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Abstract The aim of this study was to compare between the accuracy of the visual (Deauville criteria) and SUVmax also to correlate SUVmax with patients, disease features and outcome including response, PFS and OS. This prospective study was conducted on seventy-three patients with biopsy-proven lymphoma (including both HL and NHL). Those patients were either presented to oncology department at Menoufia University or the health insurance clinic at Menoufia governorate in the period between October 2019 and April 2020. And patients were followed up for at least 2 years. An informed consent was obtained before patients entered the study and from all patients who underwent biopsy. Inclusion criteria: were patients with untreated histologically proven high-grade lymphoma (DLBCL) or HD. A baseline PET scan (PET0) was mandatory with 1 or more evaluable hyper metabolic lesions. All patients were eligible for high-dose therapy with or without autologous stem cell Exclusion criteria: any patient with atopic disorders, bad general conditions, or renal impairment. Those without baseline PET/CT scans were excluded from the study. Patient evaluation was done through: Performance status (PS) was assessed, the international prognostic index was calculated for patients with DLBCs, and risk stratification was also calculated for patients with HD using the German Hod Lymphoma Study Group. Patients were staged using the Ann Arbor system. Patients with DLBCL received the planned treatment regimen rituximab in combination with cyclophosphamide, vincristine, doxorubicin, Summary 98 and hostacortine (R-CHOP). Those with HD received the ABVD regimen, which included doxorubicin, bleomycin, vinblastine, and dacarbazine. Patients were followed up for 24 months from the time of diagnosis and underwent clinical examination every cycle for signs of treatment toxicity and clinical response. Baseline PET/CT scanning was performed using FDG-PET at baseline (PET 0) before initiation of therapy and 21 days after cycle 2 (PET2) and cycle 4 (PET4). G-CSF was stopped 48 hours before PET, as bone marrow uptake (post-G-CSF) can lead to an apparent decrease in tumor SUVs. Statistical analysis of the presenting data revealed: Significant differences in age, PS and extranodal site involvement were observed between the studied groups. Stage 4 represented the main stage in the studied cases. The histological subtype of the studied cases diagnosed as NHL was DLBCL and the classic subtype was the main type (86.7%) in patients diagnosed as HD. Nodular lymphocytic predominant represented only 13.3% in patients with HD. Significant differences in the results of biopsy between the studied groups. There were 22 patients who underwent biopsy. Fifteen cases (34.9%) were diagnosed as NHL while 7 patients (23.3%) diagnosed as HD. There was one patient who was truly positive and 14 patients who were false positive. Out of the seven patients diagnosed as HD; four of them were truly positive and three patients were false positive. Significant differences in response to treatment were observed between the studied groups. R-CHOP was the first line of treatment for patients diagnosed as DLBCL NHL. While ABVD protocol was the first line of Summary 99 treatment for patients diagnosed as HD. Only 4 patients with nodular lymphocytic predominant subtypes were treated with R-CHOP. A total of 62 people (84.9%) reached CR after 2 6 cycles of treatment, while 11 people (15.1 %) were refractory. After four cycles, 22 patients required a biopsy due to inconclusive biopsy revealed that PET0- predictive value, and accuracy (95.45% vs. 54.55%) compared to visual analysis. In comparison to Deauville 5 PS, Delta SUV max 0 2 had sensitivity of 50% and specificity of 95. 56. In comparison to Deauville 5 PS, Delta SUV max 0 4,had sensitivity of 47.62% and specificity 100% . and patient response to treatment. Significant relationship was found between the mean SUV uptake value For negative scans were compared to those with positive results. There was significant difference in LDH level, bulky disease, HD stage, B2 microglobulin and biopsy results between the two groups. This comparison also confirmed the discordance between the results of 5PS -value = 0.003). 80% of positive were positive with biopsy. 94% of were also negative with biopsy. A significant relationship was observed between the two groups Summary 100 refractory disease (p-value < 0.0001 ) After 2 cycles, positive Deauville value ( <0.00). The same was after 4 cycles. The mean overall survival (OS) was 23.1 months. The median OS did not reached due to short follow-up time and the small numbers of deaths as 88.1% of patients were alive at the end of the study. Median PFS was 16.6 months .At the end of the study only 1.7% did not develop progression. There was no significant difference between Patients with positive PET scans according to Delta SUV max and those with negative scans regarding overall survival and progression free survival. Univariate COX regression analysis for the parameters affecting overall survival was non-significant. Univariate COX regression analysis for the parameters affecting progression free survival was non-significant except for type of lymphoma (NHL) and extra nodal disease. |