Predicting response to initial chemotherapy in pediatric lymphoma using a semiquantitative contrast enhanced CT (CECT)-based abdomino-thoracic score: a pilot prospective observational study.
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Abstract
Background: There is a lack of staging systems in pediatric lymphoma to quantify the burden of the disease based on the anatomical extent of lymph nodal distribution.
Purpose: To evaluate the utility of a CECT-based semiquantitative lymph nodal scoring system in predicting histopathological type of childhood lymphoma and response to initial chemotherapy.
Materials and methods: Pre-treatment CECT of abdomen and thorax was performed in children with lymphoma and a Checklist-based reporting template was used to report the lymph nodal involvement. Based on the distribution of lymph nodes, a semi-quantitative scoring system was developed to cover all the locations of thorax and abdomen. Anatomical semiquantitative scoring was done for thorax (score 0-10), abdomen (scores 0-10), and a combined thoraco-abdominal score (0-20) was calculated. Also, the mean scores were compared in patients with complete response(CR) and Non-complete response(NCR) to primary treatment. Decrease in size of all the pathological nodes to < 10 mm in short axis and < 15 mm in long axis was defined as CR.
Results: Fifty patients were included with 35 cases of Hodgkin Lymphoma(HL) and 15 cases of Non-Hodgkin Lymphoma(NHL). Mean abdominal, thoracic, and combined lymph nodal scores were significantly lower in the pre-treatment scan in children with HL (3.5 ± 2.3, 3.3 ± 1.75,and6.89 ± 3.54) compared to NHL (4.8 ± 2.1,5.2 ± 2.8,and10.0 ± 3.96). The mean abdominal, thoracic, and combined lymph nodal scores in the pre-treatment scan was significantly higher in NCR group.
Conclusion: The lymph nodal burden, estimated by semiquantitative abdominal and thoracic scores is significantly higher in lymphoma patients with non-complete response.
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Abdominal Radiology seeks to meet the professional needs of the abdominal radiologist by publishing clinically pertinent original, review and practice related articles on the gastrointestinal and genitourinary tracts and abdominal interventional and radiologic procedures. Case reports are generally not accepted unless they are the first report of a new disease or condition, or part of a special solicited section.
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