A Systematic Review of the Role of PET-CT Imaging in the Assessment of Treatment Response and its Predictive Value for Survival Outcomes in Adult patients with Newly Diagnosed Hodgkin Lymphoma: A Comparison with Conventional Imaging Techniques

A Systematic Review of the Role of PET-CT Imaging in the Assessment of Treatment Response and its Predictive Value for Survival Outcomes in Adult patients with Newly Diagnosed Hodgkin Lymphoma: A Comparison with Conventional Imaging Techniques | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review A Systematic Review of the Role of PET-CT Imaging in the Assessment of Treatment Response and its Predictive Value for Survival Outcomes in Adult patients with Newly Diagnosed Hodgkin Lymphoma: A Comparison with Conventional Imaging Techniques Smaran Kasireddy, Simran Nirmal, Rithik Kathal, Chidurala Rahul, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3837903/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: The purpose of this research is to assess how PET-CT compares to other imaging modalities in terms of predicting the prognosis of Hodgkin's Lymphoma. Data Sources: We screened for papers published in English between 2019 and 2023 in the MEDLINE, PubMed, Embase databases. Study Design: To enhance clinical decision-making, we discovered studies comparing the imaging modalities Data Collection and Extraction Methods: We designed and verified organized search queries. To improve the inclusion and exclusion criteria, abstracts were evaluated iteratively. The included studies' bibliographies were manually searched as an addition to the search. To find the clinical trial protocol and published clinical trial findings, the search comprised a forward citation search of papers nested inside a clinical trial. Principal Findings: This study consists of four retrospective studies, one multicentric prospective study, one observational study, two prospective studies, and one randomized control trial. A total of nine studies were included with a sample size of 2143. PET - CT has been shown to have a predictive value for prognosis and for markers of metastasis compared to other imaging modalities. Conclusions: While PET-CT has shown to be the most predominant imaging modality for diagnosing and predicting the prognosis of Hodgkins Lymphoma, further more specific trials may be required in comparison to Bone marrow biopsy and the benefits it provides over PET- CT. Oncology Nuclear Medicine & Medical Imaging PET-CT imaging treatment response survival analysis overall survival Hodgkin lymphoma Figures Figure 1 Introduction Globally, the incidence of Hodgkins lymphoma has rapidly increased, rising by more than 39% between 1990 and 2017. It shows a very particular bimodal distribution with the peak incidences being between 20-39 and in patients aged 60 and above. The age-standardized death rates have also increased by 2.36%. Incidence and death rates for Hodgkin lymphoma were 0.98 and 0.26 per 100,000 in 2020, respectively. High-income nations showed a higher incidence, while low-income nations had a higher fatality rate [1]. The preferred imaging technique for Hodgkins lymphoma has changed over time, but more recently, PET-CT has emerged as the preferred technique, along with the development of the Lugano classification, which has been used successfully for both the diagnosis and treatment of Hodgkin and Non-Hodgkin lymphoma [2]. The imaging modality while determining the diagnosis and severity of Hodgkin Lymphoma is important in terms of staging and ultimately determining the treatment modality, PET - CT was shown to cause upstaging and downstaging in various cases of Hodgkin's lymphoma. Extranodal involvement in previously diagnosed Hodgkin lymphoma was the primary cause of upstaging, which may require further management adjustments [3]. Along with the diagnosis of the disease interim PET-CT has also been shown to determine relapse rates in patients with HL, an FDG-positive mass can lead to relapse in 62.5 % of the cases, and in resource constraint setting where FDG PET can prove to be a costly investigation it could mean potentially missing out on a relapse diagnosis [4]. The nodes in the lymph system progressively swell over time in Hodgkin lymphoma (HL). The initial phase is thought to be unicentric, and its extensional proliferation to neighbouring nodes follows a pattern that is predictable. Hodgkin lymphoma tends to arise in the lymph nodes, most frequently in the cervical area, and spreads to other lymph nodes throughout the body [5]. HL makes for 8.8% of all juvenile malignancies in patients below the age of 20; its exact cause is unclear. For those under the age of 20, the yearly occurrence rate in the United States is 12.1 every million. An increased likelihood of HL appears to be linked to a number of conditions. These might include social and economic situations, Epstein-Barr virus (EBV) infections, and HL in the familial background. 4.5 percent of the overall HL incidences are familial HL. Monozygotic pairs of twins have a 99-fold greater risk for young people and adolescents, while brothers and sisters have a seven times higher vulnerability [5,6]. One of the most prominent instances of a cancer that is malignant where tumor grading has contributed to and continues to play an essential function in therapy choice is Hodgkin lymphoma. Precise cancer spread upon diagnosis is essential for selecting a course of treatment and determining the future prospects of the individual who is being treated. When a condition is diagnosed, staging provides a "baseline" image that is essential for evaluating the efficacy of a treatment. Grading protocols in clinical investigations must be standardized to allow for immediate comparisons across studies, especially when novel approaches or treatments are being tested. Since the Ann Arbor categorization was established, Hodgkin lymphoma staging has undergone improvements thanks to the Costwolds classification, which adopted the use of computerized tomography (CT) scans, and especially the more recently taken International Working Group (IWG), which presented fluorodeoxyglucose (FDG)-positron emission tomography (PET) [7,8]. On the basis of the pattern of distribution or CT attributes, PET imaging results tend to be documented by employing a visual evaluation [9], highlighting the precise position of elevated focal acceptance in nodal structures and extranodal areas that can be differentiated via the physiological intake as well as additional patterns of disease characterized by elevated FDG uptake, which includes infections and inflammatory conditions [10]. In Hodgkin lymphoma, PET serves a widely recognized function in evaluating the treatment response and predicting the prognosis. For intermediate PET after two or four cycles of chemotherapy along with for end-of-treatment PET, consensual parameters for evaluation were described. The International Harmony Project (IHP) released one of its initial consensus-based proposals in 2007 [11], [12]. The implementation of PET scanning in the diagnosis of Hodgkin lymphoma to assess responsiveness and risk-group individuals before the transplantation of hematopoietic stem cells continues to be of significance. Seven hundred forty-five individuals suffering from refractory/relapsed Hodgkin lymphoma who had undergone FDG-PET