The Value of 18F-FDG PET/CT in Detecting Bone Marrow Involvement in Childhood Cancers

Abstract

Background: The aim of this study was to assess the utility of 18F-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in assessing bone marrow involvement (BMI) compared with bone marrow biopsy (BMB) in the initial staging of pediatric patients with non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), Ewing sarcoma (ES), and neuroblastoma (NB). Procedure: A total of 94 patients (57 boys, 37 girls, median age 7 y, range 1 to 18 y) with newly diagnosed NHL, HL, ES, and NB between July 2014 and December 2017, who underwent BMB and 18F-FDG PET/CT before chemotherapy were included in this study. There were 36 patients with NHL, 27 HL, 16 ES, and 15 NB. 18F-FDG PET/CT and BMB results were reviewed and compared retrospectively. Findings: Retrospective analysis of data from 94 pediatric patients (57 boys, 37 girls, median age 7 y, range 1 to 18 y) was performed. Of the 94 patients, 29 had BMI on 18F-FDG PET/CT. BMB was positive in 14, negative in 13, and insufficient in 2 of these 29 patients. In 65 patients negative on 18F-FDG PET/CT, BMB was also negative in 54 and insufficient in 7. For the whole group, sensitivity, specificity, and positive and negative predictive values of 18F-FDG PET/CT in detecting bone marrow metastasis at the time of diagnosis were 90.6%, 100%, 100%, and 95.4% and those of BMB were 53.1%, 87.1%, 94.4%, and 80.6%, respectively. Conclusion: Our study demonstrates that 18F-FDG PET/CT predicts BMI better than BMB. 18F-FDG PET/CT may be used at initial staging of pediatric patients with NHL, HL, ES, and NB.

Role of bone marrow biopsy for staging new patients with Ewing sarcoma: A systematic review

“…Four studies ( Table 3) were identified that utilized FDG-PET scans for staging of BMM in newly diagnosed ES patients. 21,29,38,39 Data from these studies were aggregated for quantitative analysis to define testing characteristics of FDG-PET scans compared to BMBA. The studies ranged in publication year from 2013 to 2019, and all were completed in a retrospective manner.…”

Value of pretreatment 18F-FDG PET/CT in prognosis and the reflection of tumor burden: a study in pediatric patients with newly diagnosed neuroblastoma

“…In the present study, bone marrow SUVmax and the SUVmax-ratio were two meaningful parameters for NB patients with BMI. PET/CT has high sensitivity for assessing bone marrow infiltration in pediatric malignancies [13,26]. In particular, PET has improved sensitivity in detecting BMI in patients with lymphoma and may allow patients with positive BMI confirmed by PET/CT examinations to avoid undergoing invasive BMB [27,28].…”

Diagnostic Performance of 18F-FDG PET(CT) in Bone-Bone Marrow Involvement in Pediatric Neuroblastoma: A Systemic Review and Meta-Analysis

“…Previous meta-analysis suggested that 18 F-FDG PET had a higher sensitivity but lower specificity than MIBG scintigraphy in NB lesion detection [8]. Another recent meta-analysis reported a 17% pooled sensitivity of positron emission tomography (computed tomography) (PET(CT)) for the detection of bone marrow in pediatric NB in their subgroup analysis, which was significantly lower than several studies [9][10][11][12][13][14][15][16]. Superiorities of PET are high 18 F-FDG avidity of the bone marrow and imaging of the entire marrow [17].…”

“…en, 16 full-text articles were selected to read carefully, and 7 studies comprising a total of 127 patients were enrolled in the current meta-analysis finally [10][11][12][13][14][15][16]. A flow diagram of eligible literature is shown in Figure 1.…”

“…All studies [10][11][12][13][14][15][16] revealed an unclear risk in reference standard, owing to lack of information with regards to histological results without prior clinical and imaging data. 3 studies [14][15][16] revealed a high risk in flow and timing since not all of the patients were included in this meta-analysis.…”