Persistent mediastinal FDG uptake on PET-CT after frontline therapy for Hodgkin lymphoma: biopsy, treat or observe?

Mattia Novo, Grzegorz S. Nowakowski, Thomas M. Habermann, Thomas E. Witzig, Ivana N. Micallef, Patrick B. Johnston, David J. Inwards, Barbara Botto, Kay M. Ristow, Jason R. Young, Umberto Vitolo, Stephen M. Ansell

Research output: Contribution to journalArticle


Residual mediastinal FDG-uptake after frontline therapy for classical Hodgkin lymphoma (cHL) may constitute persistent disease or inflammatory changes. We analyzed practice patterns at two institutions to determine how often a mediastinal biopsy influenced patient management and outcome. Forty-two cases were eligible for review, mostly treated with ABVD. Twenty (group1) underwent a mediastinal biopsy and 22 did not (group2). In group1, 10/20 were positive for cHL and proceeded to salvage therapy (ST); 4/10 biopsy-negative patients were observed, and 6/10 received consolidative radiotherapy. Ten of 22 patients from group 2 were observed, 12/22 received ST. Ten of 14 observed patients remained PET-positive and 8/8 biopsies in these patients showed cHL. Deauville score (DS) 5 was associated with a positive biopsy (10/16). No overall survival difference between groups was observed. We conclude that observation and repeat a FDG-PET is reasonable for DS3-4 while for DS5, ST should be considered pending biopsy confirmation when feasible.

Original languageEnglish (US)
JournalLeukemia and Lymphoma
StateAccepted/In press - Jan 1 2019



  • ABVD
  • Deauville score
  • Hodgkin lymphoma

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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