Impact of ¹⁸F-FDG PET-CT in baseline staging of Hodgkin's lymphoma: An Indian scenario

Lymphomas can affect any organ in the body and present a wide range of symptoms. They are traditionally divided into Hodgkin's lymphoma and Non-Hodgkin lymphoma. Most patients with Hodgkin's lymphoma(HL) present with constitutional symptoms and supra-diaphragmatic lymphadenopathy. Hodgkin's lymphoma who underwent ¹⁸F-FDG PET-CT for staging from January 2021 to Dec 2022. Standard preparations for ¹⁸F-FDG PET-CT were performed, and image acquisition was made using a Siemens Biograph PET-CT scanner. Based on PET-CT findings, the staging category was done as per the Cotswolds-modifies Ann Arbor classification. Based on ¹⁸F-FDG PET-CT findings, stages I and II were seen in 14.6 % and 8.2 % of patients. Stage III and IV were seen in 40.3% and 36.6%, respectively. Splenic involvement was seen in 54.5% of patients with stage III. Marrow involvement was seen in 42.5 % of patients with Stage IV disease. Management based on regional computed tomography may underestimate staging in many patients. It could result in under treatment and poor prognostication. In the Indian scenario, splenic and bone marrow involvement is not uncommon and could be missed in anatomical imaging modalities. Especially in India, where PET-CT costs Rs. 8000- 25000. Whole-body PET CT could be more cost-effective than multiple CT scans ( Rs. 3000-4000 each) and bone marrow evaluation (Rs. 4000-8000). ¹⁸F-FDG PET-CT imaging upfront during baseline staging accurately stages the patients