Nuclear Medicine Department, A. Lacassagne Cancer Center, Nice, France.
Hematology Department, Aalborg University Hospital, Aalborg, Denmark.
J Nucl Med. 2017 Aug;58(8):1249-1254. doi: 10.2967/jnumed.116.184218. Epub 2017 Jan 26.
PET/CT-ascertained bone marrow involvement (BMI) constitutes the single most important reason for upstaging by PET/CT in Hodgkin lymphoma (HL). However, BMI assessment in PET/CT can be challenging. This study analyzed the clinicopathologic correlations and prognostic meaning of different patterns of bone marrow (BM) F-FDG uptake in HL. One hundred eighty newly diagnosed early unfavorable and advanced-stage HL patients, all scanned at baseline and after 2 adriamycin-bleomycin-vinblastine-dacarbazine (ABVD) courses with F-FDG PET, enrolled in 2 international studies aimed at assessing the role of interim PET scanning in HL, were retrospectively included. Patients were treated with ABVD × 4-6 cycles and involved-field radiation when needed, and no treatment adaptation on interim PET scanning was allowed. Two masked reviewers independently reported the scans. Thirty-eight patients (21.1%) had focal lesions (fPET), 10 of them with a single (unifocal) and 28 with multiple (multifocal) BM lesions. Fifty-three patients (29.4%) had pure strong (>liver) diffuse uptake (dPET) and 89 (48.4%) showed no or faint (≤liver) BM uptake (nPET). BM biopsy was positive in 6 of 38 patients (15.7%) for fPET, in 1 of 53 (1.9%) for dPET, and in 5 of 89 (5.6%) for nPET dPET was correlated with younger age, higher frequency of bulky disease, lower hemoglobin levels, higher leukocyte counts, and similar diffuse uptake in the spleen. Patients with pure dPET had a 3-y progression-free survival identical to patients without any F-FDG uptake (82.9% and 82.2%, respectively, = 0.918). However, patients with fPET+ (either unifocal or multifocal) had a 3-y progression-free survival significantly inferior to patients with dPET+ and nPET+ (66.7% and 82.5%, respectively, 0.03). The κ values for interobserver agreement were 0.84 for focal uptake and 0.78 for diffuse uptake. We confirmed that F-FDG PET scanning is a reliable tool for BMI assessment in HL, and BM biopsy is no longer needed for routine staging. Moreover, the interobserver agreement for BMI in this study proved excellent and only focal F-FDG BM uptake should be considered as a harbinger of HL.
PET/CT 确定的骨髓受累（BMI）是 PET/CT 在霍奇金淋巴瘤（HL）中进行分期上调的最重要原因。然而，在 PET/CT 中评估 BMI 具有挑战性。本研究分析了 HL 中不同骨髓（BM）FDG 摄取模式的临床病理相关性和预后意义。
180 例新诊断的早期不良和晚期 HL 患者，均在基线和 2 个阿霉素-博来霉素-长春碱-达卡巴嗪（ABVD）疗程后进行 F-FDG PET 扫描，这些患者均参与了旨在评估中期 PET 扫描在 HL 中的作用的 2 项国际研究，前瞻性地纳入本研究。患者接受 ABVD × 4-6 个周期和必要时的受累野放疗，不允许根据中期 PET 扫描进行治疗调整。两名盲法审核员独立报告扫描结果。
38 例患者（21.1%）存在局灶性病变（fPET），其中 10 例为单发（单灶性），28 例为多发（多灶性）BM 病变。53 例患者（29.4%）存在单纯强（>肝脏）弥漫性摄取（dPET），89 例（48.4%）显示无或轻微（≤肝脏）BM 摄取（nPET）。38 例 fPET 患者中有 6 例（15.7%）骨髓活检阳性，53 例 dPET 患者中有 1 例（1.9%）阳性，89 例 nPET 患者中有 5 例（5.6%）阳性。dPET 与年龄较小、大肿块疾病频率较高、较低的血红蛋白水平、较高的白细胞计数以及脾脏相似的弥漫性摄取相关。纯 dPET 患者的 3 年无进展生存率与无任何 F-FDG 摄取的患者相同（分别为 82.9%和 82.2%，=0.918）。然而，fPET+（无论是单灶性还是多灶性）患者的 3 年无进展生存率明显低于 dPET+和 nPET+患者（分别为 66.7%和 82.5%，=0.03）。两名观察者之间在局灶性摄取和弥漫性摄取方面的κ值分别为 0.84 和 0.78。
我们证实，FDG PET 扫描是评估 HL 中 BMI 的可靠工具，并且不再需要常规分期进行骨髓活检。此外，本研究中 BMI 的观察者间一致性非常出色，只有局灶性 FDG BM 摄取才应被视为 HL 的先兆。
