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In order to actively promote the development of clinical oncology in my country, improve the clinical and scientific research level of clinical oncologists, and further promote the formulation and promotion of CSCO guidelines for diagnosis and treatment, the Chinese Society of Clinical Oncology (CSCO) held a meeting in Beijing on April 23-24, 2021.
The 2021 CSCO Guidelines Conference will be held in a combination of online and offline methods.
At this meeting, Professor Xuejuan Wang from Peking University Cancer Hospital interpreted the "CSCO Lymphoma 18F-FDGPET/CT Guide (2021 Edition)", and Yimaitong organized the main contents as follows.
The CSCO Lymphoma 18F-FDG PET/CT Guidelines (2021 version) have been updated in the overview, baseline PET, and post-treatment PET sections, and new PET-guided clinical strategies, PET/MRI, and independent imaging evaluation (IRC) related content have been added.
Overview 18F-FDG PET/CT is used for the staging, efficacy determination and prognosis evaluation of lymphoma.
During the clinical application of 18F-FDG PET/CT, a standardized scanning process is recommended.
The same PET-CT is required for multiple examinations of the same patient.
This guide adds new content related to blood glucose management and patient management.
Strict blood sugar management is the key to ensuring PET/CT images.
It is not recommended to use insulin to lower blood sugar on the day of the examination.
Patients need to keep warm on the day of the examination to reduce brown fat intake 18F-FDG.
The level I expert recommendation of the baseline PET pretreatment assessment (baseline 18F-FDG PET/CT) is still highly metabolic aggressive lymphoma, the level II expert recommends it as moderately metabolic lymphoma, and the level III expert recommends it as low-metabolic lymphoma tumor.
In this guideline, the level I expert recommendation for mediastinal large B-cell lymphoma is added, the level I expert recommendation for peripheral T-cell lymphoma (PTCL) is added with comments, and follicular lymphoma (FL) is divided into high-grade FL and Low level FL.
Level I experts of primary central system lymphoma recommend enhanced MRI.
Hodgkin’s lymphoma (HL) baseline PET detection of bone marrow involvement is recommended as a level I expert, diffuse large B-cell lymphoma (DLBCL) and PTCL baseline PET detection of bone marrow involvement are recommended as a level II expert, other subtypes of non-Hodgkin’s lymph NHL baseline PET detection of bone marrow involvement is recommended by Level III experts.
Low-grade FL, marginal zone lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma baseline PET detection conversion are recommended as level II experts.
PET/CT before autologous hematopoietic stem cell transplantation is still recommended as a level II expert.
Since the baseline PET-CT test can determine the prognosis of patients, this guide will recommend the prognosis of HL, DLBCL, FL, and PTCL as a level III expert recommendation.
In the comment section of the pre-treatment evaluation, the staging of lymphoma still refers to the Lugano staging standard in 2014, and there is no change.
In the mid-term PET treatment evaluation (interim 18F-FDG PET/CT), level I experts recommended high-uptake lymphoma, level II experts recommended moderate uptake NHL, and level III experts recommended equal uptake NHL.
HL recommends 18F-FDG PET/CT after 2 cycles of chemotherapy, and NHL recommends 18F-FDG PET/CT after 4 cycles of chemotherapy.
The efficacy evaluation standard of HL still uses the Deauville five-point method.
This update of the guideline adds a note on the selection of lymphoma-positive lesions.
The efficacy evaluation standard of NHL still adopts the 2014 Lugano efficacy evaluation standard.
This guideline adds the LYRIC standard for the evaluation of the efficacy of immunotherapy, supplementing the evaluation of the efficacy of patients with lymphoma in uncertain remission status.
The image judgment standard for evaluation during treatment is still the five-point method and the ΔSUVmax method.
This guideline is updated to supplement the quantitative PET method, that is, the ratio method of the SUV value of the lesion after the treatment and the SUV value of the liver blood pool. After treatment, the post-treatment assessment of PET (18F-FDG PET/CT after treatment) is basically not updated, only the classification annotations of related diseases have been updated.
PET-guided clinical strategy This update of the guideline has added the part of PET-CT-guided radiotherapy and chemotherapy strategy to guide post-treatment evaluation and follow-up treatment options.
PET/MRI This guide also adds 18F-FDG PET/MRI part, 18F-FDG PET/MRI and 18F-FDG PET/CT have similar diagnostic and staging performance.
Compared with 18F-FDG PET/CT, 18F-FDG PET/MRI has more advantages in detecting intracranial microinfiltrating foci, atypical foci, FDG, etc.
/low uptake foci in central nervous system lymphoma.
At the same time, 18F-FDG PET/MRI can reduce the radiation dose by 38%-45% and help prevent secondary malignant tumors.
MRI has the advantages of high resolution, good soft tissue contrast, multiple functional imaging examinations, and low radiation dose.
However, due to its relatively high price, this guideline only treats 18F- in primary central system lymphoma, bone marrow involvement, and childhood lymphoma.
FDG PET/MRI is recommended by Level III experts.
IRC In view of the "Standard Technical Guidelines for Imaging Endpoint Procedures in Clinical Trials of Anticancer Drugs" promulgated in January 2021, the IRC section is newly added to this guideline, and the Deauville quintile, Lugano2014 standard, and LYRIC standard are recommended by level I experts.
