sahaja berbanding Non-Hodgkin Lymphoma (NHL) (p=0.019). 106 pesakit yang mempunyai imbasan negatif kekal sembuh sepanjang tempoh kajian, maka mereka dianggap sebagai negatif tulen. Kesimpulannya, imbasan positif di kepala & leher selepas tamat rawatan menunjukkan kadar positif palsu yang tinggi dan tidak harus dijalankan secara rutin. HD lebih berkemungkinan tinggi untuk mendapat imbasan positif di kepala & leher sahaja berbanding NHL. Nilai imbasan PET-CT untuk mengesan limfoma berulang dalam kalangan pesakit berisiko tinggi harus dikaji lagi dalam penyelidikan pada masa akan datang.

Kata kunci: Kepala & leher; limfoma; PET-CT

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*Pengarang untuk surat-menyurat; email: wanfariza@ppukm.ukm.edu.my

 

 

 

 

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