Bone marrow involvement in pediatric malignancies: a comparison study of Positron emission tomographycomputed tomography and bone marrow biopsy

Abstract

Background and Objectives. The comparison of Positron emission tomography- computed tomography (PETCT) and bone marrow biopsy (BMB) modalities in detecting bone marrow disease is an up to date research topic. In this study, we aimed to compare the results of PET-CT and BMB procedures in detecting bone marrow involvement in pediatric malignancies. Method. At the time of diagnosis, PET-CT imaging and BMB performed patients` data were evaluated, retrospectively. Malign diagnoses were Hodgkin's lymphoma in 23 (30.7%), non-Hodgkin's lymphoma in 20 (26.7%), neuroblastoma in 11 (14.7%), Ewing sarcoma in 10 (13.7%), Langerhans cell histiocytosis in 6 (8%), and rhabdomyosarcoma in 5 (6.6%) patients. Results. Bone marrow involvement was detected in 39 (52%) of 75 patients. Bone marrow involvement was identified by both PET-CT and BMB in 18 (46.1%) patients, by only PET-CT in 12 (30.7%) patients, by only BMB in 9 (23%) patients. The sensitivity of PET-CT was 66%, specificity was 75%, positive predictive value was 60%, and negative predictive value was 80%. Sensitivity, spesificity, positive and negative predictive values of PETCT were different in before mentioned malignancy groups. Conclusion. PET-CT may not have high sensitivity and specificity to identify bone marrow involvement for each type of cancer. The approach of using bone marrow biopsy and PET-CT as complementary modalities seems reliable.

Diagnostic Performance of 18F-FDG PET(CT) in Bone-Bone Marrow Involvement in Pediatric Neuroblastoma: A Systemic Review and Meta-Analysis

“…ere were two studies evaluating the usefulness of FDG PET, with regard to detection of bone/BMI in pediatric NB patients. Moreover, one of the two studies focused on Fawzy et al [11] Gil et al [12] Ishiguchi et al [13] Tezol et al [14] Yagci-Kupeli et al [15] Zapata et al [16] Patient pretreatment patients, which reduced the number of false positives. Since it has been known that chemotherapy can stimulate hyperactivity in bone marrow, subgroup analysis performed by two different analysis types suggested that patient-based analysis showed a lower sensitivity but a higher specificity than those of lesion-based analysis.…”

“…Previous meta-analysis suggested that 18 F-FDG PET had a higher sensitivity but lower specificity than MIBG scintigraphy in NB lesion detection [8]. Another recent meta-analysis reported a 17% pooled sensitivity of positron emission tomography (computed tomography) (PET(CT)) for the detection of bone marrow in pediatric NB in their subgroup analysis, which was significantly lower than several studies [9][10][11][12][13][14][15][16]. Superiorities of PET are high 18 F-FDG avidity of the bone marrow and imaging of the entire marrow [17].…”

“…en, 16 full-text articles were selected to read carefully, and 7 studies comprising a total of 127 patients were enrolled in the current meta-analysis finally [10][11][12][13][14][15][16]. A flow diagram of eligible literature is shown in Figure 1.…”

“…Of the seven included studies, five reported on patient-based analysis, and the rest two described on lesion-based analysis. Across the seven included studies, four studies only focused on BMI in NB, whereas the remaining three enrolled participants extended to various pediatric [13,14,16] exhibited an unclear risk of bias due to the fact that they did not mention whether or not the operators interpreted the images without reference standard.…”

“…All studies [10][11][12][13][14][15][16] revealed an unclear risk in reference standard, owing to lack of information with regards to histological results without prior clinical and imaging data. 3 studies [14][15][16] revealed a high risk in flow and timing since not all of the patients were included in this meta-analysis.…”