¹⁸F‐FDG PET‐CT and trephine biopsy assessment of bone marrow involvement in lymphoma

Abstract

The ability of positron emission tomography-computerized tomography (PET-CT) to accurately detect bone marrow involvement (BMI) has been suggested in Hodgkin lymphoma (HL) and diffuse large B-cell lymphoma (DLBCL), but its abilities in other histologies is less established. The aim of this retrospective study was to confirm the role of PET-CT in detecting BMI in DLBCL and HL, and to explore its usefulness in other subtypes. Of the 149 newly diagnosed patients, common subtypes included DLBCL, follicular lymphoma (FL) and HL. In DLBCL, the sensitivity and specificity of PET-CT at diagnosis were 75% and 92%. In FL, the sensitivity and specificity of PET-CT were 67% and 85% at diagnosis, and 73% and 89% at relapse. In HL, the sensitivity and specificity were 100% and 74%. PET-CT was able to detect BMI in patients with negative biopsies. Most of the patients in which PET-CT failed to identify BMI were already advanced stage by imaging. In this analysis, PET-CT was highly accurate for detecting BMI at diagnosis in DLBCL and HL and highly specific in FL at diagnosis and relapse. Results also suggested the diagnostic advantage of PET-CT over bone marrow biopsy in detecting BMI. Prospective evaluation is necessary and may eliminate biopsies in future patients.

Bone marrow biopsy superiority over PET/CT in predicting progression‐free survival in a homogeneously‐treated cohort of diffuse large B‐cell lymphoma

“…In the setting of B-NHL, and particularly in the DLBCL category, the use of PET/CT and/or BMB for staging purposes is presently one of the most debated issues as different strategies have been proposed according to the divergent results of a number of distinct series or metaanalysis [3][4][5][6][7][8][12][13][14][15], or experience-based recommendations from experts in the field [4,5,[16][17][18][19][20]. With an endeavor to avoid susceptibility and collinearity biases in our study design, we show here the superiority of BMB over PET/CT in predicting PFS in a homogeneously-treated cohort of 203 DLBCL patients.…”

Whole‐body MRI, FDG‐PET/CT, and bone marrow biopsy, for the assessment of bone marrow involvement in patients with newly diagnosed lymphoma

“…A study done on 38 patients with newly diagnosed diffuse large B‐cell lymphoma and negative blind BMB, showed that disease relapse or progression and death occurred more frequently in WB‐MRI positive patients than in WB‐MRI negative patients, suggesting that WB‐MRI findings may have relevant prognostic implications . Other studies have demonstrated that BMB does not change prognosis and treatment with respect to FDG‐PET/CT, in patients with HL and diffuse large B‐cell lymphoma, so FDG‐PET/CT may replace BMB for the assessment of BMI in these patients …”

“…Marginal zone and mantle cell lymphomas, even if they carry a higher risk of BMI, were under‐represented sub‐populations in our study. Second, the reference standard was BMB, the results of which are subjects to sampling errors, especially if BMI is focal or outside the pelvis . However, WB‐MRI and FDG‐PET/CT scans performed after therapy were also reviewed, and bone lesions were considered as the locations of disease when disappearing in posttreatment examinations.…”

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

“…PET/CT has become more frequently utilized in detecting lymphomatous bone marrow involvement. In contrast to bone marrow biopsy, the noninvasive procedure enables the assessment of the entire marrow cavity while concurrently evaluating the extra-medullary disease [7].…”