Knochenmarkszintigraphie und Kernspintomographie bei malignen Lymphomen: Vergleich mit histologischen Ergebnissen

Abstract

One hundred and seven patients with malignant Hodgkin and non-Hodgkin lymphoma were examined by bone marrow scintigraphy, MRI of bone marrow and bone marrow biopsy to detect bone marrow infiltration. The study included 2 patients where autopsy findings were subsequently available, 3 patients with blind rebiopsy and one patient with guided rebiopsy. The findings of bone marrow imaging and biopsy were classified as normal (grade 0), suggesting reactive changes of bone marrow (grade 1) or suspicious for infiltration (grade 2). About half of all results of biopsy and imaging methods agreed completely. There was a difference of two steps in the classification in only 2 cases (MRI) and 5 cases (scintigraphy). In patients with chronic lymphocytic leukemia false negative findings by both bone marrow imaging techniques were frequent. Unilateral blind bone marrow biopsy is usually accepted as the golden standard for the presence or absence of tumor infiltration. Although a positive biopsy result must be accepted as proof of bone marrow infiltration, our results indicate that a negative biopsy does not exclude tumor involvement. In all 4 patients with infiltration suspected on MRI or scintigraphy results but with normal findings or reactive changes in the first blind biopsy, blind rebiopsy or guided rebiopsy confirmed the results of the imaging methods. In both patients evaluated at autopsy the preceding MRI and scintigraphy results were confirmed completely, although in both of these patients antemortem biopsy had indicated different findings. Based upon these observations, bone marrow scintigraphy and MRI should be routinely included in the staging of malignant lymphoma as an adjunct to blind bone marrow biopsy in the complete evaluation of bone marrow status.