Benefits from Surveillance Imaging in Hodgkin Lymphoma

Clinical Expert Commentaries published on March 5, 2014
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James O. Armitage, MD
Professor, Internal Medicine
Division of Hematology & Oncology
University of Nebraska Medical Center
Omaha, Nebraska
Benefits from Surveillance Imaging in Hodgkin Lymphoma
Surveillance imaging is something that interestingly has been done throughout the world in different ways. In the United States, most patients for almost every kind of cancer, if they achieve a remission or apparently free of disease, they have gotten surveillance images at varying intervals using actually different things, usually CT scans or more recently PET scans, and in Europe, some countries have done the same and some countries have just not routinely done surveillance imaging. We have written about, our team has, and there are just a couple of papers recently presented at ASCO showing that it is very unlikely that in most patients with lymphoma, surveillance imaging could possibly improve survival. The mathematics make it so it just could not hardly work; that is, in a situation where most patients are cured, of the people that go into remission, more than half are cured and surveillance images have a certain proportion of times where they will be incorrect; that is the positive predictive value is not as high as you would like. The other factor is that most patients that relapse are relapsed in between times they are seen. The disease apparently, in aggressive lymphoma, comes back fairly quickly and patients from one visit to the next relapse in between, and one of the studies that was recently done suggests that if you even take people who are found to be relapsed by surveillance image and you talk to them, most of those people had symptoms that would have led to the diagnosis at any rate. So, my personal opinion is surveillance images have no routine place in the care of patients who have achieved a complete remission from lymphoma.
Last modified: March 3, 2014
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