Department of Hematology, Nilratan Sircar Medical College, Kolkata, West Bengal, India.
Department of Hematology, Christian Medical College & Hospital, Vellore, Tamil Nadu, India.
Indian J Med Res. 2021 May;154(5):691-698. doi: 10.4103/ijmr.IJMR_1420_19.
BACKGROUND & OBJECTIVES: Evaluation of bone marrow infiltration in lymphoma is usually done by bone marrow biopsy (BMB). This study analyzed the utility of F-fluorodeoxyglucose positron emission tomography/computerized tomography (F-FDG PET/CT) to detect bone marrow involvement (BMI) compared to BMB.
Treatment-naïve lymphoma patients underwent both F-FDG PET/CT scan and BMB before treatment initiation. BMI detected on PET/CT was compared with BMB.
The study population consisted of 80 patients and comprised 37 Hodgkin's lymphoma (HL) patients, 30 aggressive non-HL (NHL) and 13 indolent NHL patients. The majority of the aggressive NHLs were diffuse large B-cell lymphoma (20/30) and major indolent lymphoma was follicular lymphoma (5/13). When compared to BMB, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of focal (±diffuse) marrow FDG uptake on F-FDG PET/CT were 100, 61.3, 33.3 and 100 per cent, respectively, for HL; 100, 65.4, 30.8 and 100 per cent, respectively, for aggressive NHL and 75, 80, 85.7 and 66.7 per cent, respectively, for indolent NHL. When comparing marrow involvement on F-FDG PET/CT to baseline BMB and/or resolution of bone marrow FDG uptake at interim/end-of-treatment F-FDG PET/CT, the sensitivity, specificity, PPV and NPV were 100 per cent each for HL and aggressive NHL and 77.3, 100, 100 and 66.7 per cent, respectively, for indolent NHL.
INTERPRETATION & CONCLUSIONS: F-FDG PET/CT has a good sensitivity and NPV for detecting BMI in HL and aggressive lymphoma. The low specificity and PPV improved if marrow uptake pattern on interim or end-of-treatment F-FDG PET/CT scan was analyzed. In patients with HL who are staged withF-FDG PET/CT at baseline and followed up with an interim/end-of-treatment PET/CT, baseline BMB may be avoided. For all other lymphoma subtypes, BMB may be essential if there is no marrow FDG uptake on PET/CT scan performed at baseline.
评估淋巴瘤骨髓浸润通常通过骨髓活检（BMB）进行。本研究分析了 F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-FDG PET/CT）与 BMB 相比检测骨髓受累（BMI）的效用。
在开始治疗前，未经治疗的淋巴瘤患者同时进行 F-FDG PET/CT 扫描和 BMB。比较 PET/CT 上检测到的 BMI 与 BMB。
研究人群包括 80 名患者，其中包括 37 名霍奇金淋巴瘤（HL）患者、30 名侵袭性非霍奇金淋巴瘤（NHL）患者和 13 名惰性 NHL 患者。侵袭性 NHL 大多为弥漫性大 B 细胞淋巴瘤（20/30），主要惰性淋巴瘤为滤泡性淋巴瘤（5/13）。与 BMB 相比，F-FDG PET/CT 上局灶（±弥漫）骨髓 FDG 摄取的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 100%、61.3%、33.3%和 100%，HL；100%、65.4%、30.8%和 100%，侵袭性 NHL；75%、80%、85.7%和 66.7%，惰性 NHL。当将骨髓受累情况与基线 BMB 和/或治疗期间/结束时 F-FDG PET/CT 上骨髓 FDG 摄取的缓解情况进行比较时，HL 和侵袭性 NHL 的敏感性、特异性、PPV 和 NPV 均为 100%，而惰性 NHL 的敏感性、特异性、PPV 和 NPV 分别为 77.3%、100%、100%和 66.7%。
F-FDG PET/CT 对 HL 和侵袭性淋巴瘤的 BMI 检测具有良好的敏感性和 NPV。如果分析治疗期间/结束时 F-FDG PET/CT 扫描的骨髓摄取模式，特异性和 PPV 会提高。在基线进行 F-FDG PET/CT 分期并进行治疗期间/结束时 PET/CT 随访的 HL 患者中，可避免进行基线 BMB。对于所有其他淋巴瘤亚型，如果基线 PET/CT 扫描无骨髓 FDG 摄取，则 BMB 可能必不可少。
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