非霍奇金淋巴瘤中侵袭性淋巴瘤和惰性淋巴瘤的~(18)F-FDG PET/CT显像特征
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摘要
目的:分析非霍奇金淋巴瘤(non-Hodgkin's lymphoma,NHL)中侵袭性淋巴瘤和惰性淋巴瘤的临床病理参数和18F-FDG PET/CT代谢参数的差异,探讨18F-FDG PET/CT代谢参数对预测侵袭性和惰性淋巴瘤的价值。方法:回顾性分析2011年9月至2016年12月于哈尔滨医科大学附属肿瘤医院行18F-FDG PET/CT检查的66例淋巴瘤患者,记录患者的年龄、性别、是否发热、浅表及深部淋巴结受侵、结外侵犯、临床分期及PET/CT代谢参数[包括:最大标准化摄取值(maximum standardized uptake value,SUVmax)、肿瘤/纵隔血池比值(tumor SUVmaxvalue/mediastinal SUVmaxvalue,T/MB)、总糖酵解量(total lesion glycolysis,TLG)、肿瘤代谢体积(metabolic tumor volume,MTV)],分析以上各因素在侵袭性淋巴瘤与惰性淋巴瘤之间的差异,绘制PET/CT代谢参数诊断侵袭性淋巴瘤和惰性淋巴瘤的ROC曲线,并计算诊断效能。结果:侵袭性淋巴瘤和惰性淋巴瘤的年龄、性别、发热、浅表淋巴结侵犯、临床分期无统计学差异(P> 0. 05),而二者的深部淋巴结侵犯、结外受侵存在统计学差异(P <0. 05)。侵袭性淋巴瘤的SUVmax、T/MB、TLG较惰性淋巴瘤高(P <0. 05)。ROC曲线统计结果表明,SUVmax、T/MB、TLG分别以11. 49、3. 45、29. 44为截断点时诊断侵袭性和惰性淋巴瘤的效能最佳,灵敏度分别为75%、80. 4%、67. 9%;特异度分别为90%、90%、70%。结论:侵袭性淋巴瘤的SUVmax、T/MB和TLG显著高于惰性淋巴瘤,在分析诊断淋巴瘤侵袭性时,18F-FDG PET/CT各参数具有重要参考价值,可为临床决策提供依据。
Objective:To analyze the clinicopathologic parameters and ~(18)F-FDG PET/CT metabolic parameters of invasive lymphoma and indolent lymphoma and to discuss ~(18)F-FDG PET/CT metabolic parameters' value in predicting invasive lymphoma and indolent lymphoma.Methods:A retrospective analysis was made on sixty-six lymphoma patients who underwent ~(18)F-FDG PET/CT examination in Harbin Medical University Cancer Hospital from September 2011 to December 2016.The age,gender,fever,superficial and deep lymph nodes involvement,external organs invasion,Ann Arbor stage and PET/CT parameters such as maximum standardized uptake value(SUV_(max)),tumor SUV_(max) value/mediastinal SUV_(max) value(T/MB),total lesion glycolysis(TLG)and metabolic tumor volume(MTV) were recorded.The statistically analysis was used to discuss the differences of the above factors between the invasive lymphoma and indolent lymphoma,and draw ROC curve to explore PET/CT parameters' efficacy in diagnosing invasive lymphoma and indolent lymphoma.Results:The results showed that there was no difference in age,gender,presence of fever,superficial lymph nodes involvement and stage between the invasive lymphoma and indolent lymphoma(P>0.05),but there was significant difference in the involvement of deep lymph nodes and external organs(P <0.05).Invasive lymphoma had higher SUV_(max),T/MB and TLG than indolent lymphoma(P<0.05).The ROC curve showed that SUV_(max),T/MB and TLG had the best efficacy in the diagnosis of the invasive lymphoma and indolent lymphoma with the cut-off points of 11.49,3.45 and 29.44,respectively.The sensitivity of the diagnosis was 75%,80.4%,and 67.9%,respectively,and the specificity was 90%,90%,and 70%,respectively.Conclusion:The SUV_(max),T/MB and TLG of invasive lymphoma were significantly higher than those of indolent lymphoma.~(18)F-FDG PET/CT parameters have important reference value in the analysis of lymphoma invasiveness and can provide basis for clinical decision-making.