before receiving a hematopoietic stem cell transplant were analyzed in a study that comprised eleven studies published between 2007 and 2014 [10]. In the current investigation, 156 patients with HL from 6 Italian hospitals were included. Standard staging techniques were used, including 2-[fluorine-18] fluoro-2-deoxy-D-glucose. CT and PET scans were compared going forward. The phases determined by CT and FDG-PET were consistent in 156 cases (84%) and inconsistent in 30 individuals (16%). In 27 patients (14%) the PET staging was greater than the CT stage, while in 3 patients (1%), it was lower. After this last stage was defined, the intended treatment plan was altered in Eleven out of a total of 30 patients (37%). Ten patients (8%) having an alteration in stage from localized to advanced stages following a PET examination underwent therapy using a different technique when we took into account the 123 CT-graded individuals who had localized phase [13]. Objective: Determination of Overall Survival and Progression free survival among Newly diagnosed Hodgkin’s lymphoma patients utilizing PET-CT Methodology We included prospective, observational studies along with control trials due to the distinctive features of the study and the ultimate need of determination of PET scan for diagnostic procedure for Hodgkins’s lymphoma. The Medical Subject Headings (MeSH) terms and keywords utilized for the search were PET-CT imaging, Tomography, Treatment Outcome OR treatment response, survival analysis, overall survival and Hodgkin lymphoma among numerous other research terms were employed in an electronic search on National Library of Medicine (Pubmed), Cochrane Central Register of Controlled Trials (CENTRAL) of Cochrane Library along with Pubmed Central (PMC), Wiley, Frontier, and google scholar Elsevier, PubMed Online, NIH, EBSCO and Scopus along with google scholar. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), which are frequently utilized to conduct successful research, were followed in the conduct of this study. To determine if every component met the criteria for inclusion, it was thoroughly reviewed and analyzed. It was evaluated and examined. If they satisfied all inclusion criteria, they were simply included in the research. Inclusion Criteria: Patients of all genders and ages. People with recently discovered Hodgkin lymphoma. Patients whose treatment response has been evaluated by PET-CT imaging. Studies that use PET-CT results to indicate therapy response outcomes (such as a full response, partial response, or stable disease). Research based on the results of PET-CT that reports survival outcomes (such as overall survival or progression-free survival).Studies that include both adult and paediatric patients or provide separate data for each population. Studies done post 2019. Exclusion Criteria: Patients who have not had PET-CT imaging for the evaluation of treatment response Patients who have recurrent or relapsed Hodgkin lymphoma.Studies that focus on non-Hodgkin lymphoma or other hematological malignancies. Studies that solely focus on conventional imaging techniques (e.g., CT or MRI) without including PET-CT. Studies with insufficient data or incomplete information regarding treatment response or survival outcomes. Animal studies, review articles, case reports, and conference abstracts. Results & Discussion Table 1 Characteristics of Studies Study Year Type of Study Region Sample Size Gender Age (years) Results Manas Kalra et al. [14] 2022 multi-centric prospective study India 396 5.4M: 1F 9.37 The instances of the 5-year OS as well as 5-year EFS of both groups—ERA based on CECT (91.8%) vs. PET-CT (94.1%)—were identical. The EFS and OS for children who underwent PET-CT showed 81.7%EFS and 92.5% OS. Al-Ibraheem A et al. [15] 2022 Observational study Jordan 245 M=134 F=111 29 Participants with iPET-CMR had superior outcomes compared to individuals with iPET-nCMR (41 and 86%, accordingly,p=0.0001), especially 91% 3 years EFS and 95% 3 years OS. Rodríguez Taroco MG et al. [16] 2021 Prospective study Uruguay 21 M=8 F=13 12 Individuals who received Deauville rankings of 1, 2, 3, and X had various survival curves than the individuals who received an overall rating of 4, exhibiting 4-year PFS rates of 85 vs 29%, respectively (P = 0.05). Wan et al. [17] 2021 Retrospective Study China 84 - - 33.3% and 98.7%, with a statistically significant distinction (P 0.001), were the PFS rates after three years for the rLL1.29 group and the rLL1.29 group, respectively. After therapy, the PFS percentages for the Deauville 5-PS4 group and the Deauville 5-PS4 group had been 98.7% and 55.6%, respectively. This variation was significant (P 0.001). Ortega C et al. [18] 2023 Retrospective Study Canada 88 M=46 F=42 43.3 Participants with PET/CT had outcome of HR as 1.67 WITH 95% CI( 1.01-2.76, P=0.047) for PFS Kamal NM et al. [19] 2021 Prospective Study Saudia Arabia 254 Twenty-two of the 254 kids had intermediate PET-ve results, whereas 34 had PET+ve results. The probability categorization and qualitative investigation of intermediate 18F-FDG-PET/CT were major indicators of total actuarial survival (TAS) and disease-free survival (DFS), according to a univariate study. The semiquantitative measure with the greatest risk ratio is SUVmean2.5. Casasnovas et al. [20] 2019 Randomized Control Trial Belgium & France 823 The mean duration of follow-up of fifty consecutive months (IQR 42-9-59), the 5-year survival without progression with goal to be treated turned out 86.2%, 95% CI 81.6-89.8, in the typical treatment group compared to 85.7%, 81.4-89.1, in the PET-driven treatment group (hazard ratio [HR] 1.084, 95% CI 0737-1596; p=065), and according protocol the values were 86·7%, 95% CI 81·9-90·3 and 85·4%, 80·7-89·0, respectively (HR 1·144, 0·758-1·726; p=0·74). Kandeel AA et al. [21] 2020 Retrospective Study Egypt 138 M=70 F-68 43 F-FDG PET/CT had considerably greater sensitivity, the negative predictive value (NPV), and accuracy in Hodgkin lymphoma than Bone Marrow Biopsy (BMB), with values of 87.5, 94.4, and 96% vs 50, 81, and 84% (P = 0.02, 0.03, and 0.04 respectively). Yağci-Küpeli et al. [22] 2019 Retrospective Study 94 M=57 F=37 7 On F-FDG PET/CT, 29 of the 94 individuals had BMI. In among 29 patients, BMB was detected in 14 as positive, 13 as negative, and 2 as inadequate. F-FDG PET/CT was negative in 65 individuals, while BMB was neg in 54 and inadequate in 7. F-FDG PET/CT's sensitivity, specificity, as well as and both negative and positive predictive values for identifying bone marrow metastasis at the point of identification were respectively 90.6%, 100%, 100%, and 95.4% for the entire population. Our research shows that F-FDG PET/CT identifies BMI more accurately than BMB. For preliminary grading of pediatric Hodgkins lymphoma patients, F-FDG PET/CT can potentially be employed. EFS=event free survival OS= overall survival ERA= early response assessment PFS=progression free survival M= male F= female SUV= standardized uptake value rLL= Liver SUV BMI=bone marrow involvement Al-Ibraheem A et al. (2022) reported that in accordance with the previously documented scientific literature regarding both early-stage and advanced-stage HL, their investigation demonstrated a substantial negative predictive value (NPV) of iPET in HL of 91% utilizing the three y-EFS endpoints [15]. A multinational cohort of 260 individuals suffering from advanced HL underwent an in-depth retrospective examination of their iPET-2 scans after two rounds of Adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). The results were evaluated employing the Deauville criteria, and the results showed that the PPV was 73% and the NPV was 94% [23]. Lue et al. (2019) looked at 11 first-order and 39 higher-order features in 42 HL patients to estimate PFS and OS. In the group of 21 occurrences, it was determined that SUV, the trend, stage, and intensity non-uniformity (INU) obtained from the grey-level run length matrix (GLRLM) were independent indicators of PFS, whereas only the disease's stage and INU were independent indicators of OS. (11 deaths, 12 recurrences) [24]. Recently, Zhou et al. (2021) looked at the possibility of predicting Hodgkin lymphoma outcomes using the radiomic properties of basal FDG PET. The current study found that long-zone strong gray-level concentration and Dmax showed distinct relationships with 2-year survival without progression despite not assessing any CT-radiomics or including any medical information in their AUC examination [25]. Currently, a radiomics investigation in a more extensive cohort comprised of individuals with recurrent HL was described by Driessen, J. et al. (2021). They discovered that a radioactive substance and clinical feature combination yields a potent model of prediction for the 3-year time to progression. The design does not incorporate any second or higher-order radiomic characteristics but makes use of strong PET features that address inter-lesional variation in the length, metabolic volume, and SUV [26]. The study reported that in comparison to CECT (64.3%), PET-CT-based ERA (81.2%) had considerably higher levels of acceptable responses. The significance of the findings held even after assessing just individuals with non-bulky diseases who wouldn't have been given radiation in the event that their condition had been deemed a good responder. 84.2% of the children with non-bulky illness in the PET-CT arm and 68.5% of kids in the CECT arm experienced a good response. Due to this, fewer patients (15.8% in the PET-CT arm compared to 31.5% in the CECT arm) were assigned to radiation in the PET-CT arm. Undoubtedly, it is crucial to stress the use of interim PET-CT scans, which clearly show the cancerous cells' responsiveness to the intervention [14]. It should be noted that modern HL patients receive individualized care based on significant evidence validating the use of iPET for individualized treatment and management of changes [27]. The NCCN clinical practice recommendations from 2020, for instance, propose iPET-based customized therapy as the gold standard of care.[28] According to the study, combining CT and PET radiomics characteristics may provide extra information or assistance in determining which patients might gain benefit from further radiation to enhance their illness prognosis [18]. When taken into consideration together, the integration of combined PET and CT radiomic characteristics may increase the practical value of certain clinical criteria such as prediction of PFS and OS of patients as well as their treatment regimen throughout their treatment. Conclusion The utilization of PET/CT radiological methods to obtain a better and more precise image of the patient’s condition might act as a pivotal marker for the identification and prognosis of Hodgkin’s lymphoma that follows a distinct yet predictive pattern of metastasis in patients. Both patients and medical professionals stand to gain significantly from the use of PET/CT in combination to assess the clinical features of the disease and serve as an independent predictor of progression-free survival and overall survival in patients. Further studies need to be conducted to mark PET/CT as the most reliable source of survival prediction among patients suffering from Hodgkin’s lymphoma. References Zhou, L., Deng, Y., Li, N. et al. Global, regional, and national burden of Hodgkin lymphoma from 1990 to 2017: estimates from the 2017 Global Burden of Disease study. 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Johnson P, Federico M, Kirkwood A, Fosså A, Berkahn L, Carella A, et al. Adapted treatment guided by interim PET-CT scan in advanced Hodgkin's Lymphoma. N. Engl. J. Med. 2016;374(25):2419–2429. https://10.1056/NEJMoa1510093. Hoppe RT, Advani RH, Ai WZ, Ambinder RF, Armand P, Bello CM, et al. Hodgkin Lymphoma, Version 2.2020, NCCN clinical practice guidelines in oncology. J. Natl. Compr. Canc. Netw. 2020;18(6):755–781. https://10.6004/jnccn.2020.0026. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3837903","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":265466673,"identity":"e8c652a4-abd0-4ce3-b521-f0a2c9b97f1a","order_by":0,"name":"Smaran Kasireddy","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABNElEQVRIie2PMUvDQBTH33HgdKVrpNR+hQsHFWlA/CaXpVlOl0LnQCBdlG6SYvEzCAFxvBLQJbRrICARwalCwKWCBV9UipCKGQXzGx7H8X7v/R9ATc0fhgMQF2CHQhMY0R9/RlF0BWXXZdgnKykFqHD9i9I5j57y1xsQzXHk5/mwZ4fJsdZkdQ/7rVFGWVyenvbF5CyGrpHY3iSYO/Z1ciJxywAOpjGnLCkrLSmg4YMFCfFow49QUTx6kxJ4ooCyvBzswnkha1Q6i5lH16iEgeK4pVCcbJsCqRI4HLpc2x4lqFwZG0VuD5aqAW37hjDxFnI6d0QQL1HpS4bB+GxaPh+DheTZt8zLxd0jrIa99nikzAwsuYfBHrLlbTnYJ8bmdeR+PVhR9E/Cdw6rNNXU1NT8L94Bhftxn6o3nGYAAAAASUVORK5CYII=","orcid":"","institution":"University Hospital Leicester","correspondingAuthor":true,"prefix":"","firstName":"Smaran","middleName":"","lastName":"Kasireddy","suffix":""},{"id":265466674,"identity":"34346018-1a25-4bd3-bedc-1258e883f318","order_by":1,"name":"Simran Nirmal","email":"","orcid":"","institution":"BJ Medical College Pune, India","correspondingAuthor":false,"prefix":"","firstName":"Simran","middleName":"","lastName":"Nirmal","suffix":""},{"id":265466675,"identity":"fc75bc74-5937-40b3-a11a-4f4f0a4d6ae8","order_by":2,"name":"Rithik Kathal","email":"","orcid":"","institution":"Medical College Rewa","correspondingAuthor":false,"prefix":"","firstName":"Rithik","middleName":"","lastName":"Kathal","suffix":""},{"id":265466676,"identity":"fa4ab093-82b5-405e-b906-5466c8cde709","order_by":3,"name":"Chidurala Rahul","email":"","orcid":"","institution":"Sri Ramachandra","correspondingAuthor":false,"prefix":"","firstName":"Chidurala","middleName":"","lastName":"Rahul","suffix":""},{"id":265466677,"identity":"c5dd4a28-abcb-4904-81e0-f1251a77b78a","order_by":4,"name":"Rajasundaram Shridhar","email":"","orcid":"","institution":"Metropolitan University College of Medicine, Antigua and Barbuda","correspondingAuthor":false,"prefix":"","firstName":"Rajasundaram","middleName":"","lastName":"Shridhar","suffix":""}],"badges":[],"createdAt":"2024-01-05 17:57:12","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-3837903/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3837903/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49332862,"identity":"a978ead8-08c3-43fa-a36a-8bff55eec145","added_by":"auto","created_at":"2024-01-08 19:34:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":137790,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-3837903/v1/c13d12b3ed7f9830134e7299.png"},{"id":49333266,"identity":"78ff80f2-60b8-4f38-ad79-de419263154a","added_by":"auto","created_at":"2024-01-08 19:42:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":375703,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3837903/v1/321dcc50-cb55-40fc-913f-a3d28b7918ff.