Performance of Positron Emission Tomography-Computed Tomography and Bone Marrow Biopsy in Detecting Bone Marrow Infiltration in Lymphoma Cases

Abstract

Amaç: Kemik iliği infiltrasyonu (Kİİ), lenfoma evresini, sağkalımı ve tedaviyi etkiler. Lenfoma hastalarında Kİİ' ni saptamada kemik iliği biyopsisi (KİB) ve positron emisyon tomografi-bilgisayarlı tomografi (PET/BT)' nin performanslarını değerlendirmek istedik. Gereç veYöntemler: 269 non-Hodgkin lenfoma (NHL) ve 110 hodgkin lenfoma (HL) hastası retrospektif olarak değerlendirildi. Kİİ' ni saptamada PET/BT ve KİB için duyarlılık, negatif prediktif değer (NPD) ve doğruluk hesaplandı. Bulgular: NHL olgularında Kİİ' ni saptamada PET/BT için duyarlılık, NPD ve doğruluk sırasıyla %65, %78 ve %84.4 iken KİB için %55, %73.4 ve %79.9 idi. Diffüz büyük B hücreli lenfoma ve folliküler lenfoma için PET/BT performansı KİB' den daha iyi iken; mantle-cell lenfoma, burkitt's lenfoma ve primer mediastinal B hücreli lenfomada KİB performansı daha iyiydi. HL olgularında PET/BT için duyarlılık, NPD ve doğruluk sırasıyla %91.3, %97.75 ve %98.18 iken KİB için %56.52, %89.69 ve %90.91 idi. KİB yapılması ile NHL grubunda 43 (%15.9), HL grubunda ise 2 (%1.8) olgunun düşük evrelenmesinden korunmuş olundu. Sonuç: Kİİ' ni saptamada NHL alt tiplerine göre değişmekle birlikte PET/BT ve KİB birbirini tamamlayıcı yöntemlerdir. HL' de ise Kİİ' ni saptamak için PET/BT önemli bir tanı aracıdır ve KİB olguların önemli kısmında gerekli değildir. Anahtar Sözcükler: Lenfoma, kemik iliği infiltrasyonu, PET/BT, kemik iliği biyopsisiObjective: Bone marrow infiltration (BMI) affects the stage of lymphoma, survey, and treatment. We aimed to evaluate the performance of bone marrow biopsy (BMB) and positron emission tomography-computed tomography (PET/CT) in detecting bone marrow infiltration in lymphoma patients. Materials and Methods: 269 non-Hodgkin's lymphoma (NHL) and110 Hodgkin's lymphoma (HL) patients were evaluated retrospectively. Sensitivity, negative predictive value (NPV) and accuracy were calculated for PET/CT and BMB in detecting BMI.Results: Sensitivity, NPV and accuracy for PET/CT in detecting BMI in NHL cases were 65%, 78% and 84.4%, respectively, while 55%, 73.4% and 79.9% for BMB. PET/CT performance for diffuse large B-cell lymphoma and follicular lymphoma was better than BMB, whereas the performance of BMB was better for mantle-cell lymphoma, Burkitt's lymphoma and primary mediastinal B-cell lymphoma. Sensitivity, NPV and accuracy for PET-CT in HL cases were 91.3%, 97.75% and 98.18%, respectively, while 56.52%, 89.69% and 90.91% for BMB. Due to BMB, 43 (15.9%) patients in the NHL group and 2 (1.8%) patients in the HL group were protected from downstaging. Conclusion:PET/CT and BMB, although their results vary according to the NHL subtypes, are complementary methods in determining the BMI. In HL, PET/CT is an important diagnostic tool for detecting BMI, and BMB is not necessary in a significant proportion of cases. Turk J Hematol 2020;37:220-225 Büyükşimşek et al: Lymphoma and Bone Marrow Infiltration Öz Abstract

PET/CT and bone marrow biopsy (BMB) in evaluating bone marrow in lymphoma

“…This is consistent with the study done by Cistaro et al [28], the sensitivity of 18F-FDG PET/CT was found 96% (95% CI, 89-100%) while that of BMB was found 38% (95% CI, 20-57%). This is also consistent with the study done by Büyükşimşek et al [29], who included 110 patients with HL and found PET/CT sensitivity was 91.3% (95% CI, 71.96-98.93) compared to that of BMB which was 56.52% (95% CI, 34.49-76.81).…”

Detection performance and prognostic value of initial bone marrow involvement in diffuse large B-cell lymphoma: a single centre 18F-FDG PET/CT and bone marrow biopsy evaluation study

“…In our retrospective study, we found that 18 F-FDG PET/CT exhibited significantly higher accuracy compared to BMB as a diagnostic modality. This observation aligns with several other studies 5 , 9 , 22 , 23 , 24 , that reported superior sensitivity of 18 F-FDG PET/CT over BMB, with only one study 25 indicating similar accuracy between the two diagnostic methods.…”

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.…”

“…Patient selection was assessed with an unclear risk of bias in 20 of the included studies because the participants sample was unclearly defined as to whether selection was random or consecutive. For the index test, only one of the included studies [26] were assessed with an unclear risk of bias, due to insufficient reporting of results of the index test if they were interpreted with or without a knowledge of reference standard findings. In the reference standard domain, four studies had an unclear risk of bias because of poorly reporting if the reference standard were interpreted without knowledge about the index test findings.…”