| Objective:To evaluate fluorine-fluorodeoxyglucose positron emission tomography (FDG-PET) in the staging of lymphoma, evaluation of the therapy efficiency and prognosis.Methods:The clinical data of 179 patients with lymphoma before and after treatment were analyzed retrospectively. FDG-PET was compared with computed tomography (CT) and bone marrow biopsy (BMB) to detect lymph node/extranodal lymphopathy and bone marrow infiltration. Therapeutic efficiency was assessed by International Workshop Criteria (IWC) and Revised International Workshop Criteria (IWC+PET). The clinical data of 52 patients with lymphoma before and after 4 chemotherapy courses were analyzed retrospectively. PET response after 4 courses were scored as complete remission (CR), partial remission (PR), or no response (NR). Fifty two patients were assessed for FFS by International Prognostic Index (IPI) in conjunction with FDG-PET response. FFS was also compared between IWC-criteria and IWC+PET-criteria.Results:Among 98 patients at presentation,the sensitivities of FDG-PET and CT were 73% and 70%,respectively (P<0.01) in detecting lymphopathy,and 87% and 45%,respectively (P<0.01) in detecting extranodal lymphoma . Among 81 patients after chemotherapy , the specificities of FDG-PET and CT were 68% and 33% ,respectively (P<0.01) in detecting residual masses. Based on IWC-criteria, 33 patients had a complete response/unconfirmed complete response (CR/CRu) with a recurrence rate of 24%. Patients with a PET-positive residual mass had a recurrence rate of 40%, whereas patients with PET-negative residual mass showed a recurrence rate of 21%. Based on IWC+PET-criteria, 25 patients had a complete response, with a recurrence rate of 20%. FDG-PET and BMB produced equivalent results in 74% (133/179 ) of patients.FDG-PET could complement BMB. Among 52 patients after 4 chemotherapy courses, 34 patients were CR, 12 patients were PR, 6 patients were NR, based on FDG-PET response. The 2-year FFS for CR, PR and NR was 75%, 41% and 0 respectively. Based on survival analysis, the FFS was significantly different for each risk group (P<0.01). And a multivariate analysis was performed to design a predictive model. Only FDG-PET response (P < 0.01) was independent predictive factor for the NHL patients. The combined use of the IPI and FDG-PET response after 4 chemotherapy courses identified at least 4 categories of patients.These data indicate that IPI in conjunction with FDG-PET response provide a more accurate prognostic instrument for the outcome of treatment in NHL patients. For IWC-criteria, outcome was not significantly different in patients with CR/CRu compared to PR (P=0.1160), while for IWC+PET-criteria, FFS was significantly shorter in patients with PR compared to CR (P=0.0359). In addition, when patients with a PR by IWC-criteria were compared with those with a CR by IWC+PET-criteria, there was no significant difference in FFS (P=0.0894), indicating that IWC+PET-criteria identified a subset of IWC-criteria PR patients with a more favorable prognosis.Conclusions:FDG-PET is a sensitive and specific technique in the staging and detecting residual masses of lymphoma. FDG-PET response provides a more accurate prognostic instrument for patients with NHL.
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