Interobserver Agreement of Interim and End-of-Treatment 18 F-FDG PET/CT in Diffuse Large B-Cell Lymphoma: Impact on Clinical Practice and Trials

J Nucl Med. 2018 Dec;59(12):1831-1836. doi: 10.2967/jnumed.118.210807. Epub 2018 May 4.


We aimed to assess the interobserver agreement of interim PET (I-PET) and end-of-treatment PET (EoT-PET) using the Deauville score (DS) in first-line diffuse large B-cell lymphoma (DLBCL) patients. Methods: I-PET and EoT-PET scans of DLBCL patients were performed in the HOVON84 study (2007-2012), an international multicenter randomized controlled trial. Patients received R-CHOP14 and were randomized to receive rituximab intensification in the first 4 cycles or not. I-PET was performed after 4 cycles (for observational purposes), and EoT-PET after 6 or 8 cycles. Two independent central reviewers retrospectively scored all scans according to the DS system, masked to clinical outcomes. Results were dichotomized as negative (DS of 1-3) or positive (DS of 4-5). Besides percentage overall agreement (OA), we calculated agreement for positive and negative scores, expressed as positive agreement (PA) and negative agreement (NA), respectively. Results: 465 I-PET and 457 EoT-PET scans were centrally reviewed; baseline 18F-FDG PET or PET/CT was available in 75%-77%, and CT in the remaining cases. Percentage OA for I-PET and EoT-PET were 87.7% and 91.7% (P = 0.049), with NA of 92.0% and 95.0% (P = 0.091), and PA of 73.7% and 76.3% (P = 0.656), respectively. Conclusion: Interobserver agreement using DS in DLBCL patients in I-PET and EoT-PET yields high OA and NA. The lower PA suggests that EoT-PET/CT treatment evaluation in daily practice and I-PET-adapted trials may benefit from dual reads and central review, respectively.

Keywords: DLBCL; Deauville score; Lugano criteria; observer variation; positron emission tomography.

Publication types

  • Clinical Trial, Phase III
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Monoclonal, Murine-Derived / administration & dosage
  • Antineoplastic Agents, Immunological / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Cyclophosphamide / administration & dosage
  • Doxorubicin / administration & dosage
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Lymphoma, Large B-Cell, Diffuse / diagnostic imaging*
  • Lymphoma, Large B-Cell, Diffuse / drug therapy
  • Male
  • Middle Aged
  • Observer Variation
  • Positron Emission Tomography Computed Tomography / methods*
  • Prednisone / administration & dosage
  • Radiopharmaceuticals
  • Retrospective Studies
  • Rituximab / administration & dosage
  • Vincristine / administration & dosage
  • Young Adult


  • Antibodies, Monoclonal, Murine-Derived
  • Antineoplastic Agents, Immunological
  • R-CHOP protocol
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18
  • Rituximab
  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Prednisone