Failure of fluorodeoxyglucose positron emission tomography to detect the high-grade transformation of nodular lymphocyte predominant Hodgkin's Lymphoma

摘要

Nodular lymphocyte predominant Hodgkin's lym-phoma (NLPHL) has been clearly individualized from classic Hodgkin's lymphoma [1]. In the absence of a bulky tumor, the outcome is favorable [2]. However, with a median follow-up time of 6.5 years, up to 14% of patients experience a high-grade non-Hodgkin's lymphoma (NHL) transformation [3]. This event usually imposes a new biopsy that may be guided by 18fluorode-oxyglucose positron emission tomography (18FDG PET), which has been proposed to discriminate between low-grade and high-grade NHL [4, 5]. Schoder et al. [4] showed that the standardized uptake value (SUV, fig. 1) was lower in indolent than in aggressive NHL: 7.0 ± 3.1 and 19.6 ± 9.3, respectively. The suggested cut-off value for the distinction between indolent and high-grade lymphoma, with 100% specificity, was 13, using a receiver operating characteristic (ROC) technique. In a large series of NLPHL, the median SUV was 6.1 (range, 1.2-20.1) [6]. No SUV data were available concerning an aggressive transformation. So we report, for the first time, two cases of NLPHL high-grade transformation with 18FDG PET SUV data.