Purpose: To determine the diagnostic capability of thallium-201 ((TI)-T-201) single-photon emission computed tomography (SPECT) combined with Epstein-Barr virus DNA (EBV-DNA) in CSF for the diagnosis of AIDS-related primary CNS lymphoma (PCNSL). Patients and Methods: All human immunodeficiency virus (HIV)-infected patients with focal brain lesions observed between June 1996 and March 1998 underwent lumbar puncture and (TI)-T-201 SPECT. Each CSF sample was tested with polymerase chain reaction (PCR) for EBV-DNA. Results: Thirty-one patients were included, 13 with PCNSL and 18 with nontumor disorders. In 11 PCNSL patients, EBV-DNA was positive. Thallium-201 uptake ranged from 1.90 to 4.07 in PCNSL eases (mean, 2.77; 95% confidence interval [CI], 2.35 to 3.19) and from 0.91 ta 3.38 in nontumor patients (mean, 1.62; 95% CI, 1.30 to 1.94) (P <.0002). Using a lesion/background ratio of 1.95 as cutoff, a negative SPECT was found in one PCNSL case and 16 nonneaplastic cases. A cryprocaccoma and a tuberculoma showed highly increased (TI)-T-201 uptake. Epstein-Barr virus DNA was never detected in nonneaplastic patients. For PCNSL diagnosis, hyperactive lesions showed 92% sensitivity and 94% negative predictive value (NPV), whereas positive EBV-DNA had 100% specificity and 100% positive predictive value. The presence of increased uptake and/or positive EBV-DNA had 100% sensitivity and 100% NPV. Conclusion: Combined SPECT and EBV-DNA showed a very high diagnostic accuracy for AIDS-related PCNSL. Because PCNSL likelihood is extremely high in patients with hyperactive lesions and positive EBV-DNA, brain biopsy could be avoided, and patients could promptly undergo radiotherapy or multimodal therapy. On the contrary, in patients showing hypoactive lesions with negative EBV-DNA, empiric anti-Toxoplasma therapy is indicated. In patients with discordant SPECT/PCR results, brain biopsy seems to be advisable, (C) 1999 by American Society of Clinical Oncology.
Antinori, A., De Rossi, G., Ammassari, A., Cingolani, A., Murri, R., Di Giuda, D., et al. (1999). Value of combined approach with thallium-201 single-photon emission computed tomography and Epstein-Barr virus DNA polymerase chain reaction in CSF for the diagnosis of AIDS-Related primary CNS lymphoma RID G-8810-2011 RID A-1577-2008. JOURNAL OF CLINICAL ONCOLOGY, 17(2), 554-560.
Value of combined approach with thallium-201 single-photon emission computed tomography and Epstein-Barr virus DNA polymerase chain reaction in CSF for the diagnosis of AIDS-Related primary CNS lymphoma RID G-8810-2011 RID A-1577-2008
DE LUCA, ANDREA;
1999-01-01
Abstract
Purpose: To determine the diagnostic capability of thallium-201 ((TI)-T-201) single-photon emission computed tomography (SPECT) combined with Epstein-Barr virus DNA (EBV-DNA) in CSF for the diagnosis of AIDS-related primary CNS lymphoma (PCNSL). Patients and Methods: All human immunodeficiency virus (HIV)-infected patients with focal brain lesions observed between June 1996 and March 1998 underwent lumbar puncture and (TI)-T-201 SPECT. Each CSF sample was tested with polymerase chain reaction (PCR) for EBV-DNA. Results: Thirty-one patients were included, 13 with PCNSL and 18 with nontumor disorders. In 11 PCNSL patients, EBV-DNA was positive. Thallium-201 uptake ranged from 1.90 to 4.07 in PCNSL eases (mean, 2.77; 95% confidence interval [CI], 2.35 to 3.19) and from 0.91 ta 3.38 in nontumor patients (mean, 1.62; 95% CI, 1.30 to 1.94) (P <.0002). Using a lesion/background ratio of 1.95 as cutoff, a negative SPECT was found in one PCNSL case and 16 nonneaplastic cases. A cryprocaccoma and a tuberculoma showed highly increased (TI)-T-201 uptake. Epstein-Barr virus DNA was never detected in nonneaplastic patients. For PCNSL diagnosis, hyperactive lesions showed 92% sensitivity and 94% negative predictive value (NPV), whereas positive EBV-DNA had 100% specificity and 100% positive predictive value. The presence of increased uptake and/or positive EBV-DNA had 100% sensitivity and 100% NPV. Conclusion: Combined SPECT and EBV-DNA showed a very high diagnostic accuracy for AIDS-related PCNSL. Because PCNSL likelihood is extremely high in patients with hyperactive lesions and positive EBV-DNA, brain biopsy could be avoided, and patients could promptly undergo radiotherapy or multimodal therapy. On the contrary, in patients showing hypoactive lesions with negative EBV-DNA, empiric anti-Toxoplasma therapy is indicated. In patients with discordant SPECT/PCR results, brain biopsy seems to be advisable, (C) 1999 by American Society of Clinical Oncology.
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https://hdl.handle.net/11365/1011691
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