False-positive [18F]fluorodeoxyglucose-avid lymph nodes on positron emission tomography - Computed tomography after allogeneic but not autologous stem-cell transplantation in patients with lymphoma

Gary A. Ulaner, Joshua Lilienstein, Mithat Gon̈en, Jocelyn Maragulia, Craig H. Moskowitz, Andrew D. Zelenetz

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Purpose: Determine the clinical significance of [18F] fluorodeoxyglucose (FDG)-avid lesions in patients with lymphoma treated with stem-cell transplantation. Methods: All patients who underwent stem-cell transplantation for lymphoma at Memorial Sloan-Kettering Cancer Center between January 2005 and December 2009 and had post-transplantation FDG positron emission tomography/computed tomography (PET/CT) examinations were included. PET/CT examinations were evaluated for FDG-avid lesions suggestive of disease. Clinical records, biopsy results, and subsequent imaging examinations were evaluated for malignancy. Results: Two hundred fifty-one patients were identified, 107 with allogeneic and 144 with autologous stem-cell transplantation. Of allogeneic stem-cell transplantation recipients, 50 had FDG-avid lesions suggestive of lymphoma, defined as FDG-avidity greater than liver background. However, only 29 of these 50 demonstrated lymphoma on biopsy, whereas biopsy attempts were benign in the other 21 patients. Sensitivity analysis determined that a 1.5-cm short axis nodal measurement distinguished patients with malignant from nonmalignant biopsies. In 21 of 22 patients with FDG-avid lymph nodes ≤ 1.5 cm, biopsy attempts were benign. In the absence of treatment, these nodes either resolved or were stable on repeat imaging. Disease-free survival of patients with FDG-avid ≤ 1.5 cm lymph nodes was comparable with patients without FDG-avid lesions. In comparison, autologous stem-cell transplantation patients rarely demonstrated FDG-avid lesions suggestive of disease without malignant pathology. Conclusion: Twenty percent (21 of 107) of patients with an allogeneic stem-cell transplantation demonstrated FDG-avid lymph nodes up to 1.5 cm in short axis on PET/CT, which did not represent active lymphoma. After allogeneic stem-cell transplantation of patients with lymphoma, benign FDG-avid ≤ 1.5 cm lymph nodes can mimic malignancy.

Original languageEnglish (US)
Pages (from-to)51-56
Number of pages6
JournalJournal of Clinical Oncology
Volume32
Issue number1
DOIs
StatePublished - Jan 1 2014

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ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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