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eA Systematic Review of the Role of PET-CT Imaging in the Assessment of Treatment Response and its Predictive Value for Survival Outcomes in Adult patients with Newly Diagnosed Hodgkin Lymphoma: A Comparison with Conventional Imaging Techniques\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGlobally, the incidence of Hodgkins lymphoma has rapidly increased, rising by more than 39% between 1990 and 2017. It shows a very particular bimodal distribution with the peak incidences being between 20-39 and in patients aged 60 and above. The age-standardized death rates have also increased by 2.36%. Incidence and death rates for Hodgkin lymphoma were 0.98 and 0.26 per 100,000 in 2020, respectively. High-income nations showed a higher incidence, while low-income nations had a higher fatality rate [1]. The preferred imaging technique for Hodgkins lymphoma has changed over time, but more recently, PET-CT has emerged as the preferred technique, along with the development of the Lugano classification, which has been used successfully for both the diagnosis and treatment of Hodgkin and Non-Hodgkin lymphoma [2].\u003c/p\u003e\n\u003cp\u003eThe imaging modality while determining the diagnosis and severity of Hodgkin Lymphoma is important in terms of staging and ultimately determining the treatment modality, PET - CT was shown to cause upstaging and downstaging in various cases of Hodgkin\u0026apos;s lymphoma. Extranodal involvement in previously diagnosed Hodgkin lymphoma was the primary cause of upstaging, which may require further management adjustments [3]. Along with the diagnosis of the disease interim PET-CT has also been shown to determine relapse rates in patients with HL, an FDG-positive mass can lead to relapse in 62.5 % of the cases, and in resource constraint setting where FDG PET can prove to be a costly investigation it could mean potentially missing out on a relapse diagnosis [4].\u003c/p\u003e\n\u003cp\u003eThe nodes in the lymph system progressively swell over time in Hodgkin lymphoma (HL). The initial phase is thought to be unicentric, and its extensional proliferation to neighbouring nodes follows a pattern that is predictable. Hodgkin lymphoma tends to arise in the lymph nodes, most frequently in the cervical area, and spreads to other lymph nodes throughout the body [5].\u003c/p\u003e\n\u003cp\u003eHL makes for 8.8% of all juvenile malignancies in patients below the age of 20; its exact cause is unclear. For those under the age of 20, the yearly occurrence rate in the United States is 12.1 every million. An increased likelihood of HL appears to be linked to a number of conditions. These might include social and economic situations, Epstein-Barr virus (EBV) infections, and HL in the familial background. 4.5 percent of the overall HL incidences are familial HL. Monozygotic pairs of twins have a 99-fold greater risk for young people and adolescents, while brothers and sisters have a seven times higher vulnerability [5,6].\u003c/p\u003e\n\u003cp\u003eOne of the most prominent instances of a cancer that is malignant where tumor grading has contributed to and continues to play an essential function in therapy choice is Hodgkin lymphoma. Precise cancer spread upon diagnosis is essential for selecting a course of treatment and determining the future prospects of the individual who is being treated. When a condition is diagnosed, staging provides a \u0026quot;baseline\u0026quot; image that is essential for evaluating the efficacy of a treatment. Grading protocols in clinical investigations must be standardized to allow for immediate comparisons across studies, especially when novel approaches or treatments are being tested. Since the Ann Arbor categorization was established, Hodgkin lymphoma staging has undergone improvements thanks to the Costwolds classification, which adopted the use of computerized tomography (CT) scans, and especially the more recently taken International Working Group (IWG), which presented fluorodeoxyglucose (FDG)-positron emission tomography (PET) [7,8].\u003c/p\u003e\n\u003cp\u003eOn the basis of the pattern of distribution or CT attributes, PET imaging results tend to be documented by employing a visual evaluation [9], highlighting the precise position of elevated focal acceptance in nodal structures and extranodal areas that can be differentiated via the physiological intake as well as additional patterns of disease characterized by elevated FDG uptake, which includes infections and inflammatory conditions [10].\u003c/p\u003e\n\u003cp\u003eIn Hodgkin lymphoma, PET serves a widely recognized function in evaluating the treatment response and predicting the prognosis. For intermediate PET after two or four cycles of chemotherapy along with for end-of-treatment PET, consensual parameters for evaluation were described. The International Harmony Project (IHP) released one of its initial consensus-based proposals in 2007 [11], [12].\u003c/p\u003e\n\u003cp\u003eThe implementation of PET scanning in the diagnosis of Hodgkin lymphoma to assess responsiveness and risk-group individuals before the transplantation of hematopoietic stem cells continues to be of significance. Seven hundred forty-five individuals suffering from refractory/relapsed Hodgkin lymphoma who had undergone FDG-PET before receiving a hematopoietic stem cell transplant were analyzed in a study that comprised eleven studies published between 2007 and 2014 [10].\u003c/p\u003e\n\u003cp\u003eIn the current investigation, 156 patients with HL from 6 Italian hospitals were included. Standard staging techniques were used, including 2-[fluorine-18] fluoro-2-deoxy-D-glucose. CT and PET scans were compared going forward. The phases determined by CT and FDG-PET were consistent in 156 cases (84%) and inconsistent in 30 individuals (16%). In 27 patients (14%) the PET staging was greater than the CT stage, while in 3 patients (1%), it was lower. After this last stage was defined, the intended treatment plan was altered in Eleven out of a total of 30 patients (37%). Ten patients (8%) having an alteration in stage from localized to advanced stages following a PET examination underwent therapy using a different technique when we took into account the 123 CT-graded individuals who had localized phase [13].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDetermination of Overall Survival and Progression free survival among Newly diagnosed Hodgkin\u0026rsquo;s lymphoma patients utilizing PET-CT\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eWe included prospective, observational studies along with control trials due to the distinctive features of the study and the ultimate need of determination of PET scan for diagnostic procedure for Hodgkins\u0026rsquo;s lymphoma. The Medical Subject Headings (MeSH) terms and keywords utilized for the search were PET-CT imaging, Tomography, Treatment Outcome OR treatment response, survival analysis, overall survival and Hodgkin lymphoma among numerous other research terms were employed in an electronic search on National Library of Medicine (Pubmed), Cochrane Central Register of Controlled Trials (CENTRAL) of Cochrane Library along with Pubmed Central (PMC), Wiley, Frontier, and google scholar Elsevier, PubMed Online, NIH, EBSCO and Scopus along with google scholar. