Reporting Lymphoma
Non-Hodgkin lymphoma (NHL) is the 6th most common cancer in the UK accounting for 6% of all new cancer cases, whereas Hodgkin lymphoma (HL) is not among the 20 most common cancers in the UK, accounting for less than 1% of new cases. There are around 14,200 cases of NHL, and 2,100 cases of HL diagnosed each year. Incidence of NHL is increasing, having increased 38% since the early 1990s. Incidence of HL is also increasing, having increased 37% since the early 1990s.
PET-CT Scans Performed 2022-2023
At our institution, lymphoma accounts for 19% of all PET-CT scans performed..
The evidence-based indications for use of PET-CT in the UK 2016 list nine indications for FDG PET-CT in lymphoma:
- Staging of FDG-avid lymphomas.
- Remission assessment of FDG-avid lymphomas after completion treatment using the five-point scale (Deauville criteria) for response assessment. If there has been a complete metabolic response (CMR) on an interim scan, an end of treatment scan is not required.
- Interim assessment to guide response adapted treatment in selected patients with Hodgkin lymphoma.
- Interim assessment to monitor treatment if mid-therapy imaging is performed and to exclude progression in patients with aggressive non-Hodgkin lymphoma.
- Evaluation of suspected relapse for FDG-avid lymphomas in symptomatic patients. Surveillance imaging is not recommended.
- Assessment of response to second line treatment and subsequent treatments for FDG-avid lymphoma.
- Staging of suspected post-treatment lympho-proliferative disorder (PTLD).
- Prior to bone marrow transplant to assess remission status and residual volume of disease and suitability for transplant.
- To determine extent and identify a suitable biopsy site in patients with low-grade lymphomas in who there is suspected high-grade transformation.
The use of PET-CT in these indications will be studied in detail in this course, which is comprised of three modules, followed by a case-based assessment.
- Tutorial 1: Role of PET-CT in lymphoma
- Tutorial 2: Staging of lymphoma
- Tutorial 3: Response assessment in lymphoma
Learning Objectives
- Describe the common sub-types of lymphoma and the role 18FDG PET-CT plays in lymphoma
- Explain the staging of lymphoma, its difficulties, and the use of PET-CT in staging and improved accuracy
- Recognise the pattern of extranodal lymphoma
- Discuss the role of PET-CT in response assessment
Please note: To mark this course as complete on your Learning Dashboard and access your certificate of completion, you must finish all learning modules and submit the course evaluation.
Suitable for radiologists and nuclear medicine physicians who intend to train to report PET-CT, or who otherwise encounter these studies in their practice and wish to increase their confidence, for example in the role of a presenting radiologist at an MDT (Multi-Disciplinary Team).
References:
- Evidence-based indications for the use of PET-CT in the United Kingdom 2022
- Cancer Research UK. Accessed November 2023.
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Ben Taylor
Dr Taylor graduated from Sheffield University in 1991 and trained in Radiology in Manchester with a fellowship in Toronto. He became a consultant at the Christie in 2001 and has a wide range of interests in oncological radiology including PET-CT and image guided biopsy. He is an Advisory Editor for the journal Clinical Radiology and has contributed to the NICE guidelines for Cancer of Unknown Primary (2010) and Bladder Cancer (2015).
