FDG PET/CT as a diagnostic and prognostic tool for the evaluation of marginal zone lymphoma

Iuliana Vaxman, Hanna Bernstine, Geffen Kleinstern, Natav Hendin, Shai Shimony, Liran Domachevsky, Ronit Gurion, David Groshar, Pia Raanani, Anat Gafter‐gvili

Research output: Contribution to journalArticlepeer-review


We evaluated the role of 18‐fluoro‐2‐deoxy‐D‐glucose positron emission tomography ([18F] FDG‐PET) with computed tomography (CT) (PET/CT) as a diagnostic and prognostic tool in newly diagnosed marginal zone lymphoma (MZL) patients. This is a retrospective cohort study of patients with newly diagnosed MZL, treated with immunotherapy, chemotherapy regimens, surgery, or Helicobacter pylori eradication between 2008 and 2016 in a single tertiary center. Only patients who had a pre-treatment PET/CT (P‐PET/CT) were included. P‐PET/CT, interim (I‐PET/CT), and end-of‐treatment PET/CT (E‐PET/CT) studies were reviewed. P‐PET/CT results were reported using two methods of evaluation, qualitative and semi quantitative: visual assessment (VAS) and maximal standardized uptake value (SUVmax), and I‐PET and E‐PET results were reported by Deauville 5‐point score (DS) evaluation as well. Avidity of PET/CT was defined as abnormal uptake in any of these methods. The primary outcome was the prognostic role of P‐PET/CT, I‐PET/CT, and E‐PET/CT on progression‐free survival (PFS) and overall survival (OS). Data of 196 patients with MZL were identified, 110 of which had P‐PET/CT and were included in this analysis. Median age was 67 years (range 18‐93). The median follow-up period was 63 months (range 3‐278). The median OS and PFS for the whole cohort were 63 (interquartile range 39‐85) and 60 (interquartile range 37‐76) months, respectively. The avidity of PET at baseline for the whole cohort was 70% (77/110 patients), for MALT lymphoma, 62.5% (40/64 patients), for NMZL, 76.4% (13/17 patients), and for SMZL, 82.7% (24/29 patients). When adjusted for IPI, sex, and comorbidities, positive E‐PET/CT was associated with reduced PFS with a hazard ratio (HR) of 3.4 (95% CI, 1.27‐9.14, P = 0.02). Positive E‐PET/CT did not correlate with OS. However, there were only three events. P‐PET/CT was not predictive of PFS or OS. Our study demonstrates that above 70% of MZL are FDG avid. Positive E‐PET/CT is a strong prognostic factor for PFS.

Original languageEnglish
Pages (from-to)168-175
Number of pages8
JournalHematological Oncology
Issue number2
StatePublished - Apr 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2019 John Wiley & Sons, Ltd.


  • Marginal zone lymphoma
  • Prediction
  • Prognosis
  • SUV

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research


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