Department of Diagnostic Radiology and Oncotherapy, Semmelweis University, Üllői út 78/a, Budapest, 1082, Hungary.
PET-CT Medical, Diagnostic Ltd., Laky Adolf u. 44-46, Budapest, 1145, Hungary.
Int J Hematol. 2011 Apr;93(4):545-550. doi: 10.1007/s12185-011-0795-x. Epub 2011 Mar 1.
A 32-year-old male patient was diagnosed with nodular lymphocyte-predominant Hodgkin lymphoma. Staging FDG PET-CT detected a large right axillary lymph node conglomerate and splenic manifestation. Interim PET-CT following two cycles of ABVD chemotherapy revealed good metabolic response with the exception of a single axillary lymph node. A second "interim" PET-CT after two further cycles showed a similar result. A biopsy of the metabolically active non-palpable lymph node was performed using radioguided occult lesion localization (ROLL) with ultrasound guidance. The lymph node was successfully removed by minimally invasive surgery. Histological evaluation of the lymph node revealed a T cell-rich diffuse large B cell lymphoma. Based on this finding, a more aggressive treatment regimen followed by high dose chemotherapy with autologous stem cell rescue was adopted. To our knowledge, this is the first report of a lymphoma case in which the ROLL method was used in the radioguided biopsy of a chemoresistant lymph node detected by interim FDG PET-CT.
一位 32 岁男性患者被诊断为结节性淋巴细胞为主型霍奇金淋巴瘤。分期 FDG PET-CT 检测到一个大的右侧腋窝淋巴结团块和脾脏表现。ABVD 化疗两个周期后的中期 PET-CT 显示代谢反应良好，除了一个腋窝淋巴结外。进一步两个周期后的第二次“中期”PET-CT 显示出类似的结果。使用超声引导的放射性示踪隐匿性病变定位（ROLL）对代谢活跃的不可触及淋巴结进行了活检。该淋巴结通过微创外科手术成功切除。淋巴结的组织学评估显示富含 T 细胞的弥漫性大 B 细胞淋巴瘤。基于这一发现，采用了更积极的治疗方案，随后进行高剂量化疗和自体干细胞挽救。据我们所知，这是首例报告在 FDG PET-CT 检测到的化疗耐药淋巴结中使用 ROLL 方法进行放射性引导活检的淋巴瘤病例。
