From the Departments of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, and the Departments of Nuclear Medicine, Hematology, and Pathology, Meander Medical Center, Amersfoort, The Netherlands.
J Natl Compr Canc Netw. 2015 Feb;13(2):171-6. doi: 10.6004/jnccn.2015.0025.
This study compared CT-based and (18)F-fluoro-2-deoxy-D-glucose PET/CT (FDG-PET/CT)-based NCCN International Prognostic Index (NCCN-IPI) risk stratification in newly diagnosed diffuse large B-cell lymphoma (DLBCL).
This retrospective study included 57 patients with newly diagnosed DLBCL who had undergone both (oral and intravenous contrast-enhanced full-dose) diagnostic CT and FDG-PET/CT. Diagnostic CT only and FDG-PET/CT were evaluated separately, and corresponding NCCN-IPI scores for the 2 datasets (NCCN-IPICT and NCCN-IPIPET/CT) were calculated. Percentages of agreement and weighted k statistic between NCCN-IPICT and NCCN-IPIPET/CT scoring with regard to the formation of low-, low-intermediate-, high-intermediate-, and high-risk groups were calculated.
In 47 of 57 patients (82.5%; 95% CI, 70.4-90.4), diagnostic CT alone was in agreement with FDG-PET/CT with regard to the formation of low-, low-intermediate-, high-intermediate-, and high-risk NCCN-IPI groups, but not in the remaining 10 patients (17.5%; 95% CI, 9.6%-29.6%). All NCCN-IPI disagreements between diagnostic CT and FDG-PET/CT were from the detection of additional lesions by the latter, most of them being bone marrow lesions. Agreement between NCCN-IPICT and NCCN-IPIPET/CT with regard to the formation of low-, low-intermediate-, high-intermediate-, and high-risk groups was considered good (k=0.771).
Although agreement between NCCN-IPICT and NCCN-IPIPET/CT risk stratification is generally good, FDG-PET/CT results in higher NCCN-IPI risk stratifications in a non-negligible proportion of patients. Future studies should investigate the prognostic implications of these imaging-based differences in NCCN-IPI scoring.
本研究比较了 CT 基础和（18）F-氟代-2-脱氧-D-葡萄糖正电子发射断层扫描/CT（FDG-PET/CT）基础的 NCCN 国际预后指数（NCCN-IPI）在新发弥漫性大 B 细胞淋巴瘤（DLBCL）中的风险分层。
本回顾性研究纳入了 57 例新诊断的 DLBCL 患者，这些患者均接受了口服和静脉对比增强全剂量诊断 CT 和 FDG-PET/CT。单独评估了诊断 CT 和 FDG-PET/CT，并计算了这两个数据集（NCCN-IPICT 和 NCCN-IPIPET/CT）的相应 NCCN-IPI 评分。计算了 NCCN-IPICT 和 NCCN-IPIPET/CT 评分在形成低、低-中、高-中和高危组方面的一致性百分比和加权 k 统计量。
在 57 例患者中的 47 例（82.5%；95%CI，70.4%-90.4%）中，仅诊断 CT 与 FDG-PET/CT 形成低、低-中、高-中和高危 NCCN-IPI 组的结果一致，但在其余 10 例患者（17.5%；95%CI，9.6%-29.6%）中不一致。诊断 CT 与 FDG-PET/CT 之间的所有 NCCN-IPI 不一致均归因于后者检测到更多的病变，其中大多数为骨髓病变。NCCN-IPICT 和 NCCN-IPIPET/CT 之间在形成低、低-中、高-中和高危组方面的一致性被认为是良好的（k=0.771）。
尽管 NCCN-IPICT 和 NCCN-IPIPET/CT 风险分层之间的一致性通常较好，但 FDG-PET/CT 在相当一部分患者中导致更高的 NCCN-IPI 风险分层。未来的研究应探讨这些基于影像学的 NCCN-IPI 评分差异在预后方面的影响。
