还能再观察下去吗@橙色雨丝@小猪泡泡

心念

2019年12月5日初次治疗，当时病理为滤泡3b级，3期，6次r-chop后CR,2014年4月穿刺确认复发，病理为滤泡1-2级，分期3期，观察等待一年后右颈包块明显变大，再次穿刺病理仍然滤泡1-2级，petct显示suv升高，尤其是膓系膜SUV高达12.7(一年前5.6）,同时也出现了一些新病灶，这次穿刺的还是颈部（suv 10,原来8.7），请教大神们以下几个问题
1、是否需要对肠系膜淋巴结穿刺活检？
2、现在还没有B症状，是否还可以继续观察？
3、若启动治疗，当地医生告知可能的方案是BR,但我看到当地也在招募epcoritamab +r2与r2对照组的三期临床试验，如果条件符合是否参加临床试验更有利？谢谢
附上刚做的病理报告和PET CT报告

来自苹果APP客户端

小刀影

其实也接近治疗指征了，如果能分到双抗组也算可以了。毕竟双抗可不便宜

来自安卓APP客户端

小猪泡泡

时间写错了，应该是2024吧！petct做了没？具体也没看到你petct详细情况！肠系膜穿刺不是那么容易的，没有指证别急着做，艾伯维滤泡复发招募应该是没了，现在都是招募初治的，也可以考虑是其他双抗实验组。

来自安卓APP客户端

心念

谢谢泡泡群主回复，已经做了pet ct,相比2024年，又增加了很多新病灶，2024年只有颈部15*12 suv8.7,肠系膜16*8 suv5.6两处，今年对比颈部31*21 suv10,肠系膜20*11 suv12.7,这是否表明进展太快了呢，谢谢！

FDG PET-CT 17/06/2025 Reference: 5200899 NHI: SCN1208
Indication: Treated follicular lymphoma. Relapsing disease with new neck nodes.
Correlation: FDG PET-CT 05/06/2024.
FINDINGS:
Head/Brain: Physiological uptake in the cerebral and cerebellar hemispheres.
Pharynx: No abnormal uptake.
Neck: Cluster of tracer avid right level II nodes. The largest measures 31 x 21 mm SUV 10.0, previously 15 x 12 mm SUV 8.7.
Deauville 5. No left tracer avid left cervical nodes.
Mediastinum/Thoracic nodes: Multiple new avid thoracic nodes:
1) Cluster of left hilar nodes, largest measuring 15 x 11 mm SUV 4.1 Deauville 4.
2) Left internal mammary node, 9x7 mm SUV 6.1, Deauville 4.

Smaller nonmeasurable foci of Deauville 3 uptake at right hilar and para-oesophageal nodes.
Lungs: No suspicious pulmonary nodules or masses. Scattered nodules bilaterally measuring up to 4 mm in the lingula, unchanged from 12/02/2020 and considered benign.
Pericardium/pleura: No pleural or pericardial effusion.
Hepatobiliary: No abnormal uptake or suspicious hepatic lesions.
Scattered small probable cysts are stable. No biliary obstruction.
Spleen/Pancreas/Adrenal glands: Spleen is normal in size with physiologic uptake, no focal lesion. Unremarkable pancreas and adrenal glands.
Renal tracts: No solid lesions or hydronephrosis.
Retroperitoneum/Abdominopelvic nodes: Multiple avid nodes with Deauville 4 - 5 uptake.
1) Portocaval 17 x 13 mm SUV 3.4, Deauville 4
2) Proximal mesentery 12 x 10 mm SUV 3.2, Deauville 4.
3) Lower mesentery 20 x 11 mm SUV 12.7, previously 16 x 8 mm SUV 5.6.
Deauville 5.
4) Right inguinal 11 x 9 mm SUV 6.5.
GI tract/peritoneum: Physiological uptake in the bowel. No peritoneal nodularity or ascites.
Pelvic organs: Unremarkable.
Bones/soft tissue: No FDG avid or suspicious osseous lesions. No soft tissue lesions.
IMPRESSION: Since 5/6/2024,
1) Progressive adenopathy and increasing metabolic activity at known right cervical and mesenteric sites of nodal disease.
2) New thoracic, portocaval and right inguinal nodal disease.
3) No splenic or marrow involvement.
Deauville 5 disease.
TECHNIQUE: IV injection of 287MBq 18F-FDG and 59 minute uptake period. PET and CT (82mls Omnipaque 350 IV) images from vertex to thigh were acquired. Plasma glucose 5.6mmol/1. Liver background
SUVmean = 2.4.

来自苹果APP客户端