Page 103 - ARNM-3-1

Advances in Radiotherapy
& Nuclear Medicine PET/CT in B-cell non-Hodgkin’s lymphoma

bone marrow, and adrenals demonstrated abnormalities same side of the diaphragm was noted in three patients;
on CT but had FDG absorption levels at the physiological therefore, the stage was changed to III; additional lesions
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threshold. Particularly, studies have shown the important in two extranodal organs were noted in one patient,
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role of PET/CT in assessing bone marrow lesions in NHL. which progressed to Stage IV. Among patients in Stage
Biopsy of all bone marrow lesions is impossible, and the II, additional lesions were found on the diaphragm side
assessment of bone marrow invasion based on CT or in five patients; therefore, they were restaged to III, and
magnetic resonance imaging (MRI) is difficult. Thus, ≥2 additional extranodal organs were detected in four
PET/CT with 64 molecular metabolism images can show patients, changing their stage to IV. Among patients with
lesions with increased FDG uptake very early. According Stage III disease, five progressed to Stage IV due to the
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to Adams et al., PET/CT can detect bone marrow lesions additional spread of extranodal lesions was noted. Thus,
with a sensitivity of 70.8 – 90.8%, specificity of 99.0 – 100%, PET/CT results showed a change in stage (increased stage)
and area under the receiver operating characteristic curve in 21 of the 86 patients (24.4%). The rate of stage change
of up to 99.83%. Compared to bone marrow biopsy results, between the rapidly and slowly progressing histopathology
PET/CT gave false-negative results in 3.1% of the patients groups was not significantly different. Thus, our research
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and false-positive results in 12.5% (P < 0.05). Similarly, results were not much different from the research results
Li et al. compiled research based on 36 published reports of others in Vietnam and worldwide. Therefore, FDG
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and revealed that PET/CT has a sensitivity of 93 – 99% and PET/CT is a very valuable method in diagnosing the B-cell
specificity of 98 – 99% in detecting bone marrow invasive lymphoma stage. Accurate assessment of the disease stage
lesions in NHL, whereas bone marrow biopsy had a lower helps doctors select appropriate treatment methods with
sensitivity of 34 – 55% and specificity of 92 – 100%. the highest effectiveness. In addition, PET/CT is very
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Berthet et al. studied 142 cases of diffuse large B-cell valuable in monitoring, evaluating treatment response,
lymphoma, and FDG PET/CT showed higher sensitivity and predicting B-cell NHL. Before PET/CT, 26 (30.2%),
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than bone marrow biopsy (94% vs. 24%, P < 0.001). The 29 (33.7%), 15 (17.5%), and 16 (18.6%) patients were in
negative report of PET/CT was also higher than that of Stages I, II, III, and IV, respectively. After PET/CT, the rates
bone marrow biopsy (98% vs. 80%, P < 0.01). 13 of Stages I, II, III, and IV cases were 22.1%, 26.8%, 20.9%,
and 30.2%, respectively. The rate of patients with increased
Compared with MRI, PET/CT has a comparable
ability to accurately diagnose lesions. However, in slowly stage after PET/CT scan in the rapidly progressing
histopathology group was higher (25%) than in the slowly
progressing lymphoma, MRI could detect lesions that progressing histology group (21.4%), and the difference
barely capture FDG on PET/CT. Wang et al. examined was not significant.
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338 patients and showed that in those with rapidly
progressing lymphomas, PET/CT and MRI had the same 5. Conclusion
accuracy rates in determining the disease stage (98%,
P < 0.05), and in slowly progressing disease, PET/CT PET/CT plays an important role in accurately determining
only had a diagnostic accuracy rate of 87%, whereas MRI the disease stage of B-cell NHL, helping detect additional
recorded up to 96%. Among these, many slowly lesions missed on conventional imaging diagnostic tools.
progressing histopathological lesions could not nearly Acknowledgments
capture FDG. Similarly, Maccioni et al. evaluated MRI
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as a good imaging diagnostic tool for lymphoma stages, The authors thank the patients and the colleagues who
and the results between MRI and FDG PET/CT were made this work possible.
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very similar. 15 18 FDG PET/CT is still the “gold standard” in
accurately assessing the stage of B-cell lymphoma. Funding
Herein, before PET/CT, 86 patients were staged None.
according to the Ann - Arbor classification based on the Conflict of interest
ultrasound, CT, and MRI findings: 30.2%, 33.7%, 17.5%,
and 18.6% of the patients were in Stages I, II, III, and Phuong Pham Cam is an Editorial Board Member of this
IV, respectively. After PET/CT, patients were restaged journal but was not in any way involved in the editorial
based on the lesion number and locations identified on and peer-review process conducted for this paper, directly
PET/CT images. After PET/CT, among patients with or indirectly. Separately, other authors declared that they
Stage 1 disease, three patients had additional lymph node have no known competing financial interests or personal
damage on the same side of the diaphragm, changing relationships that could have influenced the work reported
the stage to II; another lymph node damage on the in this paper.

Volume 3 Issue 1 (2025) 95 doi: 10.36922/arnm.4813