Ngeow J Y Y, Quek R H H, Ng D C E, Hee S W, Tao M, Lim L C, Tan Y H, Lim S T
Department of Medical Oncology, National Cancer Centre.
Department of Nuclear Medicine, Singapore General Hospital.
Ann Oncol. 2009 Sep;20(9):1543-1547. doi: 10.1093/annonc/mdp030. Epub 2009 May 27.
Data assessing the role of positron emission tomography (PET)/computed tomography (CT) imaging in lymphoma staging is still being accumulated and current staging is based primarily on CT. This study aims to compare the value of PET/CT over conventional CT and bone marrow biopsy (BMB) in the initial evaluation of patients with lymphoma.
Data on 122 patients with PET/CT scans as part of their initial staging were prospectively collected and reviewed. All patients had complete staging, including BMB.
Among the 122 patients, 101 had non-Hodgkin's lymphoma (NHL) and 21 had Hodgkin's lymphoma (HL). Compared with conventional CT, PET/CT upstaged 21 (17%) cases [B-cell non-Hodgkin's lymphoma (B-NHL), 12; T-cell non-Hodgkin's lymphoma (T-NHL), 3; HL, 6]. Of significance, in 13 patients with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG)-avid splenic lesions, four had normal CT findings. A maximum FDG uptake of >10 standardized uptake value (SUV) seems to significantly correlate with an aggressive B-cell lineage (odds ratio 2.47, 95% confidence interval 2.23-2.70). Overall, PET scan was concordant with BMB results in 108 (89%) and discordant in 14 (11%) cases. In HL, our data show that PET scan and marrow results agreed in 19 of the cases (90%), being concordantly negative in 18 cases and concordantly positive in one, giving a negative predictive value (NPV) of 100%, sensitivity of 100% and specificity of 90%. Of note, all 13 with early-stage HL had negative PET/CT scan and BMB. In NHL, all 17 cases of T-NHL had concordant PET and BMB results. In patients with aggressive B-NHL, BMB and PET/CT agreed in 58 patients (92%) and disagreed in five (8%), while the corresponding rates in indolent B-cell lymphoma were 14 (67%) and seven patients (33%), respectively. All seven were falsely negative.
PET/CT upstages 17% of cases and detects occult splenic involvement. This may have potential therapeutic and prognostic implications. SUV >10 may predict for an aggressive histology. Except for indolent B-NHL, our data show that PET scans have a good overall NPV in excluding lymphomatous bone marrow involvement. This is particularly true of early-stage HL, suggesting that BMB may be safely omitted in this group.
评估正电子发射断层扫描（PET）/计算机断层扫描（CT）成像在淋巴瘤分期中作用的数据仍在积累，目前的分期主要基于CT。本研究旨在比较PET/CT与传统CT及骨髓活检（BMB）在淋巴瘤患者初始评估中的价值。
前瞻性收集并回顾了122例进行PET/CT扫描作为初始分期一部分的患者的数据。所有患者均进行了完整分期，包括BMB。
122例患者中，101例患有非霍奇金淋巴瘤（NHL），21例患有霍奇金淋巴瘤（HL）。与传统CT相比，PET/CT使21例（17%）病例分期上调[B细胞非霍奇金淋巴瘤（B-NHL），12例；T细胞非霍奇金淋巴瘤（T-NHL），3例；HL，6例]。重要的是，在13例有2-[氟-18]氟-2-脱氧-D-葡萄糖（FDG）摄取阳性的脾脏病变患者中，4例CT表现正常。最大FDG摄取>10标准化摄取值（SUV）似乎与侵袭性B细胞谱系显著相关（优势比2.47，95%置信区间2.23 - 2.70）。总体而言，PET扫描与BMB结果在108例（89%）中一致，在14例（11%）中不一致。在HL中，我们的数据显示PET扫描与骨髓结果在19例（90%）中一致，18例结果均为阴性，1例结果均为阳性，阴性预测值（NPV）为100%，敏感性为100%，特异性为90%。值得注意的是，所有13例早期HL患者的PET/CT扫描和BMB均为阴性。在NHL中，所有17例T-NHL患者的PET和BMB结果一致。在侵袭性B-NHL患者中，BMB和PET/CT在58例（92%）中一致，在5例（8%）中不一致，而在惰性B细胞淋巴瘤中的相应比例分别为14例（67%）和7例（33%）。所有7例均为假阴性。
PET/CT使17%的病例分期上调并检测到隐匿性脾脏受累。这可能具有潜在的治疗和预后意义。SUV>10可能预测侵袭性组织学类型。除惰性B-NHL外，我们的数据显示PET扫描在排除淋巴瘤骨髓受累方面总体NPV良好。早期HL尤其如此，表明该组患者可安全省略BMB。