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), which are frequently utilized to conduct successful research, were followed in the conduct of this study. To determine if every component met the criteria for inclusion, it was thoroughly reviewed and analyzed. It was evaluated and examined. If they satisfied all inclusion criteria, they were simply included in the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003ePatients of all genders and ages.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ePeople with recently discovered Hodgkin lymphoma.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ePatients whose treatment response has been evaluated by PET-CT imaging.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eStudies that use PET-CT results to indicate therapy response outcomes (such as a full response, partial response, or stable disease).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eResearch based on the results of PET-CT that reports survival outcomes (such as overall survival or progression-free survival).Studies that include both adult and paediatric patients or provide separate data for each population.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eStudies done post 2019.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003ePatients who have not had PET-CT imaging for the evaluation of treatment response\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ePatients\u0026nbsp;who have recurrent or relapsed Hodgkin lymphoma.Studies that focus on non-Hodgkin lymphoma or other hematological malignancies.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eStudies that solely focus on conventional imaging techniques (e.g., CT or MRI) without including PET-CT.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eStudies with insufficient data or incomplete information regarding treatment response or survival outcomes.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eAnimal studies, review articles, case reports, and conference abstracts.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Results \u0026 Discussion","content":"\u003cp\u003e\u003cstrong\u003eTable 1 Characteristics of Studies\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"688\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.936046511627907%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.116279069767442%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Study\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.174418604651162%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.44767441860465%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample Size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.593023255813954%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.011627906976743%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.74418604651163%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.936046511627907%\" valign=\"top\"\u003e\n \u003cp\u003eManas Kalra et al. [14]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.116279069767442%\" valign=\"top\"\u003e\n \u003cp\u003emulti-centric prospective study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.174418604651162%\" valign=\"top\"\u003e\n \u003cp\u003eIndia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.44767441860465%\" valign=\"top\"\u003e\n \u003cp\u003e396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.593023255813954%\" valign=\"top\"\u003e\n \u003cp\u003e5.4M: 1F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.011627906976743%\" valign=\"top\"\u003e\n \u003cp\u003e9.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.74418604651163%\" valign=\"top\"\u003e\n \u003cp\u003eThe instances of the 5-year OS as well as 5-year EFS of both groups\u0026mdash;ERA based on CECT (91.8%) vs. PET-CT (94.1%)\u0026mdash;were identical. The EFS and OS for children who underwent PET-CT showed 81.7%EFS and 92.5% OS.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.936046511627907%\" valign=\"top\"\u003e\n \u003cp\u003eAl-Ibraheem A\u0026nbsp;et al. [15]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.116279069767442%\" valign=\"top\"\u003e\n \u003cp\u003eObservational study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.174418604651162%\" valign=\"top\"\u003e\n \u003cp\u003eJordan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.44767441860465%\" valign=\"top\"\u003e\n \u003cp\u003e245\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.593023255813954%\" valign=\"top\"\u003e\n \u003cp\u003eM=134\u003c/p\u003e\n \u003cp\u003eF=111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.011627906976743%\" valign=\"top\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.74418604651163%\" valign=\"top\"\u003e\n \u003cp\u003eParticipants with iPET-CMR had superior outcomes compared to individuals with iPET-nCMR (41 and 86%, accordingly,p=0.0001), especially 91% 3 years\u0026nbsp;EFS and 95% 3 years\u0026nbsp;OS.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.936046511627907%\" valign=\"top\"\u003e\n \u003cp\u003eRodr\u0026iacute;guez Taroco MG\u0026nbsp;et al. [16]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.116279069767442%\" valign=\"top\"\u003e\n \u003cp\u003eProspective study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.174418604651162%\" valign=\"top\"\u003e\n \u003cp\u003eUruguay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.44767441860465%\" valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.593023255813954%\" valign=\"top\"\u003e\n \u003cp\u003eM=8\u003c/p\u003e\n \u003cp\u003eF=13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.011627906976743%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.74418604651163%\" valign=\"top\"\u003e\n \u003cp\u003eIndividuals who received Deauville rankings of 1, 2, 3, and X had various survival curves than the individuals who received an overall rating of 4, exhibiting 4-year PFS rates of 85 vs 29%, respectively (P = 0.05).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.936046511627907%\" valign=\"top\"\u003e\n \u003cp\u003eWan et al. [17]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.116279069767442%\" valign=\"top\"\u003e\n \u003cp\u003eRetrospective Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.174418604651162%\" valign=\"top\"\u003e\n \u003cp\u003eChina\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.44767441860465%\" valign=\"top\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.593023255813954%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.011627906976743%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.74418604651163%\" valign=\"top\"\u003e\n \u003cp\u003e33.3% and 98.7%, with a statistically significant distinction (P 0.001), were the PFS rates after three years for the rLL1.29 group and the rLL1.29 group, respectively. After therapy, the PFS percentages for the Deauville 5-PS4 group and the Deauville 5-PS4 group had been 98.7% and 55.6%, respectively. This variation was significant (P 0.001).