Predictive Value of FDG PET/CT Versus Bone Marrow Biopsy in Pediatric Lymphoma

Abstract

Purpose The aim of this study was to explore the positive predictive value and negative predictive value of FDG PET/CT. The prognostic impact of tumor burden of bone marrow infiltrates was diagnosed by FDG PET/CT at initial presentation. Methods This retrospective study enrolled 140 pediatric patients with pathologically proven lymphoma (113 Hodgkin disease and 27 Non-Hodgkin lymphoma). All patients had pretherapy FDG PET/CT. Bone marrow biopsy (BMB), clinical, radiological, and follow-up data were also collected. The skeleton was divided into 8 segments, and a 5-point scoring system was used for assessment of BM infiltration burden. Results Among the 140 lymphoma patients, FDG PET/CT revealed positive BM involvement in 41 patients; 2 of them were false-positive with negative BMB and regional MRI results. Positive predictive value was 95.1% for PET/CT compared with 100% with BMB. All patients diagnosed with positive BMI by BMB were detected by FDG PET/CT. On the contrary, BMB missed 25 patients (17.9%) with statistically significant difference. Negative predictive value was 100% for PET/CT compared with 80.2% for BMB (P < 0.05). FDG PET/CT upstaged 17.9% of the enrolled patients. Bone marrow involvement based on the 5-point scoring system was assessed. No significant difference was demonstrated in therapy outcome between patient with focal BMI (score 2) and extensive BMI (score 5; P = 0.06). Conclusions FDG PET/CT has optimum negative predictive value compared with BMB in detection of bone marrow infiltrations in pediatric lymphoma with upstaging cases missed with BMB. Prognostic impact of BMI based on the 5-point scoring system reveals that the main influence is presence or absence of BMI rather than its tumor burden.

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

“…This is consistent with the study made by Badr et al [34], who included 27 patients with NHL and found the sensitivity of PET/CT was 100% while that of BMB was 42.9% and the specificity was 100% in both.…”

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.…”