MRI, sIL-2R Combination Showcases Great Diagnostic Accuracy for Soft Tissue NHL

Integrating a combination of MRI and serum soluble interleukin-2 receptor (sIL-2R) measurements can help clinicians more accurately detect and diagnose soft tissue non-Hodgkin lymphoma (NHL). The benefits of this approach were explored recently in Journal of Orthopaedics, which evaluated this technique for patients who were initially referred on the basis of a soft tissue tumor.¹

A need for more diagnostic accuracy in cases of soft tissue NHL remains. | Image Credit: © sizsuz - stock.adobe.com

Although soft tissue NHL remains rare, accounting for less than 1% of all NHL cases, these manifestations can often be misclassified as another type of soft tissue mass.^2,3 For this reason, histological examinations and biopsies remain ever important; however, as the present authors outlined, the utility of imaging modalities in soft tissue NHL diagnoses has gone understudied.¹ A plethora of literature bolsters support for the efficacy of sIL-2R in these processes, which prompted the researchers to evaluate the value of a dual approach that uses sIL-2R and MRI. Considering this reality, they conducted a retrospective study in hopes of developing improved diagnostic criteria for patients with NHL who stand at risk for misdiagnosis.

The medical records of patients with soft tissue NHL who visited the researchers’ department between July 2008 and April 2019 were reviewed. During this period, 36 of 2610 referred patients were diagnosed with soft tissue NHL, all of which had available MRI and sIL-2R data available. The researchers compared these cases with an additional 48 concerning patients (the control group) who received diagnoses of carcinoma or soft tissue carcinoma—with corresponding MRI and sIL-2R data—during the same period.

The patient cohort comprised 16 females and 20 males with soft tissue NHL, with a median age of 69.5 years. The control group comprised 20 females and 28 males, with a median aged of 66 years. Soft tissue NHL lesions manifested in patients’ chest wall (n = 6), thigh (n = 8), and retroperitoneum (n = 9). These lesions also exhibited a median diameter of 10 cm. For the control group, lesions were observed in the chest wall (n = 11), thigh (n = 7), and retroperitoneum (n = 15).

The most prevalent form of soft tissue NHL were diffuse large B-cell lymphoma (DLBCL; n = 25); patients also presented with follicular lymphoma (n = 4) and peripheral T-cell lymphoma (n = 4). Control individuals were most commonly diagnosed with soft tissue sarcoma (n = 29) and carcinoma (n = 14), with lesions exhibiting a median diameter of 7 cm.

Notabley, sIL-2R levels were significantly higher in those with soft tissue NHL (4164 U/mL vs 701 U/mL; P < .0001). The area under the curve (AUC) for predicting soft tissue NHL was 0.914, and specificity and sensitivity were 88% and 86%, respectfully, showing great promise.

“Further examination of the diagnostic accuracy of a combination of sIL-2R elevation and MRI appearance revealed that when one matched more than 1 factor, sensitivity was 92 % and specificity was 71 %; when one fulfilled both criteria, sensitivity was 72 % and specificity was 100 %,” the authors indicated.

“Homogeneous appearance on T2-weighted or STIR MRI with elevated sIL-2R level exceeding 904 U/ mL strongly suggested a diagnosis of soft tissue NHL in cases of suspected soft tissue tumors,” the authors wrote, citing that the diagnostic accuracy for soft tissue NHL specificity and sensitivity was 83% and 78%, respectfully.

With their combined approach showcases such great diagnostic accuracy, the authors conclude by highlighting the importance of their findings, especially for investigating soft tissue masses prior to performing biopsies.

References

1. Watanabe T, Torigoe T, Yazawa Y, Nakazawa K, Imanishi J. Diagnostic challenge: combination of magnetic resonance imaging and serum soluble Interleukin-2 receptor in soft tissue non-hodgkin lymphoma. J Orthop. 2024;62:1-6. doi:10.1016/j.jor.2024.10.019

2. Damron TA, Le MH, Rooney MT, Vermont A, Poiesz BJ. Lymphoma presenting as a soft tissue mass. A soft tissue sarcoma simulator. Clin Orthop Relat Res. 1999;(360):221-230. doi:10.1097/00003086-199903000-00026

3. Corti M, Villafañe MF, Bistmans A, Campitelli A, Narbaitz M. Soft-tissue masses as presentation of non-Hodgkin's lymphoma in AIDS patients. An Bras Dermatol. 2013;88(4):631-634. doi:10.1590/abd1806-4841.20132138