18F-FDG PET-CT imaging versus bone marrow biopsy in pediatric Hodgkin’s lymphoma: a quantitative assessment of marrow uptake and novel insights into clinical implications of marrow involvement

Cuglievan

Pediatric Blood & Cancer

et al. 2017

PET-CT has a high sensitivity when assessing marrow infiltration in pediatric malignancies. Advances in radiologic modalities may obviate the use of invasive, painful, and costly procedures like BMB. Furthermore, biopsy results are limited by insufficient tissue or the degree of marrow infiltration (diffuse vs. focal disease). PET-CT can improve the precision of biopsy when used as a guiding tool. This study proposes the use of PET-CT as first-line screening for bone marrow infiltration to improve the accuracy of staging in new diagnoses.

Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 94%

PET/CT versus bone marrow biopsy in the initial evaluation of bone marrow infiltration in various pediatric malignancies

Cuglievan

Pediatric Blood & Cancer

et al. 2017

Egypt J Radiol Nucl Med

“…Iliac crest bone marrow biopsy (BMB) has been traditionally used for marrow assessment. It is obtained from the posterior portion of iliac crest, as it is the most easily accessible approach [4].…”

Section: Introductionmentioning

confidence: 99%

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

Elamir

Elazab

Owis

et al. 2020

Background Bone marrow assessment is an important part in the Ann Arbor staging system in lymphoma. It is done routinely through posterior iliac crest bone marrow biopsy (BMB) which is an invasive technique with limited examination of one site. 18F-FDG PET/CT is now used for staging of lymphoma. The purpose of this study was to compare the sensitivity of PET/CT and BMB in detecting bone marrow infiltration (BMI) in lymphoma and determine agreement between both in assessing bone marrow and whether we can evaluate the bone marrow by PET/CT without the need of the routine BMB. Results PET/CT detected 24 (16.5%) cases with positive BMI that were missed by BMB. BMB detected only 2 (1.4%) cases that were missed by PET/CT. The PET/CT showed a higher sensitivity of 95.6% than BMB 46.7% in detecting BMI in lymphoma. We found a moderate agreement between PET/CT and BMB results in the whole cohort using Cohen’s k computation. It was found that 0.47 with p value less than 0.0001. Conclusions PET/CT can detect more bone marrow involvement in lymphoma compared with BMB. It can replace the routine invasive BMB in many cases, especially those showing multifocal uptake in both Hodgkin and non-Hodgkin lymphoma. PET/CT can also help to guide the site of the biopsy in some cases. Iliac crest BMB is still needed in cases showing diffuse FDG uptake to differentiate malignant uptake from reactive hyperplasia, and in those with limited FDG avidity and in some cases with negative uptake to exclude early infiltration if management will differ.

Pediatric Blood & Cancer

“…Since asymmetry in 18 F‐FDG uptake was a key criterion to prompt further structured analysis, such cases could be missed. However, as frequently published, for example, for skeletal involvement, HL lesions are regularly of focal and not diffuse appearance in 18 F‐FDG‐PET 21,22 . Furthermore, five of these six patients did not show 18 F‐FDG‐PET response compatible with lymphoma manifestation when reanalyzed after two cycles of chemotherapy.…”

Section: Discussionmentioning

confidence: 53%

Assessment of Waldeyer's ring in pediatric and adolescent Hodgkin lymphoma patients—Importance of multimodality imaging: Results from the EuroNet‐PHL‐C1 trial

Kurch

Mauz‐Körholz

Fosså

et al. 2021

Background In the EuroNet Pediatric Hodgkin Lymphoma (EuroNet‐PHL) trials, decision on Waldeyer's ring (WR) involvement is usually based on clinical assessment, that is, physical examination and/or nasopharyngoscopy. However, clinical assessment only evaluates mucosal surface and is prone to interobserver variability. Modern cross‐sectional imaging technology may provide valuable information beyond mucosal surface, which may lead to a more accurate WR staging. Patients, materials, and methods The EuroNet‐PHL‐C1 trial recruited 2102 patients, of which 1752 underwent central review including reference reading of their cross‐sectional imaging data. In 14 of 1752 patients, WR was considered involved according to clinical assessment. In these 14 patients, the WR was re‐assessed by applying an imaging‐based algorithm considering information from 18F‐fluorodeoxyglucose positron emission tomography, contrast‐enhanced computed tomography, and/or magnetic resonance imaging. For verification purposes, the imaging‐based algorithm was applied to 100 consecutive patients whose WR was inconspicuous on clinical assessment. Results The imaging‐based algorithm confirmed WR involvement only in four of the 14 patients. Of the remaining 10 patients, four had retropharyngeal lymph node involvement and six an inconspicuous WR. Applying the imaging‐based algorithm to 100 consecutive patients with physiological appearance of their WR on clinical assessment, absence of WR involvement could be confirmed in 99. However, suspicion of WR involvement was raised in one patient. Conclusions The imaging‐based algorithm was feasible and easily applicable at initial staging of young patients with Hodgkin lymphoma. It increased the accuracy of WR staging, which may contribute to a more individualized treatment in the future.