Cai Mengxin, Wang Tianyi, Pan Ci, Gao Yijin, Zhou Min, Hu Wenting, Ye Qidong, Tang Jingyan
a Department of Hematology/Oncology , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China.
Pediatr Hematol Oncol. 2019 Mar;36(2):113-121. doi: 10.1080/08880018.2019.1597231. Epub 2019 Apr 19.
To assess the impact of second-look biopsy of residual mass during or after chemotherapy in pediatric mature B-cell NHL.
Patients with mature B-cell non-Hodgkin lymphoma (NHL) who were suspicious of radiological residual mass at mid or end of treatment and subjected to second biopsy were treated at our center between January 2001 and December 2015. Their clinical characteristics, imaging findings, pathological changes, management, and prognosis were reviewed retrospectively.
A total of 31 children were included (13 boys and 18 girls, median age at diagnosis 6.1 years). The median time from diagnosis to second biopsy was 3.15 months (range 2.3-18 months). Biopsy confirmed the presence of viable tumor in eight patients. The specificity and positive predictive value of conventional imaging in detecting residual detectable by biopsy were at 9 and 28.6%, while sensitivity and negative predictive value of this approach were both 100%. Three of the histologic positive patients experienced progressive disease or relapse while the others achieved complete remission (CR) and 21 patients achieved long-time CR at median follow-up of 3.2 years. The median progression-free survival (PFS) time of all 31 was 28 months and 5-year PFS rate was 90.0%. Five-year PFS rate of negative-biopsy and positive-biopsy group were 100 and 62.5%, respectively ( = 0.002).
Conventional imaging has very high sensitivity but very low specificity for the accurate determination of residual disease in pediatric NHL. Second-look biopsy is necessary to differentiate viable tumor from necrosis or fibrosis and is solid evidence-based foundation of subsequent treatment.
评估小儿成熟B细胞非霍奇金淋巴瘤（NHL）化疗期间或化疗后对残留肿块进行二次活检的影响。
2001年1月至2015年12月期间，在本中心接受治疗的成熟B细胞非霍奇金淋巴瘤（NHL）患者，这些患者在治疗中期或末期有放射学残留肿块可疑并接受了二次活检。回顾性分析他们的临床特征、影像学表现、病理变化、治疗及预后情况。
共纳入31名儿童（13名男孩和18名女孩，诊断时中位年龄6.1岁）。从诊断到二次活检的中位时间为3.15个月（范围2.3 - 18个月）。活检证实8例患者存在存活肿瘤。传统影像学检测活检可发现的残留肿瘤的特异性和阳性预测值分别为9%和28.6%，而该方法的敏感性和阴性预测值均为100%。组织学阳性的3例患者出现疾病进展或复发，其他患者获得完全缓解（CR），21例患者在中位随访3.2年时获得长期CR。31例患者的中位无进展生存期（PFS）为28个月，5年PFS率为90.0%。二次活检阴性组和阳性组的5年PFS率分别为100%和62.5%（P = 0.002）。
传统影像学对准确判断小儿NHL残留病灶具有很高的敏感性，但特异性很低。二次活检对于区分存活肿瘤与坏死或纤维化是必要的，是后续治疗坚实的循证基础。
