Can fluorodeoxyglucose positron emission tomography/computed tomography avoid negative iliac crest biopsies in evaluation of marrow involvement by lymphoma at time of initial staging?

Abstract

The assessment of bone marrow involvement (BMI) is important for accurate prognostication and deciding the appropriate therapy in patients with lymphoma. Conventional bilateral iliac crest biopsies (ILBMBs) have many limitations. F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is a useful investigative tool for detecting BMI. F-18 FDG PET/CT data for 97 patients with either non-Hodgkin lymphoma (NHL) or Hodgkin lymphoma (HL) were analyzed. ILBMB was performed 7-10 days later. A final diagnosis of BMI was made in 38/97 patients on the basis of composite criteria derived from both FDG PET/CT and ILBMB results. ILBMB detected BMI in 29/38 patients, 2/5 patients with HL, 27/33 patients with NHL, 19/25 patients with aggressive NHL, and 8/8 patients with indolent NHL with a sensitivity of 76%, 40%, 82%, 76%, and 100%, respectively. FDG PET/CT was true positive for BMI in 5/5 patients with HL and 29/33 patients with NHL, comprising 25/25 patients with aggressive NHL and 4/8 patients with indolent NHL, with a sensitivity of 100%, 88%, 100%, and 50%, respectively. FDG PET/CT performed better than ILBMB in cases of HL and aggressive NHL, but its sensitivity was poor in cases of indolent lymphoma. In addition, FDG PET/CT had a very high negative predictive value approaching 100% in HL and aggressive NHL, which might help in avoiding negative ILBMBs.

The role of bone marrow biopsy and FDG‐PET/CT in identifying bone marrow infiltration in the initial diagnosis of high grade non‐Hodgkin B‐cell lymphoma and Hodgkin lymphoma. accuracy in a multicenter series of 372 patients

“…This proposal is distinct from those of Khan et al [14], and Berthet et al [15], in that, in PET/CT negative cases, the former precludes BMB, while the latter considers it an option; therefore, according to our data, 10% of patients will be understaged with those approaches. In addition, it is distinct from those proposed by Mittal et al and Kostakoglu et al, in that they advise BMB in positive PET/CT, which is clinically unnecessary according to our data [24,25].…”

In Newly Diagnosed Diffuse Large B-Cell Lymphoma, Determination of Bone Marrow Involvement with 18F-FDG PET/CT Provides Better Diagnostic Performance and Prognostic Stratification Than Does Biopsy

“…Moreover, bone marrow status according to 18 F-FDG PET/CT appears to be a better independent prognostic factor than bone marrow status according to BMB. Several studies have already described the capacity of 18 F-FDG PET/CT to detect BMI in patients with DLBCL (12)(13)(14)(15)(16)(17)(18)(19)23). In our homogeneous series of patients, BMI was assessed in 25% of patients according to our criteria.…”

“…18 F-FDG PET/ CT findings were considered positive for BMI in cases of uni-or multifocal bone marrow 18 F-FDG uptake that could not be explained by benign findings on the underlying CT image or history (e.g., fractures) (19,23). In contrast, diffuse intense bone marrow 18 F-FDG uptake was considered negative for BMI; indeed, it has been demonstrated that diffuse intense uptake is significantly related to anemia or inflammatory processes ( Fig.…”

“…In contrast, bone marrow status was considered normal in cases of negative BMB results and diffuse bone marrow 18 F-FDG uptake, in cases of positive 18 F-FDG PET/CT findings invalidated by guided biopsy or targeted MR imaging, or in cases of persistent focal bone marrow uptake on 18 F-FDG PET/CT monitoring despite disappearance of uptake in other lymphoma lesions (15,16,23).…”

The role of PET/CT in evaluation of bone marrow involvement in lymphoma patients at the initial staging

“…In the literature, there was a significant difference in the capability of PET/CT to detect BM infiltration according to histological type of NHL. It has been reported in the literature that the performance of PET/ CT in evaluating the BM infiltration in indolent lymphomas was poor [18,21]. Since, indolent lymphomas comprise a number of different lymphoma types, we did not perform a subgroup analysis in this heterogeneous group.…”