Puccini B, Nassi L, Minoia C, Volpetti S, Ciancia R, Riccomagno P C, Di Rocco A, Mulè A, Toldo C, Sassone M C, Guariglia R, Filì C, Finolezzi E, Falorio S, Zanon S, Furlan A, Doa G, Zaja F
Division of Hematology, AOU Careggi, Florence, Italy.
Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont and Maggiore della Carità Hospital, Corso Mazzini 18, 28100, Novara, Italy.
Ann Hematol. 2017 Jul;96(7):1147-1153. doi: 10.1007/s00277-017-2996-8. Epub 2017 Apr 28.
Several studies suggested that staging bone marrow biopsy (BMB) could be omitted in patients with classical Hodgkin's lymphoma (cHL) when a positron emission tomography/computed tomography (PET/CT) is performed at baseline.To address the concordance between BMB and PET/CT in the detection of bone marrow involvement (BMI) and the BMB role in determining the Ann Arbor stage, we retrospectively collected data on 1244 consecutive patients with cHL diagnosed from January 2007 to December 2013. One thousand eighty-five patients who had undergone both BMB and PET/CT were analyzed, comparing the Ann Arbor stage assessed with PET/CT only to that resulting from PET/CT combined with BMB.One hundred sixty-nine patients (16%) showed at least one focal skeletal lesion (FSL) at PET/CT evaluation. Only 55 patients had a positive BMB (5.1%); 34 of them presented at least one FSL at PET/CT. To the contrary, 895 out of 1030 patients with a negative BMB did not show any FSL (86.9%). Positive and negative predictive values of PET/CT for BMI were 20 and 98%, respectively; sensitivity and specificity were 62 and 87%, respectively. Fifty-four out of 55 patients with a positive BMB could have been evaluated as an advanced stage just after PET/CT; only one patient (0.1%) would have been differently treated without BMB.Our data showed a very high negative predictive value of PET/CT for BMI and a negligible influence of BMB on treatment planning, strengthening the recent indications that BMB could be safely omitted in cHL patients staged with PET/CT.
多项研究表明，对于经典型霍奇金淋巴瘤（cHL）患者，若在基线时进行正电子发射断层扫描/计算机断层扫描（PET/CT），则可省略分期骨髓活检（BMB）。为了探讨BMB与PET/CT在检测骨髓受累（BMI）方面的一致性以及BMB在确定Ann Arbor分期中的作用，我们回顾性收集了2007年1月至2013年12月期间连续诊断的1244例cHL患者的数据。对1085例同时接受了BMB和PET/CT检查的患者进行分析，将仅通过PET/CT评估的Ann Arbor分期与PET/CT联合BMB得出的分期进行比较。169例患者（16%）在PET/CT评估中显示至少一处局灶性骨骼病变（FSL）。只有55例患者BMB呈阳性（5.1%）；其中34例在PET/CT上表现出至少一处FSL。相反，1030例BMB阴性的患者中有895例未显示任何FSL（86.9%）。PET/CT对BMI的阳性预测值和阴性预测值分别为20%和98%；敏感性和特异性分别为62%和87%。55例BMB阳性的患者中，有54例在PET/CT检查后即可被评估为晚期；只有1例患者（0.1%）在没有BMB的情况下治疗方案会有所不同。我们的数据显示PET/CT对BMI具有非常高的阴性预测值，且BMB对治疗计划的影响可忽略不计，这进一步支持了近期的观点，即对于通过PET/CT分期的cHL患者，可以安全地省略BMB。