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.936046511627907%\" valign=\"top\"\u003e\n \u003cp\u003eOrtega C\u0026nbsp;et al. [18]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.116279069767442%\" valign=\"top\"\u003e\n \u003cp\u003eRetrospective Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.174418604651162%\" valign=\"top\"\u003e\n \u003cp\u003eCanada\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.44767441860465%\" valign=\"top\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.593023255813954%\" valign=\"top\"\u003e\n \u003cp\u003eM=46\u003c/p\u003e\n \u003cp\u003eF=42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.011627906976743%\" valign=\"top\"\u003e\n \u003cp\u003e43.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.74418604651163%\" valign=\"top\"\u003e\n \u003cp\u003eParticipants with PET/CT had outcome of HR as 1.67 WITH 95% CI( 1.01-2.76, P=0.047) for PFS \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.936046511627907%\" valign=\"top\"\u003e\n \u003cp\u003eKamal NM et al. [19]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.116279069767442%\" valign=\"top\"\u003e\n \u003cp\u003eProspective Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.174418604651162%\" valign=\"top\"\u003e\n \u003cp\u003eSaudia Arabia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.44767441860465%\" valign=\"top\"\u003e\n \u003cp\u003e254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.593023255813954%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.011627906976743%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.74418604651163%\" valign=\"top\"\u003e\n \u003cp\u003eTwenty-two of the 254 kids had intermediate PET-ve results, whereas 34 had PET+ve results. The probability categorization and qualitative investigation of intermediate 18F-FDG-PET/CT were major indicators of total actuarial survival (TAS) and disease-free survival (DFS), according to a univariate study. The semiquantitative\u0026nbsp;measure with the greatest risk ratio is SUVmean2.5.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.936046511627907%\" valign=\"top\"\u003e\n \u003cp\u003eCasasnovas\u0026nbsp;et al. [20]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.116279069767442%\" valign=\"top\"\u003e\n \u003cp\u003eRandomized Control Trial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.174418604651162%\" valign=\"top\"\u003e\n \u003cp\u003eBelgium \u0026amp; France\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.44767441860465%\" valign=\"top\"\u003e\n \u003cp\u003e823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.593023255813954%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.011627906976743%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.74418604651163%\" valign=\"top\"\u003e\n \u003cp\u003eThe\u0026nbsp;mean duration of follow-up of fifty consecutive months (IQR 42-9-59), the 5-year survival without progression with goal to be treated turned out 86.2%, 95% CI 81.6-89.8, in the typical treatment group compared to 85.7%, 81.4-89.1, in the PET-driven treatment group (hazard ratio [HR] 1.084, 95% CI 0737-1596; p=065), and according protocol the values were 86\u0026middot;7%, 95% CI 81\u0026middot;9-90\u0026middot;3 and 85\u0026middot;4%, 80\u0026middot;7-89\u0026middot;0, respectively (HR 1\u0026middot;144, 0\u0026middot;758-1\u0026middot;726; p=0\u0026middot;74).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.936046511627907%\" valign=\"top\"\u003e\n \u003cp\u003eKandeel\u0026nbsp;AA et al. [21]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.116279069767442%\" valign=\"top\"\u003e\n \u003cp\u003eRetrospective Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.174418604651162%\" valign=\"top\"\u003e\n \u003cp\u003eEgypt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.44767441860465%\" valign=\"top\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.593023255813954%\" valign=\"top\"\u003e\n \u003cp\u003eM=70\u003c/p\u003e\n \u003cp\u003eF-68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.011627906976743%\" valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.74418604651163%\" valign=\"top\"\u003e\n \u003cp\u003eF-FDG PET/CT had considerably greater sensitivity, the negative predictive value (NPV), and accuracy in Hodgkin lymphoma than Bone Marrow Biopsy (BMB), with values of 87.5, 94.4, and 96% vs 50, 81, and 84% (P = 0.02, 0.03, and 0.04 respectively).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.936046511627907%\" valign=\"top\"\u003e\n \u003cp\u003eYağci-K\u0026uuml;peli\u0026nbsp;et al. [22]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.116279069767442%\" valign=\"top\"\u003e\n \u003cp\u003eRetrospective Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.174418604651162%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.44767441860465%\" valign=\"top\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.593023255813954%\" valign=\"top\"\u003e\n \u003cp\u003eM=57\u003c/p\u003e\n \u003cp\u003eF=37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.011627906976743%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.74418604651163%\" valign=\"top\"\u003e\n \u003cp\u003eOn F-FDG PET/CT, 29 of the 94 individuals had BMI. In among 29 patients, BMB was detected in 14 as positive, 13 as negative, and 2 as inadequate. F-FDG PET/CT was negative in 65 individuals, while BMB was neg in 54 and inadequate in 7. F-FDG PET/CT\u0026apos;s sensitivity, specificity, as well as and both negative and positive predictive values for identifying bone marrow metastasis at the point of identification were respectively 90.6%, 100%, 100%, and 95.4% for the entire population. Our research shows that F-FDG PET/CT identifies BMI more accurately than BMB. For preliminary grading of pediatric Hodgkins lymphoma patients, F-FDG PET/CT can potentially be employed.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eEFS=event free survival\u003c/p\u003e\n\u003cp\u003eOS= overall survival\u003c/p\u003e\n\u003cp\u003eERA= early response assessment\u003c/p\u003e\n\u003cp\u003ePFS=progression free survival\u003c/p\u003e\n\u003cp\u003eM= male\u003c/p\u003e\n\u003cp\u003eF= female\u003c/p\u003e\n\u003cp\u003eSUV= standardized uptake value\u003c/p\u003e\n\u003cp\u003erLL= Liver SUV\u003c/p\u003e\n\u003cp\u003eBMI=bone marrow involvement\u003c/p\u003e\n\u003cp\u003eAl-Ibraheem A et al. (2022) reported that in accordance with the previously documented scientific literature regarding both early-stage and advanced-stage HL, their investigation demonstrated a substantial negative predictive value (NPV) of iPET in HL of 91% utilizing the three y-EFS endpoints [15]. A multinational cohort of 260 individuals suffering from advanced HL underwent an in-depth retrospective examination of their iPET-2 scans after two rounds of Adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). The results were evaluated employing the Deauville criteria, and the results showed that the PPV was 73% and the NPV was 94% [23].\u003c/p\u003e\n\u003cp\u003eLue et al. (2019) looked at 11 first-order and 39 higher-order features in 42 HL patients to estimate PFS and OS. In the group of 21 occurrences, it was determined that SUV, the trend, stage, and intensity non-uniformity (INU) obtained from the grey-level run length matrix (GLRLM) were independent indicators of PFS, whereas only the disease\u0026apos;s stage and INU were independent indicators of OS. (11 deaths, 12 recurrences) \u0026nbsp;[24].