Hodgkin ve agresif B hücreli hodgkin dışı lenfomaların yönetiminde FDG-pet/bt'nin rolü
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Date
2012
Authors
Acar, Celal
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Publisher
Uludağ Üniversitesi
Abstract
Lenfomalar, immun sistem hücrelerinin çeşitli farklılaşma aşamalarından köken alan malignitelerdir. Tüm kanserlerin % 3-4'ünü oluştururlar. Yüksek tedavi başarısına rağmen önemli oranda tedavi direnci veya nüks görülmesi nedeniyle lenfomalarda tedavi ve takip planı önemlidir. Bu yüzden 3 boyutlu, invazif olmayan, fonksiyonel bir görüntüleme yöntemi olan FDG-PET ile FDG-PET/BT kullanımı, lenfomanın yaklaşımında ve yönetiminde önemli role sahiptir. Çalışmamızda, lenfomaların tanısı, tedavisi ve takibinde özellikle FDG-PET/BT olmak üzere görüntülemenin etkinliği geriye dönük olarak değerlendirildi. Bu amaçla; U.Ü.T.F İç Hastalıkları A.D. Hematoloji polikliniğinde Ocak 2004-Mayıs 2012 tarihleri arasında takip edilen 96 lenfoma tanılı (agresif Hodgkin dışı ve Hodgkin) hastanın verileri incelendi. Hastaların demografik bilgileri, biyokimyasal testleri, biyopsileri ile tedavi öncesi ve sonrası görüntülemeleri, takipte görülen olayları kaydedildi. Takip amaçlı 282 FDG-PET/BT patolojik olarak değerlendirildiğinde, %5,7 gerçek pozitiflik ve gerçek negatiflik ile %7,5 yanlış pozitiflik görüldü. FDG-PET/BT takibinin duyarlılığı %100, özgünlüğü %92,1 doğruluğu %93, olumlu öngörüsü %43,2, olumsuz öngörüsü %100 saptandı. Takipte ortalama SUVmax değerleri; gerçek pozitif lezyonlarda 13±7, yanlış pozitif lezyonlarda ise 5,3±4,2 hesaplandı. Takip FDG-PET/BT'lerde en uygun SUVmax sınır değeri %87,5 duyarlılık ve %71,4 özgüllükle 6,1 olarak bulundu. Patolojik değerlendirme ile klinik değerlendirme birleştirildiği zaman 125 lezyonda %69 duyarlılık ve %83 özgüllükle en uygun SUVmax değeri 5 olarak bulundu. Klinik değerlendirme yapılan 88 hastada tam ve yetersiz yanıtlı hastalar BT ile değerlendirildiğinde duyarlılık, özgüllük, doğruluk, olumlu ve olumsuz öngörü sırasıyla %69, %57, %60, %40, %81; FDG-PET/BT ile değerlendirildiğinde %62, %90, %82, %73, %85 olarak hesaplandı. Çalışmamızın sonucunda literatürle uyumlu olarak; FDG-PET/BT'in özellikle nüksün öngörülmesinde diğer konvansiyonel yöntemlere göre daha üstün olduğu görülmüştür.
