摘要
目的探讨弥漫大B细胞淋巴瘤（DLBCL）化疗后残余淋巴结的血流动力学状态、病理、影像及超声学改变，评价淋巴结性质及其与临床治疗的关系。方法分析50例经足疗程（R-CHOP方案6-8个疗程）化疗后有残余淋巴结存在的DLBCL患者，对其进行彩色多普勒超声检查，行超声引导下的淋巴结穿刺活组织检查，部分患者残余淋巴结与PET—CT结合，分析残余淋巴结性质。结果50例DLBCL的患者足疗程化疗后，彩色超声共发现64枚淋巴结。其中42例患者53枚残余淋巴结未见动脉血流，病理活组织检查HE染色符合临床完全缓解标准。另8例患者11枚淋巴结超声提示淋巴结周边型血流；同时PET-CT显示这些淋巴结的标准摄取值较高，提示组织处于高代谢状态，与超声动力学状态相符合；选取残余淋巴结再行活组织检查HE染色，可见淋巴结残余病灶组织，未见肿瘤组织。42例治疗有效的患者治疗后残余淋巴结为治疗后炎性反应或是纤维组织增生。结论经足疗程化疗后的患者淋巴结可持续存在，超声与PET．CT检查对恶性淋巴瘤残余病变的诊断有较好的准确性，化疗后4周复查彩色超声示淋巴结长径〉1．5om、血流信号呈中心型血流或者周边型，可行PET，CT检查作为评价肿瘤残余性质的参考指标。
Objective To evaluate hemodynamic status, pathological, imaging and ultrasound changes of residual lymph nodes from diffuse large B-cell lymphoma （DLBCL） after chemotherapy and their relationship with clinical treatment after chemotherapy. Methods 50 DLBCL patients undergoing full course of chemotherapy but still bearing residual lymph nodes were examined with ultrasound-guided lymph node biopsy. Some examinations were combined with PET-CT to analyze properties of residual lymph nodes. Results 64 lymph nodes were identified by color Doppler ultrasounda in the 50 DLBCL patients treated with full course of chemotherapy. Among them, 53 lymph nodes from 42 patients did not show artery blood flow and HE staining of these lymph node biopsy met the clinical standard for complete remission. For the other 11 lymph nodes from 8 patients, ultrasound examination displayed surrounding blood flow inside. At the same time, PET-CT showed that these lymph nodes had higher SUV values, implying high metabolic state in these tissues, which was in agreement with ultrasonic examination results. However, HE staining of these lymph nodes biopsy demonstrated only residual lesion but no tumor tissue. Conclusions Lymph nodes still exist in DLBCL patients treated with full course of chemotherapy. Ultrasound and PET-CT examination have high accuracy in diagnosing benign and malignant residual lymph nodes in follow-up examination on 4 weeks after chemotherapy showed that lymph nodes are over 〉 1.5 cm in length and have central or peripheral blood flow. Therefore, PET-CT examination of tumor could be considered as a reference index in characterizing residual tumors after chemotherapy.
出处
《白血病．淋巴瘤》
CAS
2014年第5期281-283,293,共4页
Journal of Leukemia & Lymphoma
