Increased bone marrow <scp>FDG</scp> uptake at <scp>PET</scp>/<scp>CT</scp> is not a sufficient proof of bone marrow involvement in diffuse large <scp>B</scp>‐cell lymphoma

Adams, Hugo J. A.; Kwee, Thomas C.

doi:10.1002/ajh.24061

Cited by 11 publications

(8 citation statements)

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“…Though in our previous work, and in line with others [12,17], we suggested that a positive PET/CT could abrogate the need for a BMB, according to our present results, we now believe that BMB should be performed in all DLBCL patients at baseline. In the absence of a feasible gold standard for a methodologically indisputable assessment of the sensibility and specificity of both techniques, we now agree with Adams, et al when stating that the lack of prognostic implications of bone marrow involvement detected by FDG-PET/CT strongly suggests there is a considerable proportion of false-positive FDG-PET/CT cases in patients with DLBCL [23]. In addition, Negative 197 11 208 151 10 161 Positive 36 24 60 26 16 42 Total 233 35 268 177 26 203 BMB, bone marrow biopsy; PET/CT, possitron emission tomography/computer tomography.…”

Section: Discussionsupporting

confidence: 80%

“…In the absence of a feasible gold standard for a methodologically indisputable assessment of the sensibility and specificity of both techniques, we now agree with Adams, et al. when stating that the lack of prognostic implications of bone marrow involvement detected by FDG‐PET/CT strongly suggests there is a considerable proportion of false‐positive FDG‐PET/CT cases in patients with DLBCL . In addition, it could seem contradictory that BM involvement based on BMB had prognostic impact on PFS but not on OS.…”

Section: Discussionsupporting

confidence: 74%

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Bone marrow biopsy superiority over PET/CT in predicting progression‐free survival in a homogeneously‐treated cohort of diffuse large B‐cell lymphoma

Chen-Liang¹,

Martín‐Santos

Jerez³

et al. 2017

Cancer Medicine

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Several studies have reported uneven results when evaluating the prognostic value of bone marrow biopsy (BMB) and PET/CT as part of the staging of diffuse large B‐cell lymphoma (DLBCL). The heterogeneity of the inclusion criteria and not taking into account selection and collinearity biases in the analysis models might explain part of these discrepancies. To address this issue we have carried a retrospective multicenter study including 268 DLBCL patients with a BMB and a PET/CT available at diagnosis where we estimated both the prognosis impact and the diagnostic accuracy of each technique. Only patients treated with R‐CHOP/21 as first line (n = 203) were included in the survival analysis. With a median follow‐up of 25 months the estimated 3‐year progression‐free survival (PFS) and overall survival (OS) were 76.3% and 82.7% respectively. In a multivariate analysis designed to avoid a collinearity bias with IPI categories, BMB‐BMI [bone marrow involvement](+) (HR: 3.6) and ECOG PS > 1 (HR: 2.9) were independently associated with a shorter PFS and three factors, age >60 years old (HR: 2.4), ECOG PS >1 (HR: 2.4), and abnormally elevated B2‐microglobulin levels (HR: 2.2) were independently associated with a shorter OS. In our DLBCL cohort, treated with a uniform first‐line chemotherapy regimen, BMI by BMB complemented performance status in predicting those patients with a higher risk for relapse or progression. In this cohort BMI by PET/CT could not independently predict a shorter PFS and/or OS.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 74%

Bone marrow biopsy superiority over PET/CT in predicting progression‐free survival in a homogeneously‐treated cohort of diffuse large B‐cell lymphoma

Chen-Liang¹,

Martín‐Santos

Jerez³

et al. 2017

Cancer Medicine

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“…A meta-analysis performed on 654 patients with diffuse large B-cell lymphoma showed that 3% of patients with proven bone marrow involvement on biopsy had a negative PET scan. 9 …”

