Okamoto Rumiko
Dept. of Chemotherapy, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan.
Gan To Kagaku Ryoho. 2009 Dec;36(13):2532-6.
18-Fluoro-deoxyglucose positron emission tomography (FDG-PET) has become widely used in the management of patients with malignant lymphomas. FDG-PET has been evaluated in pretreatment staging, restaging, monitoring during therapy, and posttherapy surveillance. The Ann Arbor staging system was initially based on physical examination and bone marrow evaluation, but more recently, CT scans or 67gallium scintigraphy have been incorporated. FDG-PET may provide complementary information to conventional staging methods, and may be of particular value prior to therapy for patients who appear to have stage I or II disease and for whom radiation therapy is being considered. FDG-PET has technical limitations, variability of FDG avidity among different lymphoma histologic subtypes, and in a large number of etiologies shows false-negative and false positive results. Most studies of FDG-PET involve patients with Hodgkin's disease or diffuse large B-cell lymphoma. FDG PET in lymphoma is being incorporated into the response assessment in lymphoma as published by the Imaging Subcommittee of International Harmonization Project in Lymphoma. New guidelines, the Revised Response Criteria for Malignant Lymphoma, are presented incorporating PET, IHC, and flow cytometry for definitions of response in non-Hodgkin's and Hodgkin's lymphoma. They should reduce the variability among studies. Standardized definitions of end points are provided. Standardized FDG-PET will hopefully lead to improved outcome for patients. PET as a biomarker has the potential to change the current model of drug development.
18-氟脱氧葡萄糖正电子发射断层扫描(FDG-PET)已广泛应用于恶性淋巴瘤患者的管理。FDG-PET已用于治疗前分期、再分期、治疗期间监测和治疗后监测。Ann Arbor分期系统最初基于体格检查和骨髓评估,但最近已纳入CT扫描或67镓闪烁显像。FDG-PET可为传统分期方法提供补充信息,对于看似处于I期或II期疾病且正在考虑放疗的患者,在治疗前可能具有特殊价值。FDG-PET存在技术局限性,不同淋巴瘤组织学亚型之间FDG摄取存在差异,并且在大量病因中会出现假阴性和假阳性结果。大多数FDG-PET研究涉及霍奇金病或弥漫性大B细胞淋巴瘤患者。淋巴瘤中的FDG PET正被纳入国际淋巴瘤协调项目影像小组委员会发布的淋巴瘤反应评估中。提出了新的指南,即《恶性淋巴瘤修订反应标准》,纳入了PET、免疫组化和流式细胞术,用于定义非霍奇金淋巴瘤和霍奇金淋巴瘤的反应。它们应减少研究之间的差异。提供了终点的标准化定义。标准化的FDG-PET有望改善患者的预后。PET作为一种生物标志物有可能改变当前的药物开发模式。