Department of Haematology, Aalborg Hospital, Aarhus University Hospital, Denmark.
Haematologica. 2012 Jun;97(6):931-6. doi: 10.3324/haematol.2011.056010. Epub 2011 Dec 29.
The value of performing post-therapy routine surveillance imaging in patients with Hodgkin lymphoma is controversial. This study evaluates the utility of positron emission tomography/computed tomography using 2-[18F]fluoro-2-deoxyglucose for this purpose and in situations with suspected lymphoma relapse.
We conducted a multicenter retrospective study. Patients with newly diagnosed Hodgkin lymphoma achieving at least a partial remission on first-line therapy were eligible if they received positron emission tomography/computed tomography surveillance during follow-up. Two types of imaging surveillance were analyzed: "routine" when patients showed no signs of relapse at referral to positron emission tomography/computed tomography, and "clinically indicated" when recurrence was suspected.
A total of 211 routine and 88 clinically indicated positron emission tomography/computed tomography studies were performed in 161 patients. In ten of 22 patients with recurrence of Hodgkin lymphoma, routine imaging surveillance was the primary tool for the diagnosis of the relapse. Extranodal disease, interim positron emission tomography-positive lesions and positron emission tomography activity at response evaluation were all associated with a positron emission tomography/computed tomography-diagnosed preclinical relapse. The true positive rates of routine and clinically indicated imaging were 5% and 13%, respectively (P = 0.02). The overall positive predictive value and negative predictive value of positron emission tomography/computed tomography were 28% and 100%, respectively. The estimated cost per routine imaging diagnosed relapse was US$ 50,778.
Negative positron emission tomography/computed tomography reliably rules out a relapse. The high false positive rate is, however, an important limitation and a confirmatory biopsy is mandatory for the diagnosis of a relapse. With no proven survival benefit for patients with a pre-clinically diagnosed relapse, the high costs and low positive predictive value make positron emission tomography/computed tomography unsuitable for routine surveillance of patients with Hodgkin lymphoma.
在霍奇金淋巴瘤患者中，进行治疗后常规监测影像学检查的价值存在争议。本研究评估了正电子发射断层扫描/计算机断层扫描（PET/CT）使用 2-[18F]氟-2-脱氧葡萄糖（FDG）在这方面的效用，以及在怀疑淋巴瘤复发时的情况。
我们进行了一项多中心回顾性研究。在一线治疗后至少达到部分缓解的初诊霍奇金淋巴瘤患者，如果在随访期间接受 PET/CT 监测，则有资格入组。分析了两种类型的影像学监测：“常规”是指患者在转诊至 PET/CT 时没有复发迹象，“临床提示”是指怀疑复发时。
161 例患者共进行了 211 次常规和 88 次临床提示的 PET/CT 检查。在 22 例霍奇金淋巴瘤复发患者中，有 10 例患者常规影像学监测是复发诊断的主要工具。结外疾病、中期 PET 阳性病变和反应评估时的 PET 活性均与 PET/CT 诊断的临床前复发相关。常规和临床提示影像学的真阳性率分别为 5%和 13%（P = 0.02）。PET/CT 的总体阳性预测值和阴性预测值分别为 28%和 100%。每例常规影像学诊断复发的估计成本为 50778 美元。
阴性 PET/CT 可靠地排除了复发。然而，高假阳性率是一个重要的限制，需要进行确认性活检以诊断复发。由于临床前诊断复发的患者没有生存获益，因此高成本和低阳性预测值使 PET/CT 不适合霍奇金淋巴瘤患者的常规监测。