Lymphomas are malignancy of the immune system cells that originate from various stages of differentiation, and account for about 4% of cancers in the worldwide. Despite the high treatment success rates, therapy management and the follow-up plan are important due to significant refractory nature of the disease or recurrence rate in lymphomas. Therefore, FDG-PET or FDG-PET/CT scans that are noninvasive, three-dimensional functional visualizations techniques have an important role in the evaluation and management of malignant lymphoma. In this study, efficiency of imaging modalities was evaluated retrospectively, in diagnosis, treatment and follow-up of lymphoma, particularly for FDG-PET/BT. For this purpose; data from 96 patients with aggressive non-Hodgkin's and Hodgkin's lymphoma who admitted to Department of U.Ü.T.F Internal Medicine Hematology outpatient clinic between January 2004-May 2012 was analyzed. Patient?s demographic data, biochemical test results, biopsy results, imaging scans before and after treatment and events in the follow-up stage were recorded. From the pathologic evaluation of 282 surveillance FDG-PET/CT?s, metrics for true positivity with negativity and false positivity were found 5.7% and 7.5% respectively. Sensitivity, specificity, accuracy, positive and negative predictive values of routine FDG-PET/CT surveillance were found 100%, 92.1%, 93%, 43.2% and 100%, respectively. The mean SUVmax values were 13±7 and 5.3±4.2 in true positive and false positive lesions. Appropriate SUVmax cutoff value was found 6.1 with 87.5% sensitivity and 71.4% specificity in surveillance FDG-PET/CT?s. When combined with clinical and pathological evaluation in surveillance FDG-PET/CT?s, appropriate SUVmax cutoff value was found five with 69% sensitivity and 83% specificity in 125 lesions. When 88 patients were assessed as complete response and poor response by CT and FDG-PET/CT in clinical evaluation; sensitivity, specificity, accuracy, positive and negative predictive value of CT were %69, %57, %60, %40, %81 and sensitivity, specificity, accuracy, positive and negative predictive value of FDG-PET/CT were %62, %90, %82, %73, %85. As a result of this study, FDG-PET/CT was found to be superior to the other conventional methods such as CT, particularly in accurate prediction, which is consistent with the findings of the literature survey.
Lymphomas are malignancy of the immune system cells that originate from various stages of differentiation, and account for about 4% of cancers in the worldwide. Despite the high treatment success rates, therapy management and the follow-up plan are important due to significant refractory nature of the disease or recurrence rate in lymphomas. Therefore, FDG-PET or FDG-PET/CT scans that are noninvasive, three-dimensional functional visualizations techniques have an important role in the evaluation and management of malignant lymphoma. In this study, efficiency of imaging modalities was evaluated retrospectively, in diagnosis, treatment and follow-up of lymphoma, particularly for FDG-PET/BT. For this purpose; data from 96 patients with aggressive non-Hodgkin's and Hodgkin's lymphoma who admitted to Department of U.Ü.T.F Internal Medicine Hematology outpatient clinic between January 2004-May 2012 was analyzed. Patient?s demographic data, biochemical test results, biopsy results, imaging scans before and after treatment and events in the follow-up stage were recorded. From the pathologic evaluation of 282 surveillance FDG-PET/CT?s, metrics for true positivity with negativity and false positivity were found 5.7% and 7.5% respectively. Sensitivity, specificity, accuracy, positive and negative predictive values of routine FDG-PET/CT surveillance were found 100%, 92.1%, 93%, 43.2% and 100%, respectively. The mean SUVmax values were 13±7 and 5.3±4.2 in true positive and false positive lesions. Appropriate SUVmax cutoff value was found 6.1 with 87.5% sensitivity and 71.4% specificity in surveillance FDG-PET/CT?s. When combined with clinical and pathological evaluation in surveillance FDG-PET/CT?s, appropriate SUVmax cutoff value was found five with 69% sensitivity and 83% specificity in 125 lesions. When 88 patients were assessed as complete response and poor response by CT and FDG-PET/CT in clinical evaluation; sensitivity, specificity, accuracy, positive and negative predictive value of CT were %69, %57, %60, %40, %81 and sensitivity, specificity, accuracy, positive and negative predictive value of FDG-PET/CT were %62, %90, %82, %73, %85. As a result of this study, FDG-PET/CT was found to be superior to the other conventional methods such as CT, particularly in accurate prediction, which is consistent with the findings of the literature survey.
Description
Keywords
Hodgkin ve agresif Hodgkin dışı lenfoma, FDG-PET/BT, Etkinlik, SUVmax, Geriye dönük, Hodgkin and aggressive non Hodgkin lymphoma, FDG-PET/CT, Efficiency, Retrospective
Citation
Acar, C. (2012). Hodgkin ve agresif B hücreli hodgkin dışı lenfomaların yönetiminde FDG-pet/bt'nin rolü. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.