Zapata Claudia P, Cuglievan Branko, Zapata Catalina M, Olavarrieta Raquel, Raskin Scott, Desai Kavita, De Angulo Guillermo
Department of Hematology/Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Hematology/Oncology, Nicklaus Children's Hospital, Miami, Florida.
Pediatr Blood Cancer. 2018 Feb;65(2). doi: 10.1002/pbc.26814. Epub 2017 Sep 13.
Accurate staging is essential in the prognosis and management of pediatric malignancies. Current protocols require screening for marrow infiltration with bone marrow biopsy (BMB) as the gold standard. Positron emission tomography-computed tomography (PET-CT) is commonly used to complete the staging process and can also be used to evaluate marrow infiltration.
To compare PET-CT and BMB in the initial evaluation of bone marrow infiltration in pediatric cancers.
DESIGN/METHOD: We retrospectively reviewed new cases of EWS, rhabdomyosarcoma, neuroblastoma, and lymphoma diagnosed between January 2009 and October 2014. Each case had undergone both PET-CT and BMB within 4 weeks without treatment in the interval between screening modalities.
We reviewed 69 cases. Bone marrow infiltration was demonstrated in 34 cases by PET-CT and in 18 cases by BMB. The sensitivity and negative predictive value of PET-CT were both 100%. Interestingly, the cases in which infiltration was not detected on BMB had an abnormal marrow signal on PET-CT focal or distant to iliac crest.
PET-CT has a high sensitivity when assessing marrow infiltration in pediatric malignancies. Advances in radiologic modalities may obviate the use of invasive, painful, and costly procedures like BMB. Furthermore, biopsy results are limited by insufficient tissue or the degree of marrow infiltration (diffuse vs. focal disease). PET-CT can improve the precision of biopsy when used as a guiding tool. This study proposes the use of PET-CT as first-line screening for bone marrow infiltration to improve the accuracy of staging in new diagnoses.
准确分期对于儿童恶性肿瘤的预后和治疗至关重要。目前的方案要求以骨髓活检（BMB）作为金标准来筛查骨髓浸润。正电子发射断层扫描-计算机断层扫描（PET-CT）通常用于完成分期过程，也可用于评估骨髓浸润。
比较PET-CT和BMB在儿童癌症骨髓浸润初始评估中的作用。
设计/方法：我们回顾性分析了2009年1月至2014年10月期间诊断的尤文肉瘤（EWS）、横纹肌肉瘤、神经母细胞瘤和淋巴瘤的新病例。每个病例在4周内均接受了PET-CT和BMB检查，且在两种筛查方式之间未进行治疗。
我们回顾了69例病例。PET-CT显示34例有骨髓浸润，BMB显示18例有骨髓浸润。PET-CT的敏感性和阴性预测值均为100%。有趣的是，BMB未检测到浸润的病例在PET-CT上髂嵴局部或远处有异常骨髓信号。
PET-CT在评估儿童恶性肿瘤骨髓浸润时具有高敏感性。放射学检查方法的进步可能使诸如BMB等侵入性、痛苦且昂贵的检查不再必要。此外，活检结果受组织不足或骨髓浸润程度（弥漫性与局灶性疾病）的限制。PET-CT用作指导工具时可提高活检的准确性。本研究建议将PET-CT作为骨髓浸润的一线筛查方法，以提高新诊断病例分期的准确性。
