Positron emission tomography in patients with Hodgkin's disease: correlation to histopathologic subtypes

The aim of this study was to evaluate the initial staging and restaging of Hodgkin's disease (HD) according to histopathologic subtype (HST) using fluorine-18-deoxyglucose-positron emission tomography (PET). Special attention was paid to the accuracy of PET for detection of bone marrow infiltration (BMI). 44 patients with HD (m:f = 28:16, mean age 36 +/- 15 years) underwent PET; 16 were primary stagings and 28 restaging examinations. PET results were compared with methods of conventional staging including computed tomography (CT) and bone marrow biopsy. Viable tumor tissue was detected by PET in 25/44 cases, 16 nodular sclerosis (NS), 4 mixed cellularity (MC), 3 lymphocyte predominance (LP) and 2 cases with a nonclassified subtype (NC). FDG tumor uptake, measured as standard uptake value (SUV), ranged from 1.7 to 13. Maximum SUV in NS was 5.2 +/- 1.5 (2.5-7.3), 3.2 +/- 2.4 for MC, 2.6 +/- 0.7 for LP, and 9.1 +/- 3.8 for NC, respectively. In 7% of all patients (3/44) bone marrow infiltrations were detected by PET. PET is known for its superior detection of viable tissue in HD. In this study it was shown that HST does not influence the intensity of glucose metabolism, although 2 patients with NC showed the highest SUVs. In addition PET accurately detected focal BMI and may thus be applied before BMB to guide its optimal use.