Fluorodeoxyglucose-Positron Emission Tomography Predicts Bone Marrow Involvement in the Staging of Follicular Lymphoma

Abstract

Background. Standard bone marrow biopsy (BMB) and bone involvement with follicular lymphoma (FL) on positron emission tomography (PET)/computed tomography (CT) both predict early clinical failure in FL. The key clinical question is whether PET/CT findings can obviate the need for BMB. The goal of this study was to determine the value of PET/CT in determining bone involvement in FL, using posterior iliac crest BMB as the gold standard. Materials and Methods. A total of 548 patients with newly diagnosed grade 1-3A FL were included. The presence, pattern, and location of bone involvement, spleen involvement, and standardized uptake values (SUVs) in the L3 vertebral body were recorded for all patients and compared with the BMB report. Results. Excluding patients with focal bone lesions on PET/CT, the sensitivity and specificity of PET/CT in detecting bone or marrow involvement, compared with BMB, were 53% and 88%, respectively. The sensitivity and specificity of spleen involvement on PET/CT in predicting a positive BMB were 55% and 86%, respectively. An L3 SUV max of less than 2.0 resulted in a negative predictive value (NPV) of 96% for marrow involvement on BMB; an L3 SUV mean below 1.4 resulted in an NPV of 100%. Conclusion. In newly diagnosed FL, PET/CT-detected bone and splenic involvement is highly specific for a positive BMB, and very low SUV values (<2.0 SUV max and < 1.4 SUV mean ) in the lumbar spine have a high NPV for a negative BMB. Routine BMB may be obviated in these patients. BMB remains necessary to definitively exclude bone marrow involvement in a large majority of patients with a negative PET.

Flow cytometry to detect bone marrow involvement by follicular lymphoma

“…We found a poor correlation between FC and PET vis‐à‐vis BMI. Given the low burdens detected in many patients, this finding is expected and aligns with the low sensitivity seen for PET to detect BMI in FL (Faudemer et al, 2021; St‐Pierre et al, 2020). However, it should be noted that recent data suggests that PET may complement (rather than aim to replace) other means of assessing BMI (Faudemer et al, 2021; Nakajima et al, 2020).…”

The Diagnostic Value of 18F‐FDG PET/CT Bone Marrow Uptake Pattern in Detecting Bone Marrow Involvement in Pediatric Neuroblastoma Patients

“…Among these molecular biomarkers, the PHOX2B in bone marrow and peripheral blood had the best diagnostic performance and was considered to be the most optimal biomarker for BMI detection [29][30][31]. Some previous researches had confirmed the value of 18 F-FDG PET/CT in detecting BMI compared with BMB in lymphoma [32][33][34][35]. However, few studies had explored the role of 18 F-FDG PET/CT in NB [8], and there was no study comparing PHOX2B with 18 F-FDG PET/CT in NB.…”

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.…”