PET-based risk stratification in primary mediastinal B-cell lymphoma: a comparative analysis of different segmentation methods in the IELSG37 trial patient cohort

Abstract

Standardizing tumor measurement on ¹⁸F-FDG PET is crucial for the routine clinical use of powerful PET-derived lymphoma prognostic factors such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG). The recent proposal of an SUV of 4 as a new reference segmentation threshold for most aggressive lymphomas may homogenize volume-based metrics and facilitate their clinical application. Methods: This study compared MTV and TLG in primary mediastinal B-cell lymphoma (PMBCL) patients estimated using an SUV of 4 and the current threshold at 25% of SUV _max. Baseline PET metrics were evaluated in 501 PMBCL patients from the IELSG37 trial. Results: Median MTV and TLG estimated with the 25% of SUV _max threshold were significantly lower than those obtained with the new reference threshold; however, an extremely high correlation was observed between the methods for both MTV (r 5 0.95) and TLG (r 5 0.99), resulting in superimposable prognostic power. Conclusion: These findings support the routine use of an SUV of 4 for volumetric measurements in PMBCL.

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