Objective:To analyze the clinicopathologic parameters and ~(18)F-FDG PET/CT metabolic parameters of invasive lymphoma and indolent lymphoma and to discuss ~(18)F-FDG PET/CT metabolic parameters' value in predicting invasive lymphoma and indolent lymphoma.Methods:A retrospective analysis was made on sixty-six lymphoma patients who underwent ~(18)F-FDG PET/CT examination in Harbin Medical University Cancer Hospital from September 2011 to December 2016.The age,gender,fever,superficial and deep lymph nodes involvement,external organs invasion,Ann Arbor stage and PET/CT parameters such as maximum standardized uptake value(SUV_(max)),tumor SUV_(max) value/mediastinal SUV_(max) value(T/MB),total lesion glycolysis(TLG)and metabolic tumor volume(MTV) were recorded.The statistically analysis was used to discuss the differences of the above factors between the invasive lymphoma and indolent lymphoma,and draw ROC curve to explore PET/CT parameters' efficacy in diagnosing invasive lymphoma and indolent lymphoma.Results:The results showed that there was no difference in age,gender,presence of fever,superficial lymph nodes involvement and stage between the invasive lymphoma and indolent lymphoma(P>0.05),but there was significant difference in the involvement of deep lymph nodes and external organs(P <0.05).Invasive lymphoma had higher SUV_(max),T/MB and TLG than indolent lymphoma(P<0.05).The ROC curve showed that SUV_(max),T/MB and TLG had the best efficacy in the diagnosis of the invasive lymphoma and indolent lymphoma with the cut-off points of 11.49,3.45 and 29.44,respectively.The sensitivity of the diagnosis was 75%,80.4%,and 67.9%,respectively,and the specificity was 90%,90%,and 70%,respectively.Conclusion:The SUV_(max),T/MB and TLG of invasive lymphoma were significantly higher than those of indolent lymphoma.~(18)F-FDG PET/CT parameters have important reference value in the analysis of lymphoma invasiveness and can provide basis for clinical decision-making.
引文
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[17] Dong F,Ke XY.Progress in treatment of aggressive non- Hodgkin's lymphoma[J].Chinese Journal of Practical Internal Medicine,2007,27(24):1894-1898.[董菲,克晓燕.侵袭性非霍奇金淋巴瘤治疗进展[J].中国实用内科杂志,2007,27(24):1894-1898.]
[18] Huang HH,Xiao F,Han XF,et al.Prognostic value of interim 18F-FDG PET/CT in patient with newly diagnosed diffuse large B-cell lymphoma[J].Tumor,2016,36(2):194-201.[黄洪晖,肖菲,韩晓凤,等.治疗中期18F-FDG PET/CT与初诊弥漫大B细胞淋巴瘤患者疗效及预后的相关性[J].肿瘤,2016,36(2):194-201.]
[19] Tao XM.Progress in treatment of aggressive non-Hodgkin's lymphoma[J].Internal Medicine,2011,6(5):494-497.[陶晓明.侵袭性非霍奇金淋巴瘤治疗进展[J].内科,2011,6(5):494-497.]
[20] Li Z,Tan XH,Cen H.Meta-analysis of chemoradiotherapy for limited aggressive non-Hodgkin's lymphoma in clinical significance[J].Chinese Journal of Cancer Prevention and Treatment,2015,22(11):885-890.[李喆,谭晓虹,岑洪.局限期侵袭性非霍奇金淋巴瘤联合放化疗临床意义Meta分析[J].中华肿瘤防治杂志,2015,22(11):885-890.]
[2] Qin CX,Lan XL.Application of PET/CT in therapeutic evaluation of malignant lymphoma[J].J Clin Intern Med,2015,32(3):166-169.[覃春霞,兰晓莉.PET/CT在恶性淋巴瘤疗效评估中的应用[J].临床内科杂志,2015,32(3):166-169.]
[3] Boellaard R,Delgado-Bolton R,Oyen WJ,et al.FDG PET/CT:EANM procedure guidelines for tumour PET imaging:Version 2.0[J].Eur J Nucl Med Mol Imaging,2015,42:328-354.
[4] Meignan M,Sasanelli M,Casasnovas RO,et al.Metabolic tumour volumes measured at staging in lymphoma:Methodological evaluation on phantom experiments and patients[J].Eur J Nucl Med Mol Imaging,2014,41:1113-1122.
[5] Cottereau AS,Lanic H,Mareschal S,et al.Molecular profile and FDG-PET/CT total metabolic tumor volume improve risk classification at diagnosis for patients with diffuse large B cell lymphoma[J].Clin Cancer Res,2016,22(15):3801-3809.
[6] Cheson BD,Fisher RI,Barrington SF,et al.Recommendations for initial evaluation,staging,and response assessment of Hodgkin and non-Hodgkin lymphoma:The Lugano classification[J].J Clin Oncol,2014,32(27):3059-3068.
