Ann Arbor 分期划分淋巴瘤淋巴结区域的意义探讨

Significance of lymph node regions of lymphoma classified by Ann Arbor staging

摘要:

分析淋巴瘤Ann Arbor淋巴结分区法对胸部淋巴瘤累及范围分布划分的充分性，探讨其对淋巴瘤淋巴区域累及野放疗设计的意义。方法收集湖南省肿瘤医院初治的24 例治疗前进行过18F-FDGPET/CT 检查的累及胸部的淋巴瘤患者，根据PET/CT 检查显示统计病变在胸部累及的区域以及各个区域的发生率。结果淋巴瘤患者在胸部可累及多个区域，病变累及最多的区域是纵隔的4R 区（66.7%，16/24），其次是双侧锁骨上区（62.5%，15/24）；14 例（58%）患者累及除Ann Arbor 分期设定的纵隔、肺门、腋窝及锁骨上下区 之外的淋巴结区域，包括内乳区淋巴结、心包、胸壁、横隔上淋巴结及膈角后淋巴结。结论18F-FDG PET/CT能精确显示淋巴瘤在胸部受累的淋巴结区域，目前的Ann Arbor分期并不能详细包括累及胸部的淋巴瘤受累区域，需要尽早设计出更精确的淋巴瘤受累区域区，以适合现代放疗靶区设计的范围定义及诊断。

Abstract:

To evaluate the rationality of the Ann Arbor staging classification (COSTWOLD amendment)in defining the distribution of the thoracic lymph nodes involved by lymphomas. Methods Twenty-four patients withlymphomas involving thorax who received 18F-FDG PET/CT examination before treatment were studied. According to the results of 18F-FDG PET/CT examination, the thoracic regions involved by the lesions were revealed and the incidence of lymphoma in each region was statistically analyzed and then compared with the results by the Ann Arbor staging classification. Results Several nodal sites were involved in the lymphoma patients, the most frequent sites were group 4R lymph nodes in mediastinum (16/24, 66.7%), followed by supraclavicular lymph nodes (15/24,62.5%). The nodal sites excluded in the Ann Arbor staging classification were involved in 14 patients (58%),including internal mammary, pericardial, super diaphragmatic, thoracic wall and retrocrural lymph nodes.Conclusions 18F-FDG PET/CT can accurately detect thoracic lymph node regions involved by lymphomas. The definition of nodal sites in thorax by the Ann Arbor staging classification can not include all the nodal sites for malignant lymphomas. More precise definition of nodal sites is needed for diagnose of lymphomas and design of modern radiotherapy targets.