Bone marrow involvement in young patients with non‐Hodgkin's lymphoma: The importance of multiple bone marrow samples for accurate staging

Abstract

Of 95 young patients with non‐Hodgkin's lymphoma treated at the National Cancer Institute on Pediatric Branch Protocol 7704, 18 (18.9%) had bone marrow involvement prior to treatment. Their mean age was 20.5 years. Twelve patients had small, noncleaved lymphoma (ten Burkitt's and two undifferentiated, unspecified), five had lymphoblastic lymphoma, and one had a diffuse large cell lymphoma. All had extensive disease. We obtained bilateral bone marrow biopsy specimens, touch preparations, clot sections, and aspirate smears from 13 of the 18 patients. When paired contralateral samples were reviewed, in as many as six out of ten of the pairs only one side was positive for tumor. When paired ipsilateral samples were similarly reviewed, in as many as seven out of 21 of the pairs only one specimen was positive for tumor. The biopsy specimen was the most useful of the four types of study performed, yielding positive results in 87% of the preparations. Thus, in a high percentage of patients, multiple marrow sampling revealed disease that might have been missed if fewer specimens had been obtained. Only four of our 18 patients (22.2%) had long‐term remissions. Because young patients with marrow disease are at high risk and may be eligible for more intensive treatment protocols, we recommend that staging should include bilateral bone marrow biopsies and bilateral aspirates.

Opportunities and limitations of bone marrow biopsy and bone marrow FDG-PET in lymphoma

“…This has been demonstrated by previous studies in which bilateral or paired ipsilateral BMBs were performed in the same patients, and in which only one bone marrow specimen was positive for lymphoma in a considerable proportion of patients, ranging between 10-60% [21][22][23][24]. Obtaining multiple tissue samples from different locations improves the diagnostic yield of BMB [21][22][23][24], but obviously increases patient burden and complication rate. Due to the risk of sampling errors, it should be realized that a negative BMB after completion of therapy cannot reliably exclude residual bone marrow involvement either.…”

Usefulness of 18F-FDG PET/CT for the Evaluation of Bone Marrow Involvement in Patients with High-Grade Non-Hodgkin’s Lymphoma

“…Iliac crest bone marrow biopsy (BMB) is considered the "reference standard" for detecting BM involvement, although it has been recognized to be an imperfect tool for some time. BMB is limited by technical constraints, for example, by sampling errors due to patchy BM disease, which occurs in one third to a half of high-grade non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) patients [4], by small sample sizes, which may be inconclusive, and by patterns of BM disease at presentation that diminish its ability to detect pathological conditions. Furthermore, when obtaining a biopsy specimen is inadequate, it is difficult to repeat the procedure because of its invasiveness.…”

Can [18F]fluorodeoxyglucose positron emission tomography imaging complement biopsy results from the iliac crest for the detection of bone marrow involvement in patients with malignant lymphoma?

“…It is a painful and invasive procedure with a low yield in the detection of metastatic bone marrow disease [1][2][3]. [ 18 F]Fluorodeoxyglucose positron emission tomography ([ 18 F]FDG PET) is a non-invasive imaging technique that has been proven to be useful in the diagnosis and staging of several types of malignancy [4][5][6][7][8].…”

“…It is imperative to detect and accurately determine the extent of bone marrow involvement in patients with lymphoma, especially in high-grade lymphomas where optimal staging is crucial for treatment planning [1][2][3]. The aims of this study were to assess the usefulness of PET in the detection of bone marrow involvement and its impact in the clinical management of lymphomas.…”