Hu Yingwei, Zhou Weiyan, Sun Siyuan, Guan Yihui, Ma Jiexian, Xie Yanhui
Department of Hematology, Huadong Hospital, Fudan University, Shanghai, China.
PET Center, Huashan Hospital, Fudan University, Shanghai, China.
Ann Transl Med. 2021 Jun;9(12):1009. doi: 10.21037/atm-21-2790.
Diagnostic splenectomy is often performed on patients with suspected splenic lymphoma. However, unnecessary splenectomy entails more harm than benefit for patients. Therefore, a preliminary screening method for patients with suspected splenic lymphoma that has high sensitivity and specificity is urgently needed.
From the pathology database at Huadong and Huashan Hospital, we retrospectively identified 60 patients of suspected splenic lymphoma who underwent fluorodeoxyglucose (FDG)-positron emission tomography (PET) before receiving a splenectomy and did not show any increase in FDG uptake except in the spleen. We compared the indicators of PET-CT, such as the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and the SUVmax of 18F-FDG uptake ratios between the spleen/liver, spleen/bone marrow, and liver/bone marrow.
No significant differences were detected in SUVmax, TLG, MTV, or the SUVmax ratio of the liver/bone marrow between the lymphoma and benign groups. However, the SUVmax ratios of the spleen/liver and spleen/bone marrow were significantly higher in the lymphoma group than in the benign group (P=0.001; P=0.001). Receiver operating characteristic (ROC) curve analysis determined a spleen/liver SUVmax ratio of >2.42 and a spleen/bone marrow SUVmax ratio of >1.45 to be the indications for requiring a diagnostic splenectomy for lymphoma. Parallel testing increased the specificity and sensitivity of the test.
Patients whose PET-CT results are inconclusive regarding the need for splenectomy may benefit from our prediction model. Future large-scale prospective clinical trials are required to verify these findings.
诊断性脾切除术常用于疑似脾淋巴瘤患者。然而，不必要的脾切除术对患者弊大于利。因此，迫切需要一种对疑似脾淋巴瘤患者具有高灵敏度和特异性的初步筛查方法。
从华东医院和华山医院的病理数据库中，我们回顾性地确定了60例疑似脾淋巴瘤患者，这些患者在接受脾切除术之前接受了氟脱氧葡萄糖（FDG）-正电子发射断层扫描（PET），且除脾脏外未显示FDG摄取增加。我们比较了PET-CT指标，如最大标准化摄取值（SUVmax）、代谢肿瘤体积（MTV）、总病变糖酵解（TLG）以及脾脏/肝脏、脾脏/骨髓和肝脏/骨髓之间18F-FDG摄取率的SUVmax。
淋巴瘤组和良性组在SUVmax、TLG、MTV或肝脏/骨髓的SUVmax比值方面未检测到显著差异。然而，淋巴瘤组的脾脏/肝脏和脾脏/骨髓的SUVmax比值显著高于良性组（P=0.001；P=0.001）。受试者工作特征（ROC）曲线分析确定脾脏/肝脏SUVmax比值>2.42和脾脏/骨髓SUVmax比值>1.45为淋巴瘤诊断性脾切除术的指征。平行检测提高了检测的特异性和灵敏度。
PET-CT结果对于是否需要进行脾切除术不明确的患者可能会从我们的预测模型中受益。未来需要大规模的前瞻性临床试验来验证这些发现。
