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. AZIZ^3,4, 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

Received: 24 January 2019/Accepted: 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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*Corresponding author; email: wanfariza@ppukm.ukm.edu.my