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PET Criteria for Response Assessment After Completion of Therapy for Aggressive NHL and HL

This article provides criteria for assessing PET scans after completion of therapy for aggressive NHL and HL, including definitions of positive and negative PET findings based on visual assessment. Exceptions and considerations for assessing specific locations are also discussed.

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PET Criteria for Response Assessment After Completion of Therapy for Aggressive NHL and HL

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  1. PET Criteria for Response Assessment After Completion of Therapy for Aggressive NHL and HL • Definition of a positive PET scan (Visual assessment is adequate, SUV is not necessary) • General definition of a positive (abnormal) PET findingusing visual assessment: focal or diffuse FDG uptake abovebackground in a location incompatible with normal anatomy/physiology Cheson et al. J Clin Oncol 2007; 25:579-86; Juweid et al. J Clin Oncol 2007; 25:571-8

  2. Exceptions: • Negative PET: mild and diffusely increased uptake ≤ mediastinal blood pool (BP) within residual masses ≥ 2 cm in diameter regardlessof location • Positive PET: diffuse or focaluptake > mediastinal BP for lesion ≥ 2 cm in diameter • Positive PET: any increased uptake above surrounding backgroundin lymph nodes or nodal masses < 2 cm (includingnormal sized LNs) by CT Cheson et al. J Clin Oncol 2007; 25:579-86; Juweid et al. J Clin Oncol 2007; 25:571-8

  3. Positive PET: new lung nodules ≥ 1.5 cm by CT with no evidence of pulmonary lymphoma before therapyif their uptake> mediastinal BP • Negative PET: new lung nodules regardless of their size or uptake in patients without established pulmonary lymphomaat baseline who responded completely at allknown disease sites – infectious/inflammatory • New lesions < 1.5 cm: PET is unreliable for assessment of these lesions and residual lymphoma cannot beexcluded with no FDG uptake Juweid et al. J Clin Oncol 2007; 25:571-8

  4. Residualhepatic or splenic lesions > 1.5 cm on CT • Positive, if the uptake is ≥ liver or spleen • Negative, if the uptake is < liver or spleen • Residualhepatic/spleniclesions < 1.5 cm • Positive, if their uptake is > liver orspleen • Negative PET, if their uptake is ≤ liver or spleen • Positive PET: diffusely increased splenic uptake> normal liver (unless there was recent cytokine therapy) Juweid et al. J Clin Oncol 2007; 25:571-8

  5. Positive PET: increased (multi)focal bone (marrow) uptake • NegativePET: diffusely increasedBM uptake, even if > liver uptake isusuallydue to post-therapy marrow hyperplasia • BM biopsy remains thestandard procedure for assessment ofBM (negative PET does not excludemild or moderate BM involvement) Juweid et al. J Clin Oncol 2007; 25:571-8

  6. Response Definition for Clinical Trials Cheson et al. J Clin Oncol 2007; 25:579-86

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