\u003c/p\u003e\n\u003cp\u003eRecently, Zhou et al. (2021) looked at the possibility of predicting Hodgkin lymphoma outcomes using the radiomic properties of basal FDG PET. The current study found that long-zone strong gray-level concentration and Dmax showed distinct relationships with 2-year survival without progression despite not assessing any CT-radiomics or including any medical information in their AUC examination [25].\u003c/p\u003e\n\u003cp\u003eCurrently, a radiomics investigation in a more extensive cohort comprised of individuals with recurrent HL was described by Driessen, J. et al. (2021). They discovered that a radioactive substance and clinical feature combination yields a potent model of prediction for the 3-year time to progression. The design does not incorporate any second or higher-order radiomic characteristics but makes use of strong PET features that address inter-lesional variation in the length, metabolic volume, and SUV [26].\u003c/p\u003e\n\u003cp\u003eThe study reported that in comparison to CECT (64.3%), PET-CT-based ERA (81.2%) had considerably higher levels of acceptable responses. The significance of the findings held even after assessing just individuals with non-bulky diseases who wouldn\u0026apos;t have been given radiation in the event that their condition had been deemed a good responder. 84.2% of the children with non-bulky illness in the PET-CT arm and 68.5% of kids in the CECT arm experienced a good response. Due to this, fewer patients (15.8% in the PET-CT arm compared to 31.5% in the CECT arm) were assigned to radiation in the PET-CT arm. Undoubtedly, it is crucial to stress the use of interim PET-CT scans, which clearly show the cancerous cells\u0026apos; responsiveness to the intervention [14].\u003c/p\u003e\n\u003cp\u003eIt should be noted that modern HL patients receive individualized care based on significant evidence validating the use of iPET for individualized treatment and management of changes [27]. The NCCN clinical practice recommendations from 2020, for instance, propose iPET-based customized therapy as the gold standard of care.[28]\u003c/p\u003e\n\u003cp\u003eAccording to the study, combining CT and PET radiomics characteristics may provide extra information or assistance in determining which patients might gain benefit from further radiation to enhance their illness prognosis [18].\u003c/p\u003e\n\u003cp\u003eWhen taken into consideration together, the integration of combined PET and CT radiomic characteristics may increase the practical value of certain clinical criteria such as prediction of PFS and OS of patients as well as their treatment regimen throughout their treatment.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe utilization of PET/CT radiological methods to obtain a better and more precise image of the patient\u0026rsquo;s condition might act as a pivotal marker for the identification and prognosis of Hodgkin\u0026rsquo;s lymphoma that follows a distinct yet predictive pattern of metastasis in patients. Both patients and medical professionals stand to gain significantly from the use of PET/CT in combination to assess the clinical features of the disease and serve as an independent predictor of progression-free survival and overall survival in patients. Further studies need to be conducted to mark PET/CT as the most reliable source of survival prediction among patients suffering from Hodgkin\u0026rsquo;s lymphoma.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZhou, L., Deng, Y., Li, N. et al. Global, regional, and national burden of Hodgkin lymphoma from 1990 to 2017: estimates from the 2017 Global Burden of Disease study. J Hematol Oncol 2019;12:107. https://doi.org/10.1186/s13045-019-0799-1\u003c/li\u003e\n\u003cli\u003eJohnson SA, Kumar A, Matasar MJ, Sch\u0026ouml;der H, Rademaker J. Imaging for Staging and Response Assessment in Lymphoma. Radiology. 2015;276(2):323-38. https://doi.org/10.1148/radiol.2015142088 \u003c/li\u003e\n\u003cli\u003eBednaruk-Młyński E, Pieńkowska J, Sk\u0026oacute;rzak A, et al.. Comparison of positron emission tomography/computed tomography with classical contrast-enhanced computed tomography in the initial staging of Hodgkin lymphoma. Leuk Lymphoma. 2015;56(2):377-82. https://doi.org/10.3109/10428194.2014.919635\u003c/li\u003e\n\u003cli\u003eNaumann R, Vaic A, Beuthien-Baumann B, Bredow J, Kropp J, Kittner T, Franke WG, Ehninger G. Prognostic value of positron emission tomography in the evaluation of post-treatment residual mass in patients with Hodgkin\u0026apos;s disease and non-Hodgkin\u0026apos;s lymphoma. Br J Haematol. 2001;115(4):793-800. https://doi.org/10.3109/10428194.2014.919635 \u003c/li\u003e\n\u003cli\u003eLanzkowsky, P. Germ cell tumors. Manual of pediatric hematology and oncology. 2011; 776-789.\u003c/li\u003e\n\u003cli\u003eWahed, A., Quesada, A., \u0026amp; Dasgupta, A. Hematology and coagulation: a comprehensive review for board preparation, certification and clinical practice. 2019\u003c/li\u003e\n\u003cli\u003eBangerter, M., Moog, F., Buchmann, I., Kotzerke, J., Griesshammer, M., Hafner, M., ... \u0026amp; Bergmann, L. Whole-body 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) for accurate staging of Hodgkin\u0026rsquo;s disease. Annals of oncology, 1998;9(10):1117-1122. https://doi.org/10.1023/A:1008486928190 \u003c/li\u003e\n\u003cli\u003eBarrington, S. F., Kirkwood, A. A., Franceschetto, A., Fulham, M. J., Roberts, T. H., Almquist, H., ... \u0026amp; Johnson, P. W. PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study. Blood, The Journal of the American Society of Hematology. 2016;127(12):1531-1538. https://doi.org/10.1182/blood-2015-11-679407 \u003c/li\u003e\n\u003cli\u003eRaanani, P., Shasha, Y., Perry, C., Metser, U., Naparstek, E., Apter, S., ... \u0026amp; Even-Sapir, E. Is CT scan still necessary for staging in Hodgkin and non-Hodgkin lymphoma patients in the PET/CT era?. Annals of Oncology. 2006;17(1):117-122. https://doi.org/10.1093/annonc/mdj024 \u003c/li\u003e\n\u003cli\u003eBerriolo-Riedinger, A., Becker, S., Casasnovas, O., Vander Borght, T., \u0026amp; \u0026Eacute;deline, V. Role of FDG PET-CT in the treatment management of Hodgkin lymphoma. Cancer/Radioth\u0026eacute;rapie. 2018;22(5):393-400. https://doi.org/10.1016/j.canrad.2018.06.001 \u003c/li\u003e\n\u003cli\u003eMoulin-Romsee, G., Hindi\u0026eacute;, E., Cuenca, X., Brice, P., Decaudin, D., B\u0026eacute;namor, M., ... \u0026amp; Moretti, J. L. 18 F-FDG PET/CT bone/bone marrow findings in Hodgkin\u0026rsquo;s lymphoma may circumvent the use of bone marrow trephine biopsy at diagnosis staging. European journal of nuclear medicine and molecular imaging. 2010;37:1095-1105. https://doi.org/10.1007/s00259-009-1377-5 \u003c/li\u003e\n\u003cli\u003eEl-Galaly, T. C., d\u0026apos;Amore, F., Mylam, K. J., de Nully Brown, P., B\u0026oslash;gsted, M., Bukh, A., ... \u0026amp; Hutchings, M. Routine bone marrow biopsy has little or no therapeutic consequence for positron emission tomography/computed tomography\u0026ndash;staged treatment-naive patients with Hodgkin lymphoma. Journal of clinical oncology. 2012;30(36):4508-4514. https://10.1200/JCO.2012.42.4036 \u003c/li\u003e\n\u003cli\u003eRigacci L, Vitolo U, Nassi L, et al. Positron emission tomography in the staging of patients with Hodgkin\u0026apos;s lymphoma. A prospective multicentric study by the Intergruppo Italiano Linfomi. Ann Hematol. 