Speaker Biography

Ahmed Elhussein

Children Cancer Hospital

Title: Role of FDG-PET/CT in the management of pediatric burkitt lymphoma

Ahmed Elhussein
Biography:

Dr Ahmed Elhussein is associate consultant of pediatric oncology in 57357 Children’s cancer hospital Egypt and an MD holder with a thesis under the title of “role of PET CT in pediatric non Hodgkin lymphoma”. I’m also part of my hospital’s study team in Hodgkin and non Hodgkin lymphoma. I'm highly interested in the field of PET/CT in lymphoma especially pediatric non Hodgkin lymphoma.

Abstract:

Background: Burkitt lymphoma (BL) is highly FDG-avid even though its usefulness in the management of pediatric patients with BL is still controversial.

Objectives: We analyzed the role of positron emission tomography/computerized tomography (PET/CT) in staging and evaluation of tumor response in newly diagnosed children with BL receiving LMB 96 protocol.

Design/Method: A total of 180 PET/CTs were performed in 94 patients (94 at diagnosis and 91 at time of evaluation). Involved areas were prospectively compared with those observed in contrast enhanced CT. Residual lesions in both PET/CT and contrast-enhanced CT were correlated with patient outcome at one year after end of treatment.

Results: A total of 199 disease sites were detected at PET/CT, while 172 sites were detected at contrast-enhanced CT and bone marrow biopsy (BMB). PET/CT showed improved detection of nodal lesions (P <0.0001) (Kappa value = 0.633), extranodal lesions (P <0.0001) (Kappa value = 0.632) and bone marrow (P <0.0001) (Kappa value = 0.728) compared to contrast enhanced CT and BMB. PET/CT had upstaged 15 cases (16%) and down-staged 4 cases (4.3%) (P <0.001) (Kappa value = 0.649). Among the upstaged 15 cases, 10 patients (10.9%) were upstaged from stage II to III, based on residual in PET/CT not seen in contrast enhanced CT after abdominal mass excision. Four patients (4.3%) were upstaged from stage III to IV based on bone marrow uptake in FDG-PET without positivity in BMA or BMB. Regarding response assessment, sensitivity was 60% for PET and 80% for contrast-enhanced CT (p=0.56). Specificity was 100% for PET and 65% for CT (p< 0.0001). Positive predictive value for PET was 100%, while was 12% for CT scan (p< 0.0001). Negative predictive value for both PET and CT was 98% (p= 0.82). Five patients had 2nd biopsy to confirm viability of the residual lesions, 4 lesions were negative in pathological examination (all of them were metabolic negative in PET/CT; Deauville score below 4). One lesion was positive in pathological examination (was positive in PET/CT; Deauville score of 4).

Conclusion: PET/CT detected additional sites compared with contrast-enhanced CT and resulted in changing stage of disease. PET scan is significantly more specific than CT in the management of children with Burkitt lymphoma.