Cerci Juliano Júlio, Bogoni Mateos, Buccheri Valeria, Etchebehere Elba Cristina Sá de Camargo, Silveira Talita Maira Bueno da, Baiocchi Otavio, Neto Carlos de Araujo Cunha Pereira, Sapienza Marcelo Tatit, Marin Jose Flavio Gomes, Meneghetti José Cláudio, Novis Yana, Souza Carmino Antonio de, Chiattone Carlos, Torresan Marcia, Ramos Celso Dario
Quanta Diagnóstico e Terapia, Curitiba, PR, Brazil.
Quanta Diagnóstico e Terapia, Curitiba, PR, Brazil.
Hematol Transfus Cell Ther. 2018 Jul-Sep;40(3):245-249. doi: 10.1016/j.htct.2018.03.002. Epub 2018 Apr 24.
To investigate, in a large prospective multicenter study, whether 2-[18F]-fluoro-2-deoxy-d-glucose-positron emission tomography is sufficiently accurate to identify clinically important bone marrow involvement by Hodgkin's lymphoma to replace routine bone marrow biopsy in a developing tropical country.
Patients newly diagnosed with Hodgkin's lymphoma were recruited from six cancer centers in Brazil. All were staged by the results of positron emission tomography/computed tomography that were centrally reviewed and by iliac crest bone marrow biopsy. Patients were classified as having marrow disease if they had lymphoma identified by marrow biopsy histology or had focal 2-[18F]-fluoro-2-deoxy-d-glucose marrow uptake that resolved following chemotherapy.
A total of 246 participants were recruited from six different centers and 62 (25.2%) were judged to have Hodgkin's lymphoma in the bone marrow. Positron emission tomography and biopsies were concordant in 206 patients (83%). Positron emission tomography correctly identified marrow disease in 59/62 patients (95.1%) and marrow biopsy in 25/62 patients (40.3%). In 22/62 (35.4%) patients, the two techniques were concordant in the diagnosis of marrow involvement. Of the forty discordant results, positron emission tomography found bone marrow involvement in 37 patients, upstaging 22 to stage IV and having an impact on therapeutic decision in nine cases given their reallocation from early to advanced stage. Three false negative positron emission tomography results were obtained with bone marrow biopsy giving positive findings. All three cases were classified as stage IV regardless of bone marrow findings implying no modification in the clinical management. The sensitivity, specificity and accuracy of positron emission tomography for detecting bone marrow disease were 95%, 100% and 98% and for bone marrow biopsy they were 40%, 100% and 84%, respectively.
We conclude that positron emission tomography can replace marrow biopsy in Brazilian patients with Hodgkin's lymphoma without compromising clinical management.
在一项大型前瞻性多中心研究中，探讨2-[¹⁸F]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描术是否足够准确，以识别霍奇金淋巴瘤临床上重要的骨髓受累情况，从而在一个发展中的热带国家取代常规骨髓活检。
从巴西的六个癌症中心招募新诊断为霍奇金淋巴瘤的患者。所有患者均通过正电子发射断层扫描/计算机断层扫描结果（经集中审查）和髂嵴骨髓活检进行分期。如果患者通过骨髓活检组织学检查发现淋巴瘤，或化疗后局灶性2-[¹⁸F]-氟-2-脱氧-D-葡萄糖骨髓摄取消失，则被分类为患有骨髓疾病。
从六个不同中心共招募了246名参与者，其中62名（25.2%）被判定骨髓中有霍奇金淋巴瘤。正电子发射断层扫描和活检在206例患者中结果一致（83%）。正电子发射断层扫描在59/62例患者（95.1%）中正确识别出骨髓疾病，骨髓活检在25/62例患者（40.3%）中正确识别出骨髓疾病。在22/62例（35.4%）患者中，两种技术在骨髓受累诊断上结果一致。在40例不一致的结果中，正电子发射断层扫描发现37例患者有骨髓受累，其中将22例患者分期上调至IV期，并且由于9例患者从早期重新分配到晚期而对治疗决策产生了影响。骨髓活检呈阳性结果，得到了3例假阴性正电子发射断层扫描结果。无论骨髓检查结果如何，所有3例病例均被分类为IV期，这意味着临床管理没有改变。正电子发射断层扫描检测骨髓疾病的敏感性、特异性和准确性分别为95%、100%和98%，骨髓活检的敏感性、特异性和准确性分别为40%、100%和84%。
我们得出结论，在巴西霍奇金淋巴瘤患者中，正电子发射断层扫描可以取代骨髓活检，而不影响临床管理。
