Teagle Alexandra R, Barton Hannah, Charles-Edwards Elizabeth, Dizdarevic Sabina, Chevassut Timothy
1 Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
2 Department of Haematology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
Acta Radiol. 2017 Dec;58(12):1476-1484. doi: 10.1177/0284185117701305. Epub 2017 Apr 6.
Background Non-Hodgkin's lymphoma (NHL) accounts for around 4% of new cancer cases annually. Bone marrow involvement is important for staging and management. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is used increasingly to identify this, in addition to bone marrow biopsy (BMB), which is seen as "gold" reference standard. Purpose To compare determination of bone marrow involvement by FDG PET/CT against BMB in diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). Material and Methods This was a retrospective study of patients with histologically confirmed NHL at a single UK cancer center undergoing pre-treatment FDG PET/CT and BMB between June 2010 and February 2013. Information was collected from patient notes, cancer registry, histological and imaging reports. Diagnostic accuracy of FDG PET/CT was determined, compared to BMB as the reference standard. Results Twenty-four patients with DLBCL and 12 with FL were included. Five DLBCL patients had bone marrow involvement on PET/CT; all were confirmed on BMB. Three FL patients had marrow involvement on PET/CT but not on BMB; one FL patient had positive BMB but negative PET/CT. Using BMB as the reference standard, the sensitivity and specificity of FDG PET/CT for detecting bone marrow involvement in DLBCL were 100% and 100%, respectively, and in FL were 0% and 72.7%, respectively. Conclusion FDG PET/CT is accurate for detection of bone marrow involvement in newly diagnosed DLBCL, but not FL. In DLBCL, positive FDG PET/CT may negate the need for routine BMB, although BMB in addition or combination may be appropriate if this would influence management or prognosis.
非霍奇金淋巴瘤（NHL）每年约占新增癌症病例的4%。骨髓受累情况对分期和治疗管理很重要。除了被视为“金”标准的骨髓活检（BMB）外，氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET/CT）越来越多地用于识别骨髓受累情况。目的：比较FDG PET/CT与BMB在弥漫性大B细胞淋巴瘤（DLBCL）和滤泡性淋巴瘤（FL）中对骨髓受累情况的判定。材料与方法：这是一项对英国一家癌症中心2010年6月至2013年2月期间组织学确诊为NHL且接受治疗前FDG PET/CT和BMB检查的患者进行的回顾性研究。从患者病历、癌症登记处、组织学和影像学报告中收集信息。以BMB作为参考标准，确定FDG PET/CT的诊断准确性。结果：纳入24例DLBCL患者和12例FL患者。5例DLBCL患者PET/CT显示骨髓受累；所有这些患者BMB均得到证实。3例FL患者PET/CT显示骨髓受累但BMB未显示；1例FL患者BMB阳性但PET/CT阴性。以BMB作为参考标准，FDG PET/CT检测DLBCL骨髓受累的敏感性和特异性分别为100%和100%，检测FL骨髓受累的敏感性和特异性分别为0%和72.7%。结论：FDG PET/CT对新诊断的DLBCL骨髓受累情况检测准确，但对FL不准确。在DLBCL中，FDG PET/CT阳性可能无需常规进行BMB，不过如果BMB结果会影响治疗管理或预后，那么额外进行BMB或联合使用BMB可能是合适的。
