PET/CT、骨髓活检及骨髓涂片评估弥漫大B细胞淋巴瘤骨髓侵犯的应用及预后价值  

Utility and prognostic value of PET/CT,bone marrow biopsy and aspirate for detection of bone marrow involvement in diffuse large B-cell lymphoma

作　　者：蒋显勇[1] 邹东梅 张迎强 王孜[1] 张薇[1] 周道斌[1] 张炎[1] Jiang Xianyong;Zou Dongmei;Zhang Yingqiang;Wang Zi;Zhang Wei;Zhou Daobin;Zhang Yan(Department of Hematology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院、北京协和医学院北京协和医院血液内科,北京100730 [2]中国医学科学院、北京协和医学院北京协和医院核医学科,北京100730

出　　处：《中华血液学杂志》2022年第8期663-667,共5页Chinese Journal of Hematology

摘　　要：目的探索PET/CT、骨髓活检(BMB)、骨髓涂片(BMA)在评估弥漫大B细胞淋巴瘤(DLBCL)骨髓侵犯中的作用及预后价值。方法回顾性分析2015年1月至2017年11月于北京协和医院确诊,且同时具有PET/CT、BMB、BMA结果的DLBCL患者的临床资料。髂骨骨髓SUVmax与正常肝脏组织SUVmax比值≥1为诊断PET/CT骨髓受累的标准。结果共纳入76例患者,男32例,中位年龄53(17~79)岁。PET/CT阳性者16例,BMB阳性者12例,BMA阳性者13例。BMB与BMA在诊断DLBCL骨髓侵犯方面具有良好一致性(κ=0.943),PET/CT与BMB(κ=0.763)及BMA(κ=0.776)的一致性略差。中位随访52(0~82)个月,BMB及BMA阳性是总生存的不良预后因素(P值分别为0.037和0.007),PET/CT阳性对预后无明显影响(P值均>0.05)。结论PET/CT、BMB、BMA对于诊断DLBCL骨髓侵犯具有较好的一致性,均为有效的检测手段。BMB和BMA的预后判断价值优于PET/CT。Objective This study aimed to determine the value of bone marrow biopsy(BMB),bone marrow aspiration(BMA),and positron emission tomography combined with computed tomography(PET/CT)in bone marrow(BM)involvement and prognosis evaluation in diffuse large B-cell lymphoma(DLBCL).Methods The clinical data of patients with DLBCL who underwent PET/CT,BMB,and BMA of the iliac crest were retrospectively analyzed in Peking Union Medical College Hospital from January 2015 to November 2017.The BM involvement on PET/CT was defined as the ratio of maximal standardized uptake values of iliac crest BM to liver parenchyma intensity≥1.Results A total of 76 patients without liver involvement were enrolled,there were 32 males,and the median age was 53(17-79).Moreover,16 patients(21.1%)had BM involvement on PET/CT,12(15.8%)had positive BMB,and 13(17.1%)had positive BMA.Excellent correlation between BMA and BMB(κ=0.943)was found,including good correlation between PET/CT and BMB/BMA(κ=0.763 and 0.776,respectively).After a median follow-up of 52(0-82)months,BM involvement by BMB(P=0.037)and BMA(P=0.007)were poor prognostic factors for overall survival,positive PET/CT had no significant effect on prognosis(P>0.05).Conclusion PET/CT,BMB,and BMA are effective methods to detect BM involvement with great concordance.However,iliac crest BMB and BMA showed superior performance in prognosis evaluation.

关 键 词：淋巴瘤 大B细胞 弥漫性 骨髓活检 骨髓涂片 正电子发射断层显像计算机体层摄影术 

分 类 号：R733.1[医药卫生—肿瘤]