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Dissemination patterns of Hodgkin lymphoma using a probability network model based on [18F]-FDG PET/CT

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Abstract

Purpose

The preferred hypothesis for the dissemination patterns of Hodgkin lymphoma (HL) is the contiguity hypothesis. However, this hypothesis is based on studies performed before the advent of [18F]-FDG PET/CT which is now the established reference for HL staging. This study aims to extract the dissemination patterns of HL using [18F]-FDG PET/CT and a probability network model.

Methods

We retrospectively analyzed [18F]-FDG PET/CT performed for initial staging of patients with classical HL. The HL involvement status (presence of absence) was reported for 19 supra- and infra-diaphragmatic lymph node regions and 4 extranodal regions (lung, spleen, liver, and osteo- medullary). The analysis of HL dissemination was carried out using HL involvement status for all regions through 3 distinct methods: comparison of nearby lymph node regions, correlation assessment between all regions and relationship strength between all regions using Ising network model.

Results

A total of 196 patients were included. Our results showed strong relationships between nearby involved lymph node regions (for example between the left pelvic and the abdominal lymph node regions (relationship strength = 0.980)) and between more distant regions (for example between right and left axillary lymph node regions (strength = 0.714)). Furthermore, involvement of the infra-diaphragmatic lymph node regions was significantly correlated with Ann Arbor stage IV (phi = 0.56, p < 0.001).

Conclusion

This study confirms the hypothesis of lymphatic dissemination of HL in a contiguous mode, with additional links between more distant regions. These predictable dissemination patterns could be useful for the initial staging assessment of patients with HL using [18F]-FDG PET/CT.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, Rennes, France

    Mehdi Mouheb, Anne Devillers, Florence Le Jeune & Xavier Palard-Novello

  2. Univ Rennes, CHU de Rennes, INSERM, LTSI - UMR 1099, Rennes, France

    Morgane Pierre-Jean

  3. CLCC Gustave Roussy, Villejuif, France

    Christophe Fermé

  4. Univ Rennes, CHU de Rennes, INSERM, BIGRES - UMR 1236, Rennes, France

    Thierry Lamy & Roch Houot

Authors
  1. Mehdi Mouheb
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  2. Morgane Pierre-Jean
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  3. Christophe Fermé
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  4. Anne Devillers
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  8. Xavier Palard-Novello
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Contributions

RH and XPN contributed to the study conception and design. Data collection were performed by MM and XPN. MPJ performed statistical analysis. The first draft of the manuscript was written by MM. All authors were involved in review of the manuscript and approved the final manuscript.

Corresponding author

Correspondence to Xavier Palard-Novello.

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Ethics approval

This study was approved by the local institutional review board of the University Hospital of Rennes (IRB-No. 21/94) and performed in accordance with the Declaration of Helsinki. Written, informed consent was waived for this retrospective analysis.

Competing interests

The authors declare no competing interests.

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Mouheb, M., Pierre-Jean, M., Fermé, C. et al. Dissemination patterns of Hodgkin lymphoma using a probability network model based on [18F]-FDG PET/CT. Eur J Nucl Med Mol Imaging 50, 1414–1422 (2023). https://doi.org/10.1007/s00259-022-06086-z

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