New proposed guidelines emphasize FDG-PET scanning for initial evaluation of lymphoma

1. New guidelines from the 11^th and 12^th International Conferences on Malignant Lymphoma emphasize the use of FDG-PET scans in staging of most lymphomas. 

2. The use of bone marrow biopsies and routine chest x-rays are no longer recommended for lymphoma staging.

Statement Rundown: Though first published in 1999, universal guidelines for the initial evaluation, staging and assessment of lymphomas were most recently updated in 2007. Given the rapid progression in diagnostic and therapeutic modalities since this revision, a special committee was held at 11^th and 12^th International Conferences on Malignant Lymphoma in Lugano, Switzerland to re-evaluate and update these guidelines.

The most significant recommendation focused on the inclusion of fluorodeoxyglucose (FDG) positron emission tomography (PET)-CT scans as the standard staging and treatment response modality for all FDG-avid lymphomas. PET-CT scans have previously demonstrated improved accuracy of staging compared with regular CT scans. Only a small subset of non-FDG-avid lymphomas was recommended to be staged with CT scans. Traditional staging techniques, such as bone marrow biopsy and chest x-rays, are no longer recommended for staging of Hodgkin’s and most diffuse large B-cell lymphomas. Furthermore, although treatment recommendations still divide patients into limited (Stages I and II) versus advanced (Stages III and IV); previous Ann Arbor lymphoma classification for treatment allocation has been recommended to be limited for only Hodgkin’s Lymphoma. Finally, routine surveillance imaging post-treatment is now discouraged due to potential high false-positive rates. It should be noted that, while these guidelines are intended to improve the management of lymphoma as well as to enhance the quality of clinical trials, care of individual patients is still at the discretion of the practitioner.

Click to read the guidelines in JCO

Relevant Reading: Report of the committee on Hodgkin’s disease staging classification

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Image: PD 

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