Kumar Rajender, Krishnaraju Venkata Subramanian, Mittal Bhagwant Rai, Shankar Kritin, Singh Harmandeep, Ramachandran Arivan, Bhattacharya Anish, Prakash Gaurav, Bal Amanjit, Malhotra Pankaj
Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India.
Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Nucl Med Mol Imaging. 2024 Oct;58(6):332-340. doi: 10.1007/s13139-024-00868-z. Epub 2024 Jun 15.
PET/CT-based Deauville scoring (DS) is routinely used for lymphoma response assessment. However, pathological correlation of DS is not yet precisely documented. In the present study we aimed to pathological confirm the PET/CT-based Deauville scoring (DS) in lymphoma after first-line chemotherapy.
Participants undergoing PET/CT for response assessment following first-line treatment were recruited prospectively. DS ≥ 4 lesions were interpreted as PET-positive, while DS ≤ 3 as PET-negative. Participants with a PET-positive lesion or suspicious of inadequate response (DS ≤ 3) were recruited for metabolic core-needle biopsy. True-negative and benign histopathology were kept on follow-up for three months. Histopathological, clinical and imaging findings were assessed for diagnostic performance. Procedure-related complications were also noted.
In all, 148/480 participants were PET-positive, and 332/480 were PET-negative. 138/148 PET-positive and 12/332 PET-negative lesions were recruited for biopsy. Biopsy was performed in 147/150 participants (PET-positive 135; PET-negative 12). Three patients with inaccessible lesions were excluded. The diagnostic yield of the procedure was 97.3% (143/147). Histology revealed lymphoma in 106 participants (including 70% of total DS-4, 100% of DS-5a and 73.9% of DS-5b lesions), with three false-negative lesions. DS ≤ 3 lesions were true-negative except one diagnosed with lymphoma (8.3%) on follow-up. Non-lymphomatous malignancies ( = 5), granulomas ( = 12), non-specific inflammation ( = 9) and no residual disease ( = 11) were diagnosed in the rest. No major procedure-related adverse event was noted.
A DS-5a lesion suggests residual disease; hence, a biopsy can be prevented unless Richter's transformation is suspected. DS-4 and DS-5b lesions require a biopsy before changing the treatment plan, as a certain number of participants had non-lymphomatous F-18 FDG-avid lesions.
基于PET/CT的迪厄多内评分（DS）常用于淋巴瘤反应评估。然而，DS与病理的相关性尚未得到确切记录。在本研究中，我们旨在对一线化疗后淋巴瘤患者基于PET/CT的迪厄多内评分（DS）进行病理确认。
前瞻性招募接受一线治疗后进行PET/CT反应评估的参与者。DS≥4的病灶被判定为PET阳性，而DS≤3为PET阴性。PET阳性病灶或怀疑反应不足（DS≤3）的参与者被纳入代谢性粗针活检。真阴性和良性组织病理学结果进行三个月的随访。评估组织病理学、临床和影像学检查结果的诊断性能。同时记录与操作相关的并发症。
总共480名参与者中，148名PET阳性，332名PET阴性。148例PET阳性病灶中的138例和332例PET阴性病灶中的12例被纳入活检。150名参与者中的147名（PET阳性135名；PET阴性12名）进行了活检。3例病灶难以取材的患者被排除。该操作的诊断率为97.3%（143/147）。组织学检查显示106名参与者患有淋巴瘤（包括DS-4病灶的70%、DS-5a病灶的100%和DS-5b病灶的73.9%），有3例假阴性病灶。DS≤3的病灶除1例在随访中被诊断为淋巴瘤（8.3%）外，其余均为真阴性。其余诊断为非淋巴瘤性恶性肿瘤（=5）、肉芽肿（=12）、非特异性炎症（=9）和无残留疾病（=11）。未观察到与操作相关的重大不良事件。
DS-5a病灶提示有残留疾病；因此，除非怀疑有里氏转化，否则可避免活检。DS-4和DS-5b病灶在改变治疗方案前需要进行活检，因为一定数量的参与者有非淋巴瘤性F-18 FDG摄取病灶。
