Soydal Cigdem, Koksoy Elif Berna, Yasar Arzu, Turgal Ebru, Erdogan Beyza Doganay, Akbulut Hakan, Kucuk Nuriye Ozlem
1 Department of Nuclear Medicine, Ankara University Medical Faculty , Ankara, Turkey .
2 Department of Medical Oncology, Ankara University Medical Faculty , Ankara, Turkey .
Cancer Biother Radiopharm. 2016 Dec;31(10):361-365. doi: 10.1089/cbr.2016.2132.
To define the role of F-flourodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in the detection of bone marrow (BM) involvement in patients with diffuse large B cell lymphoma (DLBCL).
Fifty-four (mean age: 55.5 ± 18.3 years, 20 female and 34 male) DLBCL patients who underwent pretreatment F-FDG PET/CT were included to the study. Focal or diffuse BM F-FDG uptake that is higher than mediastinal blood pool uptake was accepted as positive. After staging of disease by CT and F-FDG PET/CT, all the patients received R-CHOP treatment after diagnostic blinded bone marrow biopsy (BMB). Presence of positive BM uptake in F-FDG PET/CT and histopathological examination results of BMBs were analyzed by Chi-square test. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of F-FDG PET/CT in the detection of BM involvement were calculated. Prognostic importance of the presence of BM F-FDG uptake was analyzed by Kaplan-Meier analysis.
BM F-FDG uptake was detected in 8 patients. Histopathological examination of BMB revealed BM involvement in 6 out of 8 patients. BMB was negative in all patients who have no F-FDG uptake in the evaluation of PET/CT images. Sensitivity, specificity, accuracy, PPV, and NPV of F-FDG PET/CT in the detection of BM involvement were calculated as 100%, 96%, 96%, 75%, and 100%, respectively. In the Kaplan-Meier analysis, we found that presence of pretreatment F-FDG uptake in BM has a prognostic importance. Whereas mean time to progression (TTP) in patients with BM uptake was 32.25 ± 10.9 months and mean TTP in those without was 51.69 ± 3.6 months (p = 0.013).
BM uptake in pretreatment F-FDG PET/CT is an important prognostic factor in DLBCL patients. Moreover, in consideration of high NPV, F-FDG PET/CT could eliminate unnecessary BMB in FDG-negative patients.
明确氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）在检测弥漫性大B细胞淋巴瘤（DLBCL）患者骨髓（BM）受累情况中的作用。
本研究纳入了54例（平均年龄：55.5±18.3岁，女性20例，男性34例）接受治疗前F-FDG PET/CT检查的DLBCL患者。局灶性或弥漫性骨髓F-FDG摄取高于纵隔血池摄取被视为阳性。通过CT和F-FDG PET/CT对疾病进行分期后，所有患者在诊断性盲法骨髓活检（BMB）后接受R-CHOP治疗。采用卡方检验分析F-FDG PET/CT中骨髓摄取阳性情况与BMB组织病理学检查结果。计算F-FDG PET/CT检测骨髓受累的敏感性、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）。通过Kaplan-Meier分析评估骨髓F-FDG摄取的预后重要性。
8例患者检测到骨髓F-FDG摄取。BMB组织病理学检查显示8例中有6例骨髓受累。在PET/CT图像评估中，所有无F-FDG摄取的患者BMB均为阴性。F-FDG PET/CT检测骨髓受累的敏感性、特异性、准确性、PPV和NPV分别计算为100%、96%、96%、75%和100%。在Kaplan-Meier分析中，我们发现治疗前骨髓中F-FDG摄取具有预后重要性。骨髓摄取阳性患者的平均进展时间（TTP）为32.25±10.9个月，无骨髓摄取患者的平均TTP为51.69±3.6个月（p = 0.013）。
治疗前F-FDG PET/CT中的骨髓摄取是DLBCL患者的重要预后因素。此外，考虑到高NPV，F-FDG PET/CT可避免对FDG阴性患者进行不必要的BMB。
