Hassan Aamna, Siddique Maimoona, Bashir Humayun, Riaz Saima, Wali Rabia, Mahreen Asma, Nawaz M Khalid
Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7-A, Block R-3, Johar Town, Lahore, Pakistan, 54000.
Paediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.
Eur J Nucl Med Mol Imaging. 2017 Jul;44(7):1198-1206. doi: 10.1007/s00259-017-3647-y. Epub 2017 Feb 22.
To evaluate whether positron emission tomography/computed tomography using fluorine-18 fluoro-deoxyglucose (F-FDG PET-CT) predicts bone marrow involvement (BMI) in pediatric Hodgkin's lymphoma (pHL) with sufficient accuracy to supplant routine staging bone marrow biopsy (BMB), and to assess the clinical importance of marrow disease by comparing the prognosis of stage IV HL with BMI versus that without BMI.
Data were retrospectively analyzed for all cases of pHL between July 2010 and June 2015 referred for staging F-FDG PET-CT scan and BMB. The reference standard was BMB. Stage IV patients were divided into three groups to compare their progression-free and overall survival: PET+ BMB-, PET+ BMB+, and PET- BMB-.
Of the 784 patients, 83.3% were male and 16.7% female, with age ranging from 2 to 18 years (mean 10.3 years). Among the total cases, 104 (13.3%) had BMI; of these, 100 were detected by PET imaging and 58 by BMB. BMB and F-FDG PET/CT scans were concordant for BMI detection in 728 patients (93%): positive concordance in 54 and negative in 674. Of the 56 discordant cases, four had a false-negative PET scans and were upstaged by BMB, 46 with focal uptake were PET/CT-positive and BMB-negative (not obtained from active sites), and six with diffuse uptake were false-positive on PET due to paraneoplastic marrow activation. The sensitivity, specificity, PPV, and NPV of PET for identifying BMI was 93.6, 94, 53, and 99.4% respectively. On quantitative assessment, mean iBM-SUV of bilateral iliac crests was significantly higher in those with BMI versus those without (p < 0.05).
F-FDG PET-CT imaging is more sensitive than BMB for BMI detection in pHL staging. BMB should be limited to those with normal marrow uptake in the presence of poor risk factors or those with diffusely increased uptake to exclude marrow involvement in the background of reactive marrow.
评估使用氟-18氟脱氧葡萄糖（F-FDG PET-CT）的正电子发射断层扫描/计算机断层扫描是否能以足够的准确性预测儿童霍奇金淋巴瘤（pHL）中的骨髓受累（BMI），从而取代常规分期骨髓活检（BMB），并通过比较有BMI的IV期HL与无BMI的IV期HL的预后，评估骨髓疾病的临床重要性。
回顾性分析2010年7月至2015年6月间所有因分期进行F-FDG PET-CT扫描和BMB的pHL病例的数据。参考标准为BMB。IV期患者分为三组，比较其无进展生存期和总生存期：PET+BMB-、PET+BMB+和PET-BMB-。
784例患者中，男性占83.3%，女性占16.7%，年龄范围为2至18岁（平均10.3岁）。在所有病例中，104例（13.3%）有BMI；其中，PET成像检测到100例，BMB检测到58例。728例患者（93%）的BMB和F-FDG PET/CT扫描在BMI检测方面结果一致：阳性一致54例，阴性一致674例。在56例不一致的病例中，4例PET扫描为假阴性，经BMB检查上调分期，46例有局灶性摄取的PET/CT为阳性而BMB为阴性（未取自活跃部位），6例有弥漫性摄取的PET因副肿瘤性骨髓激活而呈假阳性。PET识别BMI的敏感性、特异性、阳性预测值和阴性预测值分别为93.6%、94%、53%和99.4%。在定量评估中，有BMI者双侧髂嵴的平均iBM-SUV显著高于无BMI者（p<0.05）。
在pHL分期中，F-FDG PET-CT成像在检测BMI方面比BMB更敏感。BMB应限于存在不良风险因素时骨髓摄取正常的患者或摄取弥漫性增加的患者，以排除反应性骨髓背景下的骨髓受累。
