Abstract：
OBJECTIVE: To systematically determine the role of FDG PET/CT for the diagnosis of bone marrow involvement in mature T- and natural killer (NK)-cell lymphomas.
METHODS: The PubMed, Embase and Cochrane Library databases were searched to identify eligible studies. Data extraction and quality assessment were independently conducted. Then, pooled diagnostic performance with the 95 % confidence interval (CI) was calculated and further analyzed based on different interpretation criteria, tumor type and stage.
RESULTS: Fifteen studies were eventually included for quantitative analysis. Overall, the methodological quality of included studies was acceptable. For detecting bone marrow involvement, FDG PET/CT achieved a poor sensitivity of 0.62 (95 % CI, 0.48-0.71) and a reasonable specificity of 0.92 (95 % CI, 0.87-0.96). Similar performance was observed for the specific type of extranodal NK/T-cell lymphoma (ENKTCL). In early-stage patients revealed by PET/CT, extremely small proportion (2/777) showed positive bone marrow biopsy, especially for the specific type of ENKTCL, whereas in advanced-stage patients, the specificity of FDG PET/CT dropped to 0.77 (95 % CI, 0.72-0.82). Regarding the interpretation, both diffuse and focal increased uptake patterns as positivity may result in increased sensitivity but decreased specificity compared with focal pattern alone as positivity.
CONCLUSIONS: FDG PET/CT demonstrated excellent negative predictive value for detecting marrow involvement in early-stage patients with mature T- and NK-cell lymphomas, especially the ENKTCL. Conversely, FDG PET/CT showed poor performance for the diagnosis of bone marrow involvement in advanced-stage patients.
METHODS: The PubMed, Embase and Cochrane Library databases were searched to identify eligible studies. Data extraction and quality assessment were independently conducted. Then, pooled diagnostic performance with the 95 % confidence interval (CI) was calculated and further analyzed based on different interpretation criteria, tumor type and stage.
RESULTS: Fifteen studies were eventually included for quantitative analysis. Overall, the methodological quality of included studies was acceptable. For detecting bone marrow involvement, FDG PET/CT achieved a poor sensitivity of 0.62 (95 % CI, 0.48-0.71) and a reasonable specificity of 0.92 (95 % CI, 0.87-0.96). Similar performance was observed for the specific type of extranodal NK/T-cell lymphoma (ENKTCL). In early-stage patients revealed by PET/CT, extremely small proportion (2/777) showed positive bone marrow biopsy, especially for the specific type of ENKTCL, whereas in advanced-stage patients, the specificity of FDG PET/CT dropped to 0.77 (95 % CI, 0.72-0.82). Regarding the interpretation, both diffuse and focal increased uptake patterns as positivity may result in increased sensitivity but decreased specificity compared with focal pattern alone as positivity.
CONCLUSIONS: FDG PET/CT demonstrated excellent negative predictive value for detecting marrow involvement in early-stage patients with mature T- and NK-cell lymphomas, especially the ENKTCL. Conversely, FDG PET/CT showed poor performance for the diagnosis of bone marrow involvement in advanced-stage patients.
摘要：
目的：系统确定FDGPET/CT在诊断成熟T-和自然杀伤（NK）细胞淋巴瘤骨髓受累中的作用。
方法：PubMed，搜索Embase和Cochrane图书馆数据库以确定合格的研究。独立进行数据提取和质量评价。然后，基于不同的解释标准,计算并进一步分析了具有95%置信区间(CI)的合并诊断性能,肿瘤类型和分期。
结果：最终纳入15项研究进行定量分析。总的来说,纳入研究的方法学质量是可以接受的.为了检测骨髓受累，FDGPET/CT的敏感性差，为0.62（95％CI，0.48-0.71），合理的特异性为0.92（95％CI，0.87-0.96）。对于特定类型的结外NK/T细胞淋巴瘤(ENKTCL)观察到类似的表现。在PET/CT显示的早期患者中，极小比例（2/777）显示骨髓活检阳性，特别是对于特定类型的ENKTCL，而在晚期患者中，FDGPET/CT的特异性降至0.77（95％CI，0.72-0.82）。关于解释，与仅作为阳性的局灶性模式相比，作为阳性的弥漫性和局灶性增加的摄取模式可能导致敏感性增加，但特异性降低。
结论：FDGPET/CT在检测早期T和NK细胞淋巴瘤患者的骨髓受累方面表现出良好的阴性预测值，尤其是ENKTCL。相反，FDGPET/CT在诊断晚期患者骨髓受累方面表现不佳。
方法：PubMed，搜索Embase和Cochrane图书馆数据库以确定合格的研究。独立进行数据提取和质量评价。然后，基于不同的解释标准,计算并进一步分析了具有95%置信区间(CI)的合并诊断性能,肿瘤类型和分期。
结果：最终纳入15项研究进行定量分析。总的来说,纳入研究的方法学质量是可以接受的.为了检测骨髓受累，FDGPET/CT的敏感性差，为0.62（95％CI，0.48-0.71），合理的特异性为0.92（95％CI，0.87-0.96）。对于特定类型的结外NK/T细胞淋巴瘤(ENKTCL)观察到类似的表现。在PET/CT显示的早期患者中，极小比例（2/777）显示骨髓活检阳性，特别是对于特定类型的ENKTCL，而在晚期患者中，FDGPET/CT的特异性降至0.77（95％CI，0.72-0.82）。关于解释，与仅作为阳性的局灶性模式相比，作为阳性的弥漫性和局灶性增加的摄取模式可能导致敏感性增加，但特异性降低。
结论：FDGPET/CT在检测早期T和NK细胞淋巴瘤患者的骨髓受累方面表现出良好的阴性预测值，尤其是ENKTCL。相反，FDGPET/CT在诊断晚期患者骨髓受累方面表现不佳。
