Abstract:
18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is now an integral part of lymphoma staging and management. Because of its greater accuracy compared with CT alone, PET/CT is currently routinely performed for staging and for response assessment at the end of treatment in the vast majority of FDG-avid lymphomas and is the cornerstone of response classification for these lymphomas according to the Lugano classification. Interim PET/CT, typically performed after 2 to 4 of 6 to 8 chemotherapy/chemoimmunotherapy cycles with or without radiation, is commonly performed for prognostication and potential treatment escalation or de-escalation early in the course of therapy, a concept known as response-adapted or risk-adapted treatment. Quantitative PET is an area of growing interest. Metrics, such as the standardized uptake value, changes (Δ) in the standardized uptake value, metabolic tumor volume, and total lesion glycolysis, are being investigated as more reproducible and potentially more accurate predictors of response and prognosis. Despite the progress made in standardizing the use of PET/CT in lymphoma, challenges remain, particularly with respect to its limited positive predictive value, emphasizing the need for more specific molecular probes. This review highlights the most relevant applications of PET/CT in Hodgkin and B-cell non-Hodgkin lymphoma, its strengths and limitations, as well as recent efforts at implementing PET/CT-based metrics as promising tools for precision medicine.
摘要:
18F-氟脱氧葡萄糖(FDG)正电子发射断层扫描/计算机断层扫描(PET/CT)现在是淋巴瘤分期和管理的组成部分。由于其与单独的CT相比具有更高的准确性,目前,PET/CT通常用于绝大多数FDG-avid淋巴瘤的分期和治疗结束时的反应评估,并且是根据Lugano分类对这些淋巴瘤进行反应分类的基石。中期PET/CT,通常在有或没有放疗的6至8个化疗/化学免疫疗法周期中的2至4个周期后进行,通常在治疗过程的早期进行预后和潜在的治疗升级或降级,称为反应适应或风险适应治疗的概念。定量PET是越来越感兴趣的领域。Metrics,例如标准化的摄取值,标准化摄取值的变化(Δ),代谢性肿瘤体积,和总病变糖酵解,正在被研究为更具可重复性和潜在更准确的反应和预后预测因子。尽管在标准化使用PET/CT在淋巴瘤中取得了进展,挑战依然存在,特别是关于其有限的阳性预测值,强调需要更具体的分子探针。这篇综述强调了PET/CT在霍奇金和B细胞非霍奇金淋巴瘤中最相关的应用。它的优势和局限性,以及最近在实施基于PET/CT的指标作为精准医学的有前途的工具方面的努力。