This intriguing study looks at alternatives to PET/CT and CT for followup of Hodgkin lymphoma. The study prospectively enrolled 300 patients into either F18 PET/CT or US + CXR at specified intervals. The US/CXR arm had higher specificity than PET/CT (96% vs 86%), and both arms had similar sensitivity (97.5% vs 100%).
This is an intriguing approach to reduce radiation dose (14.5 mSv per PET/CT vs 0.1 mSv per CXR) in this population who have a high baseline risk of second malignancy (as documented in this study, ~5% 5yr risk of secondary malignancy with no difference between the two arms). Further benefit is the reduced cost of the US/CXR approach, which in Italy was estimated at €1071 per PET/CT vs €103 per US/CXR. There were also lower secondary costs and fewer invasive procedures (eg mediastinoscopy) in the US/CXR arm.
The main limitation is the technical feasibility of performing US screening, in the study this was all done by one 'expert' radiologist, and its extension to other practices may be challenging but is worth considering.
PICO Analysis:
Population: advanced stage Hodgkin Lymphoma
Intervention: US + CXR f/u post initial tx
Comparison: PET/CT f/u post initial tx
Outcome: Sensitivity & specificity for relapse, time to recurrence and cost
Reference:
Pubmed Full Text
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