Predictive value of interim and post-treatment PET/CT for clinical
evaluation in pediatric and adolescent Hodgkin lymphoma: A comparison of
the Deauville Criteria and the International Harmonization Project
Background. The criteria for response evaluation in pediatric and
adolescent Hodgkin lymphoma (HL) are controversial. We compared
different criteria for the interpretation of interim and post-treatment
PET/CT to predict the outcome of pediatric and adolescent HL. Procedure.
Baseline, interim, and post-treatment 18F-FDG-PET/CT scans of 147
pediatric and adolescent HL patients were interpreted according to the
International Harmonization Project Criteria (IHPC) and Deauville
Criteria (DC). Two thresholds of positivity were used for the DC: DC-3,
scores of 3–5; and DC-4, scores of 4–5. Diagnostic performance of
interim and post-treatment PET in outcome prediction was evaluated.
Progression-free survival (PFS) was analyzed by the Kaplan-Meier method
and Cox proportional hazards model. Results. Sensitivity, specificity,
positive predictive value (PPV), negative predictive value (NPV), and
accuracy of interim FDG-PET/CT were 82%, 33%, 15%, 93%, and 39%,
respectively, for IHPC, 82%, 51%, 19%, 95%, and 55%, respectively,
for DC-3, and 27%, 78%, 15%, 88%, and 72%, respectively, for DC-4.
The corresponding values for post-treatment PET/CT were 73%, 74%,
23%, 96%, and 74% for IHPC, 67%, 80%, 27%, 96%, and 79% for
DC-3, and 47%, 90%, 33%, 94%, and 86% for DC-4. PFS significantly
differed between patients with positive and negative post-treatment
PET/CT according to IHPC, DC-3, and DC-4 (P < 0.01 for all),
but only DC-4 was an independent prognostic factor for PFS (hazard
ratio: 7.82). Conclusion. Compared to interim PET/CT, post-treatment
PET/CT better predicted the outcomes of pediatric and adolescent HL.
DC-4 had superior diagnostic performance over IHPC and DC-3.