PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom;
Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom;
Blood. 2016 Mar 24;127(12):1531-8. doi: 10.1182/blood-2015-11-679407. Epub 2016 Jan 8.
International guidelines recommend that positron emission tomography-computed tomography (PET-CT) should replace CT in Hodgkin lymphoma (HL). The aims of this study were to compare PET-CT with CT for staging and measure agreement between expert and local readers, using a 5-point scale (Deauville criteria), to adapt treatment in a clinical trial: Response-Adapted Therapy in Advanced Hodgkin Lymphoma (RATHL). Patients were staged using clinical assessment, CT, and bone marrow biopsy (RATHL stage). PET-CT was performed at baseline (PET0) and after 2 chemotherapy cycles (PET2) in a response-adapted design. PET-CT was reported centrally by experts at 5 national core laboratories. Local readers optionally scored PET2 scans. The RATHL and PET-CT stages were compared. Agreement among experts and between expert and local readers was measured. RATHL and PET0 stage were concordant in 938 (80%) patients. PET-CT upstaged 159 (14%) and downstaged 74 (6%) patients. Upstaging by extranodal disease in bone marrow (92), lung (11), or multiple sites (12) on PET-CT accounted for most discrepancies. Follow-up of discrepant findings confirmed the PET characterization of lesions in the vast majority. Five patients were upstaged by marrow biopsy and 7 by contrast-enhanced CT in the bowel and/or liver or spleen. PET2 agreement among experts (140 scans) with a κ (95% confidence interval) of 0.84 (0.76-0.91) was very good and between experts and local readers (300 scans) at 0.77 (0.68-0.86) was good. These results confirm PET-CT as the modern standard for staging HL and that response assessment using Deauville criteria is robust, enabling translation of RATHL results into clinical practice.
国际指南建议，正电子发射断层扫描-计算机断层扫描（PET-CT）应替代霍奇金淋巴瘤（HL）的 CT。本研究旨在比较 PET-CT 与 CT 进行分期，并使用 5 分制（Deauville 标准）衡量专家和当地读者之间的一致性，以适应临床试验中的治疗：高级霍奇金淋巴瘤的适应性治疗（RATHL）。患者使用临床评估、CT 和骨髓活检进行分期（RATHL 分期）。在适应性设计中，PET-CT 在基线（PET0）和 2 个化疗周期后（PET2）进行。PET-CT 由 5 个国家核心实验室的专家进行中心报告。当地读者可选择对 PET2 扫描进行评分。比较了 RATHL 和 PET-CT 分期。测量了专家之间以及专家与当地读者之间的一致性。在 938 名（80%）患者中，RATHL 和 PET0 分期一致。PET-CT 使 159 名（14%）患者分期升高，使 74 名（6%）患者分期降低。骨髓（92）、肺（11）或多个部位（12）的结外疾病 PET-CT 分期升高是造成大多数差异的原因。对差异发现的随访证实了 PET 对病变特征的分类在绝大多数情况下都是正确的。5 名患者骨髓活检分期升高，7 名患者肠道和/或肝脏或脾脏增强 CT 分期升高。专家之间（140 次扫描）的 PET2 一致性非常好，κ 值（95%置信区间）为 0.84（0.76-0.91），专家与当地读者之间（300 次扫描）为 0.77（0.68-0.86）也很好。这些结果证实了 PET-CT 是 HL 分期的现代标准，使用 Deauville 标准进行反应评估是可靠的，能够将 RATHL 结果转化为临床实践。
