Diagnostic performance of 18F-2-fluoro-2-deoxy-D-glucose PET/computerized tomography in identifying bone marrow infiltration in new patients with diffuse large B-cell lymphoma and Hodgkin lymphoma

Abstract

Objective To compare between 18F-2-fluoro-2-deoxy-D-glucose PET/computerized tomography (18F-FDG PET/CT) and routine iliac bone marrow biopsy (BMB) in assessment of bone marrow infiltration (BMI) in Hodgkin lymphoma and diffuse large B-cell lymphoma (DLBCL) patients at initial presentation. Patients and methods A retrospective analysis of 138 patients (50 Hodgkin lymphomas, 88 DLBCLs). The study included 70 males and 68 females with median age of 43 years. All patients underwent 18F-FDG PET/CT and iliac crest BMB before treatment. Any focal or patchy FDG uptake in the bone marrow, superior-to hepatic uptake was interpreted as abnormal with or without corresponding CT changes. Treatment response was evaluated clinically with each cycle of chemotherapy, radiologically after three cycles and at the end of treatment. Results The overall diagnostic performance showed significant higher sensitivity of 18F-FDG PET/CT than that of BMB (73.9 versus 62.5%, P = 0.046), while the specificity was higher in BMB than in 18F-FDG PET/CT (100% in BMB versus 93.5% in 18F-FDG PET/CT). In Hodgkin lymphoma, sensitivity, negative predictive value (NPV) and accuracy were significantly higher in 18F-FDG PET/CT compared with BMB, being 87.5, 94.4 and 96% versus 50, 81 and 84% (P = 0.02, 0.03, 0.04, respectively). However, for DLBCL patients, almost comparable results were found between both tests in terms of sensitivity, NPV and accuracy (66.7, 83.9 and 81.8% versus 68.8, 84.9 and 88.6%, respectively). After PET/CT scan, 12 patients (8.6%) were upstaged to stage IV, eight of them were negative by BMB. Conclusion 18F-FDG PET/CT seemed to be an excellent diagnostic test in assessment of BMI at initial assessment and staging of Hodgkin lymphoma and DLBCL patients.

18F-FDG PET/CT versus bone marrow biopsy in detecting bone marrow infiltration in initial staging of pediatric lymphoma

“…However, the diagnostic performance of BMB is better in NHL than in HL. These results are consistent with those reported by Kandeel et al, who revealed that 18 F-FDG PET/CT demonstrated better diagnostic accuracy than BMB in detecting BMI in patients with HL (Kandeel et al 2020 ). .…”

Comparative Review of the Current and Future Strategies to Evaluate Bone Marrow Infiltration at Diffuse Large B-Cell Lymphoma Diagnosis

“…It seems that PET sensitivity is higher when BM is focal rather than diffuse [ 10 ], which indicates that some studies considered true positive cases for BMi those with PET+ by a focal pattern [ 16 , 33 , 44 ]. Studies that used a true positive BMi defined by BMB+ or by PET+ if accompanied with targeted/morphologic imaging changes or FDG disappearance with response after treatment or concordant FDG progression on follow-up [ 10 , 44 , 46 ], reported a higher PET sensitivity and diagnostic accuracy, while a higher BMB specificity. Equivalent findings were seen in one study that considered BMB+ or PET+ focal as true positive BMi [ 16 ].…”

“…Regarding the BM uptake pattern by PET, three studies reported the prognostic significance of PET+ focal [ 20 , 46 , 48 ]. Chen et al presented data about prognosis according to focal and diffuse PET+ patterns, showing PET+ focal cases had a worse impact in both EFS and OS, while PET+ diffuse cases did not relate to a worse outcome.…”

FDG PET/CT versus Bone Marrow Biopsy for Diagnosis of Bone Marrow Involvement in Non-Hodgkin Lymphoma: A Systematic Review

“…This systematic review involved some limitations. In some studies PET/CT images were interpreted using qualitative criteria [15][16][17]19,20,22,26,29,31,[34][35][36][37][38][39]42,43,47,48,50,[52][53][54], whereas in other studies both qualitative and quantitative criteria were used [18,21,[23][24][25]27,28,30,32,33,40,41,[44][45][46]49,51,55]. As the qualitative evaluation is based on a subject's experience, this might underestimate the PET/CT diagnostic performance.…”