2007;86(12):897-903. https://doi:10.1007/s00277-007-0356-9 \u003c/li\u003e\n\u003cli\u003eManas Kalra, Sameer Bakhshi, M. Singh, et al. Response Assessment by PET CT as compared to CECT in childhood Hodgkin Lymphoma can reduce the need for radiotherapy in low and middle income countries. Authorea. 2022 https://doi.org/10.22541/au.166004872.21036087/v1 \u003c/li\u003e\n\u003cli\u003eAl-Ibraheem A, Anwer F, Juweid ME, Shagera QA, Khalaf AN, Obeidat S, Mansour A, Ma\u0026apos;koseh M, Halahleh K, Jaradat I, Almasri N, Mansour A. Interim FDG-PET/CT for therapy monitoring and prognostication in Hodgkin\u0026apos;s Lymphoma. Sci Rep. 2022;12(1):17702. https://10.1038/s41598-022-22032-3. \u003c/li\u003e\n\u003cli\u003eRodr\u0026iacute;guez Taroco MG, Cu\u0026ntilde;a EG, Pages C, Schelotto M, Gonz\u0026aacute;lez-Sprinberg GA, Castillo LA, Alonso O. Prognostic value of imaging markers from 18FDG-PET/CT in paediatric patients with Hodgkin lymphoma. Nucl Med Commun. 2021;1;42(3):306-314. https://10.1097/MNM.0000000000001337\u003c/li\u003e\n\u003cli\u003eWan, H., Liu, P., Liang, Y., Jiang, S. Y., Lyu, L., Zhang, Z. W., Wu, N., \u0026amp; Liu, Y. Zhonghua zhong liu za zhi [Chinese journal of oncology]. 2021;43(12):1275\u0026ndash;1281. https://doi.org/10.3760/cma.j.cn112152-20191212-00799 \u003c/li\u003e\n\u003cli\u003eOrtega C, Eshet Y, Prica A, et al. Combination of FDG PET/CT Radiomics and Clinical Parameters for Outcome Prediction in Patients with Hodgkin\u0026apos;s Lymphoma. Cancers (Basel). 2023;30;15(7):2056. https://10.3390/cancers15072056. \u003c/li\u003e\n\u003cli\u003eKamal NM, Elsaban K. Role of 18f-fdg-pet/ct in assessment of pediatric Hodgkin\u0026apos;s lymphoma. Q J Nucl Med Mol Imaging. 2021;65(4):376-385. https://10.23736/S1824-4785.16.02695-9. \u003c/li\u003e\n\u003cli\u003eCasasnovas RO, Bouabdallah R, Brice P et al. M. PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study. Lancet Oncol. 2019;20(2):202-215. https://10.1016/S1470-2045(18)30784-8. \u003c/li\u003e\n\u003cli\u003eKandeel AA, Hussein M, Zidan L, Younis J, Edesa W, Alsayed Y. Diagnostic performance of 18F-2-fluoro-2-deoxy-D-glucose PET/computerized tomography in identifying bone marrow infiltration in new patients with diffuse large B-cell lymphoma and Hodgkin lymphoma. Nucl Med Commun. 2020;41(3):269-279. https://10.1097/MNM.0000000000001139 \u003c/li\u003e\n\u003cli\u003eYağci-K\u0026uuml;peli B, Ko\u0026ccedil;yiğit-Deveci E, Adamhasan F, K\u0026uuml;peli S. The Value of 18F-FDG PET/CT in Detecting Bone Marrow Involvement in Childhood Cancers. J Pediatr Hematol Oncol. 2019;41(6):438-441. https://10.1097/MPH.0000000000001499. \u003c/li\u003e\n\u003cli\u003eBiggi A, Gallamini A, Chauvie S, Hutchings M, Kostakoglu L, Gregianin M, et al. International validation study for interim PET in ABVD-treated, advanced-stage hodgkin lymphoma: Interpretation criteria and concordance rate among reviewers. J. Nucl. Med. 2013;54(5):683\u0026ndash;690. https://10.2967/jnumed.112.110890. \u003c/li\u003e\n\u003cli\u003eLue K.-H., Wu Y.-F., Liu S.-H., Hsieh T.-C., Chuang K.-S., Lin H.-H., Chen Y.-H. Prognostic Value of Pretreatment Radiomic Features of 18F-FDG PET in Patients With Hodgkin Lymphoma. Clin. Nucl. Med. 2019;44:559\u0026ndash;565. https://10.1097/RLU.0000000000002732. \u003c/li\u003e\n\u003cli\u003eZhou Y., Zhu Y., Chen Z., Li J., Sang S., Deng S. Radiomic Features of 18F-FDG PET in Hodgkin Lymphoma Are Predictive of Outcomes. Contrast Media Mol. Imaging. 2021;2021:6347404. https://10.1155/2021/6347404. \u003c/li\u003e\n\u003cli\u003eDriessen J., Zwezerijnen G.J.C., Sch\u0026ouml;der H et al. Predictive Value Of Quantitative 18 F-Fdg-Pet-Ct Radiomics Analysis in 174 Patients with Relapsed/Refractory Classical Hodgkin Lymphoma. Hematol. Oncol. 2021;39. https://10.1002/hon.21_2879. \u003c/li\u003e\n\u003cli\u003eJohnson P, Federico M, Kirkwood A, Foss\u0026aring; A, Berkahn L, Carella A, et al. Adapted treatment guided by interim PET-CT scan in advanced Hodgkin\u0026apos;s Lymphoma. N. Engl. J. Med. 2016;374(25):2419\u0026ndash;2429. https://10.1056/NEJMoa1510093. \u003c/li\u003e\n\u003cli\u003eHoppe RT, Advani RH, Ai WZ, Ambinder RF, Armand P, Bello CM, et al. Hodgkin Lymphoma, Version 2.2020, NCCN clinical practice guidelines in oncology. J. Natl. Compr. Canc. Netw. 2020;18(6):755\u0026ndash;781. https://10.6004/jnccn.2020.0026.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University Hospitals of Leicester NHS Trust","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"PET-CT imaging, treatment response, survival analysis, overall survival, Hodgkin lymphoma","lastPublishedDoi":"10.21203/rs.3.rs-3837903/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3837903/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThe purpose of this research is to assess how PET-CT compares to other imaging modalities in terms of predicting the prognosis of Hodgkin's Lymphoma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Sources: \u003c/strong\u003eWe screened for papers published in English between 2019 and 2023 in the MEDLINE, PubMed, \u0026nbsp;Embase databases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Design: \u003c/strong\u003eTo enhance clinical decision-making, we discovered studies comparing the imaging modalities\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection and Extraction Methods: \u003c/strong\u003eWe designed and verified organized search queries. To improve the inclusion and exclusion criteria, abstracts were evaluated iteratively. The included studies' bibliographies were manually searched as an addition to the search. To find the clinical trial protocol and published clinical trial findings, the search comprised a forward citation search of papers nested inside a clinical trial.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrincipal Findings: \u003c/strong\u003eThis study consists of four retrospective studies, one multicentric prospective study, one observational study, two prospective studies, and one randomized control trial. A total of nine studies were included with a sample size of 2143. PET - CT has been shown to have a predictive value for prognosis and for markers of metastasis compared to other imaging modalities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eWhile PET-CT has shown to be the most predominant imaging modality for diagnosing and predicting the prognosis of Hodgkins Lymphoma, further more specific trials may be required in comparison to Bone marrow biopsy and the benefits it provides over PET- CT.\u003c/p\u003e","manuscriptTitle":"A Systematic Review of the Role of PET-CT Imaging in the Assessment of Treatment Response and its Predictive Value for Survival Outcomes in Adult patients with Newly Diagnosed Hodgkin Lymphoma: A Comparison with Conventional Imaging Techniques","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-08 19:34:30","doi":"10.21203/rs.3.rs-3837903/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c4d1ab90-dd13-4bc6-a87f-aba0587b63ea","owner":[],"postedDate":"January 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":27983067,"name":"Oncology"},{"id":27983068,"name":"Nuclear Medicine \u0026 Medical Imaging"}],"tags":[],"updatedAt":"2024-01-08T19:34:30+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-08 19:34:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3837903","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3837903","identity":"rs-3837903","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}