Is it sufficient to evaluate bone marrow involvement in newly diagnosed lymphomas using 18F-FDG PET/CT and/or routine iliac crest biopsy? A new approach of PET/CT-guided targeted bone marrow biopsy

Abstract

BackgroundTo investigate whether PET/CT-guided bone marrow biopsy adds complementary information for evaluation of bone marrow involvement (BMI) in newly diagnosed lymphomas.MethodsPatients with newly diagnosed lymphomas that received both 18F-FDG PET/CT and bone marrow biopsy (BMB) were included in this retrospective study. PET/CT classification of bone lesions was classified as isolated, multifocal (2 lesions or more), diffuse (homogeneous uptake of the entire axial skeleton), or negative. BMBs included PET/CT-guided targeted BMB and/or the routine unilateral iliac crest biopsy. Of 34 patients with focal lesions on PET/CT scan, 30 received both PET/CT-guided targeted BMB and iliac crest biopsy, and 4 patients received targeted biopsy without iliac crest biopsy. The final diagnosis of BMI depends on BMB results.ResultsA total of 299 patients with lymphomas were included. PET/CT classification of bone lesions was isolated (16/5.4%), multifocal (67/22.4%), diffuse (52/17.4%), and negative (164/54.8%). If only positive iliac crest biopsy was considered as the reference standard, the sensitivity of 18F-FDG PET/CT for identifying focal and diffuse BMI was 48 and 56%, respectively, and the respective specificities were 70 and 83%. Three of 30 patients (10.0%) with focal lesions on PET/CT were confirmed to be false-positive by targeted BMB, and 25 of 30 patients (83.3%) with focal lesions on PET/CT were confirmed as false-negative by iliac crest biopsy.ConclusionIt is insufficient to evaluate BMI in newly diagnosed lymphomas using both 18F-FDG PET/CT and routine iliac crest biopsy. 18F-FDG PET/CT imaging should be performed before BMB. In focal bone lesions, PET/CT-guided targeted BMB may complement the results of possible false-positive PET/CT and false-negative iliac crest biopsy findings. However, in diffuse and negative lesions, iliac crest biopsy cannot be safely omitted.

Concordance of PD-L1 Status Between Image-Guided Percutaneous Biopsies and Matched Surgical Specimen in Non-Small Cell Lung Cancer

“…Image-guided biopsy was performed with an 18G or 20G semiautomatic core needle (Coaxial Achieve, Bard, IL, USA) with coaxial guide needle. The percutaneous biopsy was performed by a board-certified interventional radiologist following a step-by-step technique as previously described ( 8 , 13 ). Briefly, the patients were positioned in a supine or prone position in accordance with factors such as the location of FDG-avid lesion, shortest skin-to-target distance, and optimal needle path.…”

“…Meanwhile, 18 F-FDG PET/CT provides both anatomic structures and metabolic features and has therefore been suggested to improve the diagnostic accuracy of image-guided biopsy ( 9 – 12 ). We have previously reported the importance of PET/CT-guided biopsy for patient evaluation at various stages of cancers ( 9 , 13 , 14 ). Applying PET/CT information to image-guided biopsy may facilitate accurate histopathological diagnosis and help with staging.…”

Positron emission tomography/computed tomography-guided percutaneous trans-pararectal space prostate biopsy for the diagnosis of prostate cancer: A retrospective study

“…Therefore, a safer and more effective algorithm for the diagnosis of prostatic diseases should be [18][19][20]. In our previous study, we proved the efficacy of PET/CT-guided targeted biopsy for the evaluation of advanced lung cancer with metastatic bone lesions, for surveillingthe surveillance of molecular subtype switching of in metastatic breast cancer cells and identifying the identification of bone marrow involvement in newly diagnosed cases of lymphoma [21][22]. However, no studies have examined the utility of PET/CT-guided targeted biopsy for prostate pathologies.…”

Positron emission tomography/computed tomography-guided percutaneous trans-pararectal space prostate biopsy for the diagnosis of prostate cancer: A retrospective study

“…Recent advancements in molecular imaging techniques (positron emission tomography [PET]/computed tomography [CT], PET/MRI) have led to the development of several new highspecificity probes for the diagnosis of prostate cancer and may play a crucial role in facilitating the management of prostate cancer at all clinical stages [18][19][20]. In our previous study, we proved the efficacy of PET/CT-guided targeted biopsy for the evaluation of advanced lung cancer with metastatic bone lesions, for surveillingthe surveillance of molecular subtype switching of in metastatic breast cancer cells and identifying the identification of bone marrow involvement in newly diagnosed cases of lymphoma [21][22]. However, no studies have examined the utility of PET/CT-guided targeted biopsy for prostate pathologies.…”