Department of Oncology, The Children's Hospital at Westmead, New South Wales, Australia.
Department of Nuclear Medicine, The Children's Hospital at Westmead, New South Wales, Australia.
Pediatr Blood Cancer. 2020 Jan;67(1):e28034. doi: 10.1002/pbc.28034. Epub 2019 Oct 10.
Langerhans cell histiocytosis (LCH) in pediatric patients presents with single-system or multisystem disease. Accurate staging is essential for selecting the most appropriate therapy ranging from local surgery to chemotherapy.
A retrospective review was undertaken of reported fludeoxyglucose (FDG) positron emission tomography - computed tomography (PET-CT) scans performed in children with LCH from June 2006 to February 2017. Findings were compared with a reference standard of biopsy or informed clinical follow-up.
One hundred nine scans were performed in 33 patients (age 7 weeks to 18 years). Nineteen patients had single-system, bone unifocal disease; seven patients had single-system, bone multifocal disease; four patients had single-system, skin unifocal disease; two patients had multisystem disease; and one patient had single-system, lymph node disease. Twenty-six scans were performed to stage biopsy-proven LCH, and 83 scans were performed during follow-up to assess treatment response or recurrence after therapy completion. At staging, FDG PET-CT detected all sites of biopsy-proven LCH (except where bone unifocal disease had been resected). There was one false-positive thymic finding that resolved without therapy. The per-patient false-positive rate of FDG PET-CT at staging was 4% (1/26). During follow-up, five LCH recurrences and one case of progressive disease on therapy occurred, all positive on FDG PET-CT. During follow-up two patients had FDG PET-CT scans with false-positive findings and one patient with a magnetic resonance imaging false-positive finding. The per-scan false-positive rate of FDG PET-CT during follow-up was 2% (2/83).
FDG PET-CT is highly sensitive for the staging and follow-up of pediatric patients with LCH, and has a very low false-positive rate.
儿童朗格汉斯细胞组织细胞增生症（LCH）表现为单系统或多系统疾病。准确分期对于选择最合适的治疗方案至关重要，治疗方案范围从局部手术到化疗。
对 2006 年 6 月至 2017 年 2 月期间在儿童 LCH 患者中进行的氟脱氧葡萄糖（FDG）正电子发射断层扫描-计算机断层扫描（PET-CT）的报告进行了回顾性审查。结果与活检或知情临床随访的参考标准进行了比较。
在 33 例患者中进行了 109 次扫描（年龄 7 周至 18 岁）。19 例患者为单系统、骨单发疾病；7 例患者为单系统、骨多发病变；4 例患者为单系统、皮肤单发疾病；2 例患者为多系统疾病；1 例患者为单系统、淋巴结疾病。26 次扫描用于分期活检证实的 LCH，83 次扫描用于评估治疗反应或完成治疗后复发。在分期时，FDG PET-CT 检测到所有活检证实的 LCH 部位（除了骨单发疾病已切除的部位）。有一个胸腺假阳性发现，但未经治疗就自行消退。FDG PET-CT 在分期时的每位患者假阳性率为 4%（26 例中有 1 例）。在随访期间，5 例 LCH 复发和 1 例治疗进展病例，均为 FDG PET-CT 阳性。在随访期间，有 2 例患者的 FDG PET-CT 扫描有假阳性结果，1 例患者的磁共振成像有假阳性结果。FDG PET-CT 在随访期间的每次扫描假阳性率为 2%（83 次中有 2 次）。
FDG PET-CT 对儿童 LCH 的分期和随访具有高度敏感性，假阳性率很低。
