[PET in lymphomas: a pattern for the treatment at measure]

Positron Emission Tomography with FDG (PET-FDG) is a molecular diagnostic imaging technique that allows for the detection of tumour lesions based on their increased anaerobic glycolytic metabolism. It is acquiring increasing significance in oncology. The introduction of PET in the field of lymphomas has been slow. The main reasons are: budget limitations, difficulties to perform biopsies in all the lesions, absence of a perfect gold standard and reduced number of publications with appropriate methodological quality. Several papers have appeared in the last 3 years that assess the value of PET-FDG in lymphomas, demonstrating the relationship between the results of PET-FDG and survival (total, disease free, progression free and relapse free) or between results of PET-FDG and relapse average. All of this has great interest in the definition of the most appropriate treatment and especially to decide when it is necessary to continue with a determined treatment or to stop it, or when an inefficient treatment line must be substituted early by another. The main indications are: a. Initial staging. b. Assessment in the middle of the treatment for defining the response and for detecting residual disease. c. To confirm or exclude the doubtful complete remission at the end of the treatment. In these cases CT scan shows a residual mass with response superior to 75%. If PET-FDG is negative, the most probable diagnosis is complete remission. d. In a certain type of lymphoma the situation if the PET-FDG is positive or negative at the end of treatment is very different. A negative PET-FDG can predict longer survival (total, disease free, relapse free, progression free) and a positive PET-FDG can indicate a change in the treatment or the need for more treatment. e. Residual disease evaluation in autologous transplantation. Prognostic utility. f. Variable utility of PET-FDG depending on the type of lymphoma.