Biopsy remains indispensable for evaluating bone marrow involvement in DLBCL patients despite the use of positron emission tomography
Biopsy remains indispensable for evaluating bone marrow involvement in DLBCL patients despite the use of positron emission tomography
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DOI：
10.1007/s12185-021-03080-3
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发表时间：
2021-01-30
影响因子：
2.1
通讯作者：
Arai, Ayako
中科院分区：
文献类型：
--
作者：
Saiki, Yusuke;Tomita, Naoto;Arai, Ayako
对于弥漫性大B细胞淋巴瘤（DLBCL）患者，建议通过正电子发射断层扫描/计算机断层扫描（PET/CT）进行初始分期。是否需要PET/CT和骨髓活检（BMB）仍不清楚。本研究探讨了PET/CT分期是否足够。包括使用PET/CT和BMB评估的患有未经治疗的DLBCL的参与者。患者接受放射科医生和血液病理学家的独立诊断评估。苏木精-伊红染色和CD 20免疫组化检测BMB的骨髓浸润情况。共纳入84例患者。通过PET/CT和BMB确定的阳性骨髓受累患者数量分别为16例（19%）和22例（26%）。8例（10%）患者在两项试验中均显示阳性结果。当考虑BMB作为参考时，PET/CT显示36%的敏感性和87%的特异性，阳性和阴性预测值分别为50%和79%。BMB阳性患者的无进展生存期（PFS）和总生存期（OS）均短于BMB阴性患者。与PET/CT阴性患者相比，PET/CT阳性患者的PFS和OS无显著差异。然而，在16例PET/CT阳性患者中，观察到BMB阳性患者的PFS和OS较差。BMB仍然是未经治疗的DLBCL患者分期的强制性步骤。
Initial staging by positron emission tomography/computed tomography (PET/CT) scanning is recommended for patients with diffuse large B-cell lymphoma (DLBCL). Whether both PET/CT and bone marrow biopsy (BMB) are required remains unclear. This study examined whether staging by PET/CT is sufficient. Participants with untreated DLBCL assessed using both PET/CT and BMB were included. Patients received independent diagnostic assessments from a radiologist and a hematopathologist. Both hematoxylin-eosin staining and CD20 immunostaining were performed to determine the bone marrow involvement in BMB. A total of 84 patients were included. The number of patients with positive bone marrow involvement identified by PET/CT and BMB was 16 (19%) and 22 (26%), respectively. Eight (10%) patients showed positive results in both tests. When considering BMB as a reference, PET/CT showed 36% sensitivity and 87% specificity, with positive and negative predictive values of 50% and 79%, respectively. BMB-positive patients had shorter progression-free (PFS) and overall (OS) survival than their BMB-negative counterparts. Compared to PET/CT-negative patients, patients with positive results did not show any significant differences in PFS and OS. However, among 16 PET/CT-positive patients, poor PFS and OS were observed among patients who were also BMB positive. BMB remains a mandatory step in staging of untreated DLBCL patients.