Staging

Initial staging of disease presents a critical issue in the care of lymphoma patients, affecting prognosis and choice of therapy. Studies investigating the utility of FDG-PET in lymphoma have shown promising results for improving the accuracy of staging in these patients. Several groups have compared FDG-PET with traditional staging studies, such as CT, MRI, and bone marrow biopsy, in detecting specific sites of disease. In general, these investigators report improved sensitivity and specificity using FDG-PET as compared to anatomic imaging studies in both NHL and HL. The results of selected studies are presented in Table 79.1.

In addition to anatomic imaging, evaluation of bone marrow involvement represents a critical issue in staging of lymphoma. Investigations of the ability of FDG-PET to accurately stage bone marrow involvement by lymphoma have yielded conflicting results. Some have shown improved detection of bone marrow disease by PET, particularly in cases of patchy bone marrow involvement.25 Others, however, demonstrate poor sensitivity and specificity, with a significant incidence of both false-negative FDG-PET, especially in indolent lymphomas, and false-positive FDG-PET, often in the setting of B symptoms and benign bone marrow hyperplasia.15 26 27 At this point, FDG-PET is

Table 79.1

Studies

FDG-PET versus conventional imaging modalities (CIM) in staging lymphoma Histology Patients Major findings

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