The composition of the relevant expert committee is explained.
Poke "read the original text" and we will make progress together
The 2021 CSCO Guidelines Conference will be held in a combination of online and offline methods.
At this meeting, Professor Xuejuan Wang from Peking University Cancer Hospital interpreted the "CSCO Lymphoma 18F-FDGPET/CT Guide (2021 Edition)", and Yimaitong organized the main contents as follows.
The CSCO Lymphoma 18F-FDG PET/CT Guidelines (2021 version) have been updated in the overview, baseline PET, and post-treatment PET sections, and new PET-guided clinical strategies, PET/MRI, and independent imaging evaluation (IRC) related content have been added.
Overview 18F-FDG PET/CT is used for the staging, efficacy determination and prognosis evaluation of lymphoma.
During the clinical application of 18F-FDG PET/CT, a standardized scanning process is recommended.
The same PET-CT is required for multiple examinations of the same patient.
This guide adds new content related to blood glucose management and patient management.
Strict blood sugar management is the key to ensuring PET/CT images.
It is not recommended to use insulin to lower blood sugar on the day of the examination.
Patients need to keep warm on the day of the examination to reduce brown fat intake 18F-FDG.
The level I expert recommendation of the baseline PET pretreatment assessment (baseline 18F-FDG PET/CT) is still highly metabolic aggressive lymphoma, the level II expert recommends it as moderately metabolic lymphoma, and the level III expert recommends it as low-metabolic lymphoma tumor.
In this guideline, the level I expert recommendation for mediastinal large B-cell lymphoma is added, the level I expert recommendation for peripheral T-cell lymphoma (PTCL) is added with comments, and follicular lymphoma (FL) is divided into high-grade FL and Low level FL.
Level I experts of primary central system lymphoma recommend enhanced MRI.
Hodgkin’s lymphoma (HL) baseline PET detection of bone marrow involvement is recommended as a level I expert, diffuse large B-cell lymphoma (DLBCL) and PTCL baseline PET detection of bone marrow involvement are recommended as a level II expert, other subtypes of non-Hodgkin’s lymph NHL baseline PET detection of bone marrow involvement is recommended by Level III experts.
Low-grade FL, marginal zone lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma baseline PET detection conversion are recommended as level II experts.
PET/CT before autologous hematopoietic stem cell transplantation is still recommended as a level II expert.
Since the baseline PET-CT test can determine the prognosis of patients, this guide will recommend the prognosis of HL, DLBCL, FL, and PTCL as a level III expert recommendation.
In the comment section of the pre-treatment evaluation, the staging of lymphoma still refers to the Lugano staging standard in 2014, and there is no change.
In the mid-term PET treatment evaluation (interim 18F-FDG PET/CT), level I experts recommended high-uptake lymphoma, level II experts recommended moderate uptake NHL, and level III experts recommended equal uptake NHL.
HL recommends 18F-FDG PET/CT after 2 cycles of chemotherapy, and NHL recommends 18F-FDG PET/CT after 4 cycles of chemotherapy.
The efficacy evaluation standard of HL still uses the Deauville five-point method.
This update of the guideline adds a note on the selection of lymphoma-positive lesions.
The efficacy evaluation standard of NHL still adopts the 2014 Lugano efficacy evaluation standard.
This guideline adds the LYRIC standard for the evaluation of the efficacy of immunotherapy, supplementing the evaluation of the efficacy of patients with lymphoma in uncertain remission status.
The image judgment standard for evaluation during treatment is still the five-point method and the ΔSUVmax method.
This guideline is updated to supplement the quantitative PET method, that is, the ratio method of the SUV value of the lesion after the treatment and the SUV value of the liver blood pool. After treatment, the post-treatment assessment of PET (18F-FDG PET/CT after treatment) is basically not updated, only the classification annotations of related diseases have been updated.
PET-guided clinical strategy This update of the guideline has added the part of PET-CT-guided radiotherapy and chemotherapy strategy to guide post-treatment evaluation and follow-up treatment options.
PET/MRI This guide also adds 18F-FDG PET/MRI part, 18F-FDG PET/MRI and 18F-FDG PET/CT have similar diagnostic and staging performance.
Compared with 18F-FDG PET/CT, 18F-FDG PET/MRI has more advantages in detecting intracranial microinfiltrating foci, atypical foci, FDG, etc.
/low uptake foci in central nervous system lymphoma.
At the same time, 18F-FDG PET/MRI can reduce the radiation dose by 38%-45% and help prevent secondary malignant tumors.
MRI has the advantages of high resolution, good soft tissue contrast, multiple functional imaging examinations, and low radiation dose.
However, due to its relatively high price, this guideline only treats 18F- in primary central system lymphoma, bone marrow involvement, and childhood lymphoma.
FDG PET/MRI is recommended by Level III experts.
IRC In view of the "Standard Technical Guidelines for Imaging Endpoint Procedures in Clinical Trials of Anticancer Drugs" promulgated in January 2021, the IRC section is newly added to this guideline, and the Deauville quintile, Lugano2014 standard, and LYRIC standard are recommended by level I experts.
The composition of the relevant expert committee is explained.
Poke "read the original text" and we will make progress together
