Background/Objectives: This study evaluates the diagnostic accuracy of [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) using bone marrow biopsy (BMB) and clinical follow-up as reference standards. It further identifies predictive factors for bone marrow involvement (BMI) in non-Hodgkin lymphoma (NHL) patients.Methods: NHL patients who underwent [18F]FDG PET and BMB at diagnosis in a tertiary cancer center were included in this study. Diagnostic accuracy was analyzed, and logistic regression was performed to identify BMI predictors using Stata software version 17. A retrospective analysis of 262 NHL patients was conducted.Results: Concordance rates between [18F]FDG PET and BMB and between [18F]FDG PET and clinical follow-up were 75.6% and 88.1%, respectively. The primary cause of discordance between [18F]FDG PET and BMB was the detection of extra-iliac focal hypermetabolic bone marrow lesions by [18F]FDG PET, which were negative on BMB. The sensitivity, specificity, and accuracy of [18F]FDG PET were 62.9%, 80%, and 75.6%, respectively, with BMB as a reference, and 74.1%, 97.5%, and 88.2%, respectively, with clinical follow-up as a reference. The focal bone marrow [18F]FDG pattern was the most reliable indicator of BMI. Univariate logistic regression showed that advanced NHL stage, elevated alkaline phosphatase, thrombocytopenia, leukopenia, and elevated lactate dehydrogenase were significant predictors of BMI. Multivariate analysis revealed advanced NHL stage and thrombocytopenia as clinical predictors.Conclusions: [18F]FDG PET is a reliable tool for assessing BMI, providing comprehensive total-body evaluation and identifying extra-iliac involvement beyond the scope of BMB. The collective interpretation of molecular imaging, clinical, and biochemical factors is crucial for predicting BMI.
背景/目的：本研究以骨髓活检和临床随访为参照标准，评估[18F]氟脱氧葡萄糖正电子发射断层扫描对非霍奇金淋巴瘤骨髓浸润的诊断效能，并进一步探究骨髓浸润的预测因素。方法：纳入某三级癌症中心初诊时同时接受[18F]FDG PET和骨髓活检的非霍奇金淋巴瘤患者进行回顾性分析，共262例。采用Stata 17.0软件进行诊断效能分析和逻辑回归以确定骨髓浸润预测因子。结果：[18F]FDG PET与骨髓活检的总体一致率为75.6%，与临床随访的一致率为88.1%。两者差异主要源于[18F]FDG PET检测到髂外局灶性高代谢骨髓病灶而骨髓活检结果为阴性。以骨髓活检为参照时，[18F]FDG PET诊断骨髓浸润的敏感性、特异性及准确率分别为62.9%、80%和75.6%；以临床随访为参照时则分别为74.1%、97.5%和88.2%。局灶性骨髓[18F]FDG摄取模式是骨髓浸润最可靠的影像学标志。单因素分析显示晚期淋巴瘤分期、碱性磷酸酶升高、血小板减少、白细胞减少及乳酸脱氢酶升高是骨髓浸润的显著预测因素；多因素分析确定晚期分期和血小板减少为独立临床预测因子。结论：[18F]FDG PET是评估骨髓浸润的可靠工具，能实现全身综合评价并检测骨髓活检范围之外的髂外病灶。综合分子影像、临床及生化指标对预测骨髓浸润具有重要意义。
肿瘤(癌症)患者之家