S. de Hematología Y Oncología Médica. H.J.M. Morales Meseguer, Murcia, Spain.
S. de Hematología. H, Universitario de Canarias, La Laguna, Tenerife, Spain.
Am J Hematol. 2015 Aug;90(8):686-90. doi: 10.1002/ajh.24044. Epub 2015 May 28.
Bone marrow infiltration (BMI), categorized as an extra-nodal site, affects stage and is associated with poor prognosis in newly diagnosed lymphoma patients. We have evaluated the accuracy of PET/CT and bone marrow biopsy (BMB) to assess BMI in 372 lymphoma patients [140 Hodgkin Lymphoma (HL) and 232 High Grade B-cell non-Hodgkin Lymphoma (HG B-NHL), among them 155 Diffuse Large B-Cell Lymphoma (DLCL)]. For HL cases, and taking into account PET/CT, sensitivity, negative predictive value (NPV) and accuracy were 96.7, 99.3, and 99.3% while those of BMB were 32.3, 83.8, and 85%, respectively. For HG B-NHL and considering PET/CT, sensitivity, NPV, and accuracy were 52.7, 81.7, and 84.1%, while those of BMB were 77.6, 90.2, and 90.7%, respectively. In the HG B-NHL group, 25 patients would have been under-staged without BMB. These results lead us to recommend PET/CT and the avoidance of BMB to assess BMI in HL. In the case of HG B-NHL, bone marrow status should be assessed firstly by means of PET/CT; only in either focal or diffuse PET/CT with low borderline SUV max values or in negative cases, should BMB be carried out afterwards. In the HG B-NHL setting and at the present moment, both techniques are complementary.
骨髓浸润（BMI）归类为结外部位，影响分期，并与新诊断淋巴瘤患者的预后不良相关。我们评估了 PET/CT 和骨髓活检（BMB）在 372 例淋巴瘤患者（140 例霍奇金淋巴瘤[HL]和 232 例高级别 B 细胞非霍奇金淋巴瘤[HG B-NHL]）中评估 BMI 的准确性，其中 155 例为弥漫性大 B 细胞淋巴瘤（DLCL）。对于 HL 病例，考虑到 PET/CT，其敏感性、阴性预测值（NPV）和准确性分别为 96.7%、99.3%和 99.3%，而 BMB 的分别为 32.3%、83.8%和 85%。对于 HG B-NHL 并考虑到 PET/CT，其敏感性、NPV 和准确性分别为 52.7%、81.7%和 84.1%，而 BMB 的分别为 77.6%、90.2%和 90.7%。在 HG B-NHL 组中，有 25 例患者如果不进行 BMB 将被低估分期。这些结果使我们建议在 HL 中使用 PET/CT 并避免进行 BMB 来评估 BMI。在 HG B-NHL 的情况下，应首先通过 PET/CT 评估骨髓状态；仅在 PET/CT 呈现局灶性或弥漫性且 SUVmax 值较低或为阴性的情况下，才应随后进行 BMB。在目前的情况下，对于 HG B-NHL，这两种技术是互补的。
