Routine Bone Marrow Biopsy Has Little or No Therapeutic Consequence for Positron Emission Tomography/Computed Tomography–Staged Treatment-Naive Patients With Hodgkin Lymphoma

Abstract

A consistent finding of this study was the absence of positive BMBs in PET/CT-assessed stage I to II disease. The omission of staging BMB would not have changed the risk assessment or treatment strategy in this cohort of 454 newly diagnosed patients with HL.

The role of bone marrow biopsy and FDG‐PET/CT in identifying bone marrow infiltration in the initial diagnosis of high grade non‐Hodgkin B‐cell lymphoma and Hodgkin lymphoma. accuracy in a multicenter series of 372 patients

“…Regarding HL, our results demonstrate a higher sensitivity of PET/ CT over BMB and show that when using the former the number of patients that could be understaged, and therefore treated less than optimal, is marginal. These findings are consistent with previous reports and very recent recommendations [5,6,8,18], and ultimately preclude the routine use of BMB for staging in this group of patients. Whether diffuse uptake should be considered malignant in HL is a controversial area.…”

“…Whether diffuse uptake should be considered malignant in HL is a controversial area. Most studies found that diffusely increased bone marrow FDG uptake is invariably associated with a negative BMB while positive histologic involvement can be expected in most DLCL cases [8,19]. However, others found that the diffuse pattern in HL could be due to BMI in a small percentage of cases [20,21].…”

“…In the last few years, a number of studies have shown the superiority of PET/CT over BMB in the evaluation of bone marrow involvement in the setting of Hodgkin Lymphoma (HL) in terms of diagnostic accuracy [8][9][10]. More recently, a number of studies have addressed this issue in the context of non-Hodgkin Lymphoma (NHL), particularly in diffuse large B-cell lymphoma (DLCL) with differing results [11][12][13][14][15][16].…”

Advances in the diagnosis and control of lymphomas

“…Focal Fluordeoxyglucose (FDG) uptake within the bone or bone marrow, liver, and spleen is highly sensitive for involvement in HL and aggressive NHL and may obviate the need for bone marrow biopsy. 7 In contrast, diffuse increased uptake may occur with abnormal focal uptake, but in HL, diffuse uptake without focal activity often represents reactive hyperplasia and should not be confused with lymphomatous involvement. PET-CT can miss low-volume involvement, typically 20% of the marrow and coexistent low-grade lymphoma in Diffuse Large B Cell Lymphoma (DLBCL), although this rarely affects management.…”

Advanced Hodgkin’s lymphoma: End-of-treatment FDG-PET should be maintained

“…It offers better initial staging and risk stratification [3]. FDG-PET often detects occult extranodal disease, notably focal bone marrow lesions [5][6][7]. It rendered useless routine bone marrow biopsy [3].…”