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霍奇金淋巴瘤(Hodgkin lymphoma,HL)是一种罕见的累及淋巴结及淋巴系统的恶性肿瘤。世界卫生组织将HL分为两种主要类型:结节性淋巴细胞为主型霍奇金淋巴瘤(nodular lymphocyte predominant Hodgkin lymphoma,NLPHL)和经典型霍奇金淋巴瘤(classical Hodgkin lymphoma,CHL)[1]。近几十年来,随着个体化治疗方案的实施,HL患者的治疗已有明显进展,现在至少80%的患者可被治愈。治疗后定期复查,及时发现有无肿瘤残留或其他组织浸润,准确评价治疗效果并判断是否复发,对HL患者的预后或下一步治疗方案的选择有至关重要的意义。过去,临床常用B超、CT等影像学方法基于病灶大小、密度等形态学改变来评价HL治疗疗效,但均存在一定的局限性[2]。目前,能同时显示解剖结构和代谢信息的PET/CT已成为HL患者初始分期及治疗结束后疗效评估的重要手段,它对HL的诊断、疗效监测和预后判断具有重要作用,但对HL复发诊断的应用价值需更多临床研究证实[3]。2014年恶性淋巴瘤成像工作小组国际会议发表的共识中,推荐使用Deauville标准进行PET/CT报告分析,并认为这一标准方法简便、重复性好[4]。本研究选择24例临床可疑复发的HL患者进行研究,并基于Deauville标准进行PET/CT报告分析,旨在探讨18F-FDG PET/CT在HL复发诊断中的应用价值。
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本研究中PET/CT结果显示:1~2分(阴性)者2例;3分者2例,其中1例在降阶梯治疗后2个月,判定为阳性(图 1中A),另1例判定为阴性;4~5分(阳性)者19例;X分者1例,图像显示左上肺结节伴纵隔淋巴结肿大(图 1中B)。
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24例患者中经病理结果证实17例复发,3例淋巴结反应性增生,1例左肺上叶非小细胞肺癌伴纵隔淋巴结转移,3例未见明确复发。
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对比病理结果,本研究中共出现3例假阳性,其中,Deauville评分3分者1例,4~5分者2例。假阳性病例18F-FDG摄取增高的淋巴结主要分布在咽旁间隙、下颌下及纵隔内,未见骨髓18F-FDG摄取增高。Deauville评分与病理结果的相关性对照见表 1。
病理结果 Deauville评分 1~2分 3分 4~5分 复发 0 0 17 未复发 2 2 2 注:根据影像学判断,评分为X分的患者病灶不太可能与淋巴瘤相关,故不纳入相关性研究。 表 1 Deauville评分与病理结果对照(n=23)
Table 1. The correlation between the score of Deauville and pathologic results(n=23)
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根据Deauville标准,18F-FDG PET/CT对HL复发的诊断效能分别为:灵敏度100%(17/17)、特异度50%(3/6)、阳性预测值85%(17/20)、阴性预测值100%(3/3)、准确率87%(20/23)。根据影像学判断,评分为X分的患者病灶不太可能与淋巴瘤相关,故不纳入统计学处理。
基于Deauville标准探讨18F-FDG PET/CT在霍奇金淋巴瘤复发诊断中的应用价值
Value of 18F-FDG PET/CT on diagnosis of Hodgkin lymphoma recurrence using Deauville criterion
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摘要:
目的 基于Deauville标准探讨18F-FDG PET/CT在霍奇金淋巴瘤(HL)复发诊断中的应用价值。 方法 基于Deauville标准, 回顾性分析24例治疗结束后5~27个月, 临床可疑复发的HL患者, 对其18F-FDG PET/CT显像结果进行评分判断, 并与淋巴结活检和(或)骨髓活检病理结果进行对照分析。 结果 病理结果证实17例复发、3例淋巴结反应性增生、1例肺癌并纵隔淋巴结转移、3例未见明确复发。18F-FDG PET/CT诊断HL复发的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为100%、50%、85%、100%和87%。 结论 基于Deauville标准18F-FDG PET/CT在HL复发诊断中具有重要的临床应用价值。 -
关键词:
- 霍奇金病 /
- 氟脱氧葡萄糖F18 /
- 正电子发射断层显像术 /
- 体层摄影术, X线计算机 /
- 复发诊断 /
- Deauville标准
Abstract:Objective To investigate the diagnostic value of 18F-FDG PET/CT on Hodgkin lymphoma(HL) recurrence according to Deauville criterion. Methods Retrospective analysis was performed on 24 HL cases for a period of 5-27 months after treatment. These patients were clinically suspected of recurrence. Results of 18F-FDG PET/CT imaging according to Deauville criterion, lymph node biopsies, and(or) bone marrow biopsy pathology were analyzed and compared. Results Seventeen cases of recurrence were confirmed by pathologic findings. Three cases of lymph node reactive hyperplasia, 1 case of lung cancer with mediastinal lymph node metastasis, and 3 cases without recurrence were recorded. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 100%, 50%, 85%, 100%, and 87% for 18F-FDG PET/CT on HL recurrence diagnosis. Conclusion 18F-FDG PET/CT is of important clinical value on the diagnosis of HL recurrence according to the standard of Deauville criterion. -
表 1 Deauville评分与病理结果对照(n=23)
Table 1. The correlation between the score of Deauville and pathologic results(n=23)
病理结果 Deauville评分 1~2分 3分 4~5分 复发 0 0 17 未复发 2 2 2 注:根据影像学判断,评分为X分的患者病灶不太可能与淋巴瘤相关,故不纳入相关性研究。 -
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