Section: Discussionmentioning

confidence: 99%

Primary cardiac lymphoma: a case report

Saghie

Higgisson

2023

European Heart Journal - Case Reports

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Introduction Primary cardiac lymphoma is an extremely rare malignancy involving the heart and pericardium. It is a disease that most commonly effects the right atrium and right ventricle. Left untreated it carries a very poor prognosis. Recent advancements in therapy including early recognition and initiation of chemotherapy has led to improved survival. Case Presentation A 78 year old female presented with weight loss, abdominal pain and distension. An ultrasound abdomen pre admission showed abdominal ascites. An echocardiogram performed during admission showed a large pericardial effusion with asymmetrical increase in left ventricular wall thickness and a new left atrial mass. Pericardial fluid analysis led to the diagnosis of diffuse large B cell non-Hodgkin’s lymphoma. Positron Emission Tomography CT (PET-CT) shows avid fluorodeoxyglucose (FDG) uptake in cardiac muscle. Prompt treatment was initiated with a chemotherapy regimen involving Rituximab, Cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). An echocardiogram 3 months post initiation of treatment showed resolution of the pericardial effusion and left atrial mass as well as an improvement in left ventricular wall thickness. A PET-CT following completion of treatment showed complete metabolic response. Discussion The diagnosis of primary cardiac lymphoma is uncommon and the presence of left rather than right heart involvement is rarer still. Multimodality imaging is key in diagnosis. Early recognition and treatment is vital in improving associated morbidity and mortality.

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“… 9 As we have previously debated, diagnostic performance studies (including ours) comparing BMB vs PET‐CT in this setting inevitably suffer a bias derived from the lack of an independent gold‐standard. 41 , 42 Thus, the prognostic value of each technique emerges as a better surrogate marker for clinical utility.…”

Section: Discussionmentioning

confidence: 99%

Accuracy and prognostic impact of FDG PET/CT and biopsy in bone marrow assessment of follicular lymphoma at diagnosis: A Nation‐Wide cohort study

et al. 2022

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Backgound In the workup of follicular lymphoma (FL), bone marrow biopsy (BMB) assessment is a key component of FLIPI and FLIPI2, the most widely used outcome scores. During the previous decade, several studies explored the role of FDG‐PET/CT for detecting nodal and extranodal disease, with only one large study comparing both techniques. Methods The aim of our study was to evaluate the diagnostic accuracy and the prognostic impact of both procedures in a retrospective cohort of 299 FL patients with both tests performed at diagnosis. In order to avoid a collinearity bias, FLIPI2 was deconstructed in its founding parameters, and the bone marrow involvement (BMI) parameter separately included as: a positive BMB, a positive PET/CT, the combined “PET/CT and BMB positive” or “PET/CT or BMB positive”. These variables were also confronted independently with the POD24 in 233 patients treated with intensive regimens. Results In the total cohort, bone marrow was involved in 124 and 60 patients by BMB and PET/CT, respectively. In terms of overall survival, age > 60 y.o. and the combined “PET/CT or BMB positive” achieved statistical independence as a prognostic factor. In patients treated with an intensive regimen, only the combined “PET/CT or BMB positive” added prognostic value for a shorter overall survival, when confronted with the POD24. Conclusion Our results show that in FL both BMB and PET/CT should be considered at diagnosis, as their combined assessment provides independent prognostic value in the context of the most widely use clinical scores.

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Increased bone marrow FDG uptake at PET/CT is not a sufficient proof of bone marrow involvement in diffuse large B‐cell lymphoma

Cited by 11 publications

References 11 publications

Bone marrow biopsy superiority over PET/CT in predicting progression‐free survival in a homogeneously‐treated cohort of diffuse large B‐cell lymphoma

Bone marrow biopsy superiority over PET/CT in predicting progression‐free survival in a homogeneously‐treated cohort of diffuse large B‐cell lymphoma

Primary cardiac lymphoma: a case report

Accuracy and prognostic impact of FDG PET/CT and biopsy in bone marrow assessment of follicular lymphoma at diagnosis: A Nation‐Wide cohort study

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