Sorigue Marc, Miljkovic Milos, Mozas Pablo
Trialing Health, Barcelona, Spain.
Cartesian Therapeutics, Gaithersburg, MD, USA.
Blood Rev. 2025 May;71:101270. doi: 10.1016/j.blre.2025.101270. Epub 2025 Jan 28.
The strength of evidence supporting use of PET in the evaluation of suspected histological transformation (HT) of follicular lymphoma (FL) is unknown. We conducted a systematic review of studies reporting the diagnostic performance of ≥1 PET parameters for the detection of HT in patients with known FL. We searched PubMed for any study reporting ≥1 diagnostic performance metrics. Risk of bias was evaluated with the QUADAS2 tool. We included 7 studies encompassing 152 patients with a biopsy showing FL (or indolent non-Hodgkin lymphoma) and 111 with a biopsy confirming HT. Study designs and study populations differed substantially. PET methods were poorly reported and F-FDG dose was highly variable. Most studies were judged to be at high risk of bias in the patient and index test domains of QUADAS2. The diagnostic performance of 5 PET parameters were reported in at least one study but only SUVmax (n = 7) was reported in >2. Median SUVmax ranged from 9.2 to 10.9 in FL/iNHL and from 13.7 to 24.4 in HT. While SUVmax was consistently higher in the HT group, there was considerable overlap between the two groups and significant variability between studies. Area under the ROC curve for SUVmax to distinguish between FL/iNHL and HT ranged from 0.68 to 0.97. Sensitivity and specificity of the proposed cutoffs also varied widely (sensitivity ∼0.6 to 1, specificity ∼0.4 to 1). In conclusion, few studies - mostly small and potentially biased - have addressed this question. Although SUVmax is generally higher in HT than in FL, the diagnostic performance and optimal cutoffs remain unclear. Proposed SUVmax cutoffs should not be used to determine whether a patient has HT or to decide whether a biopsy should be obtained. For now, we encourage physicians to evaluate results of their own practice to devise a prudent workup of suspected.
支持正电子发射断层扫描（PET）用于评估滤泡性淋巴瘤（FL）疑似组织学转化（HT）的证据强度尚不清楚。我们对报告了≥1个PET参数在已知FL患者中检测HT的诊断性能的研究进行了系统评价。我们在PubMed上搜索了任何报告≥1个诊断性能指标的研究。使用QUADAS2工具评估偏倚风险。我们纳入了7项研究，其中包括152例活检显示为FL（或惰性非霍奇金淋巴瘤）的患者和111例活检证实为HT的患者。研究设计和研究人群差异很大。PET方法报告不佳，氟代脱氧葡萄糖（F-FDG）剂量变化很大。大多数研究在QUADAS2的患者和指标测试领域被判定为高偏倚风险。至少有一项研究报告了5个PET参数的诊断性能，但只有最大标准摄取值（SUVmax，n = 7）在>2项研究中被报告。FL/惰性非霍奇金淋巴瘤（iNHL）的SUVmax中位数范围为9.2至10.9，HT的SUVmax中位数范围为13.7至24.4。虽然HT组的SUVmax始终较高，但两组之间有相当大的重叠，且研究之间存在显著差异。用于区分FL/iNHL和HT 的SUVmax的受试者工作特征曲线（ROC）下面积范围为0.68至0.97。提议的截断值的敏感性和特异性也有很大差异（敏感性约为0.6至1，特异性约为0.4至1）。总之，很少有研究——大多规模小且可能存在偏倚——探讨过这个问题。虽然HT中的SUVmax通常高于FL，但诊断性能和最佳截断值仍不清楚。提议的SUVmax截断值不应被用于确定患者是否患有HT或决定是否应进行活检。目前，我们鼓励医生评估自己的临床实践结果，以制定对疑似病例的谨慎检查方案。
