Zinzani Pier Luigi, Tani Monica, Trisolini Rocco, Fanti Stefano, Stefoni Vittorio, Alifano Marco, Castellucci Paolo, Musuraca Gerardo, Dalpiaz Giorgia, Alinari Lapo, Marchi Enrica, Fina Mariapaola, Pellegrini Cinzia, Farsad Mohsen, Cancellieri Alessandra, Busca Annalisa, Canini Romeo, Pileri Stefano, Baccarani Michele, Boaron Maurizio
Institute of Hematology and Oncology L. and A. Seràgnoli, University of Bologna, Bologna, Italy.
Haematologica. 2007 Jun;92(6):771-7. doi: 10.3324/haematol.10798.
Follow-ups of patients with mediastinal lymphoma are not accurate if they rely on computed tomography (CT). Positron emission tomography (PET) has been suggested to be useful in several lymphoma settings, such as initial staging, evaluation of residual masses after therapy, and assessment of response early in the course of treatment. The aim of this retrospective study was to verify the reliability of positive PET scans of the mediastinum in following up patients with mediastinal lymphoma, using histological findings as a comparison.
From January 2002 to July 2005, 151 patients with mediastinal lymphoma (57 with Hodgkin's disease [HD] and 94 with aggressive non-Hodgkin's lymphoma [NHL]) were followed-up after the end of front-line treatment. Patients with a positive PET scan of the mediastinum underwent CT scanning and surgical biopsy.
In 30 (21 HD and 9 NHL) out of 151 patients (20%) a suspicion of lymphoma relapse was raised based on positive mediastinal PET scanning. Histology confirmed this suspicion in 17 (10 HD and 7 NHL) out of 30 patients (57%), whereas either benign (9 fibrosis, 3 sarcoid-like granulomatosis) or unrelated neoplastic conditions (1 thymoma) were demonstrated in the remaining 13 patients (43%). SUVmax was significantly higher among patients who had signs of relapse (17 true positive cases) than among those who stayed in remission (13 false positive cases), the median values being 5.95 (range, 3.5-26.9) and 2.90 (range, 1.4-3.3), respectively (p=0.01).
We suggest that a positive PET scan of the mediastinum of a patient being followed-up for a mediastinal lymphoma should not be considered sufficient for diagnostic purposes in view of its lack of discrimination. Histological confirmation can safely be carried out with various biopsy techniques, the choice of which should be made on the basis of the findings of the clinical and imaging studies of the individual case.
如果纵隔淋巴瘤患者的随访仅依赖计算机断层扫描（CT），则不够准确。正电子发射断层扫描（PET）已被证明在多种淋巴瘤情况下有用，如初始分期、治疗后残留肿块的评估以及治疗早期反应的评估。这项回顾性研究的目的是，以组织学结果作为对照，验证纵隔PET扫描阳性在纵隔淋巴瘤患者随访中的可靠性。
2002年1月至2005年7月，151例纵隔淋巴瘤患者（57例霍奇金病[HD]和94例侵袭性非霍奇金淋巴瘤[NHL]）在一线治疗结束后接受随访。纵隔PET扫描阳性的患者接受CT扫描和手术活检。
151例患者中有30例（20%）（21例HD和9例NHL）基于纵隔PET扫描阳性怀疑淋巴瘤复发。组织学证实30例患者中有17例（57%）（10例HD和7例NHL）存在复发，其余13例患者（43%）显示为良性（9例纤维化、3例类肉瘤样肉芽肿病）或无关的肿瘤性疾病（1例胸腺瘤）。复发患者（17例真阳性病例）的SUVmax显著高于缓解患者（13例假阳性病例），中位数分别为5.95（范围3.5 - 26.9）和2.90（范围1.4 - 3.3）（p = 0.01）。
鉴于纵隔PET扫描缺乏鉴别能力，我们建议对于接受纵隔淋巴瘤随访的患者，纵隔PET扫描阳性不能作为充分的诊断依据。可以通过各种活检技术安全地进行组织学确认，具体选择应根据个体病例的临床和影像学研究结果来决定。