[7] Guo K,Huang Y,Wei YX,et al.18F-FDG PET/CT for screening of lymphoma in patients with fever of unknown origin[J].Journal of Chinese Oncology,2017,23(2):116-120.[郭坤,黄勇,魏熠鑫,等.18F-FDG PET/CT在不明原因发热患者中对淋巴瘤的筛查价值[J].肿瘤学杂志,2017,23(2):116-120.]
[8] Kitajima K,Miyoshi Y.Present and future role of FDG-PET/CT imaging in the management of breast cancer[J].Jpn J Radiol,2016,34(3):167-180.
[9] Ding CY,Sun J,Wu YL,et al.Maximum standard uptake on pretreatment 18F-FDG PET/CT scan in assessment of prognosis of nasal natural killer/T-cell lymphoma[J].Chin J Med Imaging Technol,2015,31(5):729-732.[丁重阳,孙晋,吴宇霖,等.治疗前18F-FDG PET/CT最大标准摄取值评估鼻腔NK/T细胞淋巴瘤的预后[J].中国医学影像技术,2015,31(5):729-732.]
[10] Golder W.Positron emission tomography and lymphoma therapy[J].Onkologie,2001,24(5):496-498.
[11] Barrington SF,Mikhaeel NG,Kostakoglu L,et al.Role of imaging in the staging and response assessment of lymphoma:Consensus of the international conference on malignant lymphomas imaging working group[J].J Clin Oncol,2014,32(27):3048-3058.
[12] Li J.18F-FDG PET/CT in diagnose and treatment of non Hodgkin's lymphoma[D].Jilin:Jilin University,2014.[李佳.18F-FDG PET/CT在非霍奇金淋巴瘤诊断及治疗中的意义[D].吉林:吉林大学,2014.]
[13] Ma LF,Fan W.18F-FDG uptake of lymphoma lesions of various histological subtypes[J].Chinese Journal of Cancer,2009,28(4):425-430.[马林峰,樊卫.淋巴瘤病灶对18F-FDG摄取与不同病理亚型的关系[J].癌症,2009,28(4):425-430.]
[14] Sch?der H,Noy A,G?nen M,et al.Intensity of 18-fluorodeoxyglucose uptake in positron emission tomography distinguishes between indolent and aggressive non-Hodgkin's lymphoma[J].J Clin Oncol,2005,23(21):4643-4651.
[15] Niu B,Wang SC,Hu B,et al.The correlation of SUV and LDH in non-Hodgkin's lymphoma[J].Chinese Clinical Oncology,2011,16(2):151-153.[牛奔,汪世存,胡冰,等.PET/CT标准摄取值和LDH与非霍奇金淋巴瘤临床病理特征的相关性研究[J].临床肿瘤学杂志,2011,16(2):151-153.]
[16] Gui S,Tang RJ,Li JS,et al.Correlation analysis of the SUV value in pre-therapy FDG-PET/CT in patients with non-Hodgkin's lymphoma[J].Chinese Journal of Coal Industry Medicine,2014,17(11):1741-1745.[桂思,汤日杰,李建生,等.非霍奇金淋巴瘤治疗前PET/CT中SUV的相关因素研究[J].中国煤炭工业医学杂志,2014,17(11):1741-1745.]
[17] Dong F,Ke XY.Progress in treatment of aggressive non- Hodgkin's lymphoma[J].Chinese Journal of Practical Internal Medicine,2007,27(24):1894-1898.[董菲,克晓燕.侵袭性非霍奇金淋巴瘤治疗进展[J].中国实用内科杂志,2007,27(24):1894-1898.]
[18] Huang HH,Xiao F,Han XF,et al.Prognostic value of interim 18F-FDG PET/CT in patient with newly diagnosed diffuse large B-cell lymphoma[J].Tumor,2016,36(2):194-201.[黄洪晖,肖菲,韩晓凤,等.治疗中期18F-FDG PET/CT与初诊弥漫大B细胞淋巴瘤患者疗效及预后的相关性[J].肿瘤,2016,36(2):194-201.]
[19] Tao XM.Progress in treatment of aggressive non-Hodgkin's lymphoma[J].Internal Medicine,2011,6(5):494-497.[陶晓明.侵袭性非霍奇金淋巴瘤治疗进展[J].内科,2011,6(5):494-497.]
[20] Li Z,Tan XH,Cen H.Meta-analysis of chemoradiotherapy for limited aggressive non-Hodgkin's lymphoma in clinical significance[J].Chinese Journal of Cancer Prevention and Treatment,2015,22(11):885-890.[李喆,谭晓虹,岑洪.局限期侵袭性非霍奇金淋巴瘤联合放化疗临床意义Meta分析[J].中华肿瘤防治杂志,2015,22(11):885-890.]