Systematic review and meta-analysis on the diagnostic performance of FDG-PET/CT in detecting bone marrow involvement in newly diagnosed Hodgkin lymphoma: is bone marrow biopsy still necessary?

Abstract

Although the methodological quality of studies that were included in this systematic review and meta-analysis was moderate, the current evidence suggests that FDG-PET/CT may be an appropriate method to replace BMB in newly diagnosed Hodgkin lymphoma.

Prognostic Value of Bone Marrow Tracer Uptake Pattern in Baseline PET Scans in Hodgkin Lymphoma: Results from an International Collaborative Study

“…In previous studies, the same high diagnostic performance of 18 F-FDG PET/CT was observed, as described in a meta-analysis of 955 patients with sensitivity ranging from 87.5% to 100% (10). The sensitivity of PET for BMI was indeed suboptimal in our study (84%), and this finding, though not influential on treatment decision, should be taken into account during patient restaging in the case of resistant or relapsing lymphoma.…”

“…The sensitivity of PET for BMI was indeed suboptimal in our study (84%), and this finding, though not influential on treatment decision, should be taken into account during patient restaging in the case of resistant or relapsing lymphoma. When either a positive BMB or focal BM lesions on PET/CT that disappear during treatment in the following scans or both is considered as the standard reference for BMI by HL, as previously suggested (10,12), this is a more accurate method than BMB alone, because of the inability of BMB to detect BMI for the patchy nature of BM infiltration by HL. As a matter of fact, in our study only 12 of 180 patients (6.6%) had a positive BMB, whereas, predictably, most focal lesions recorded at baseline (86.8%) disappeared in the interim PET, in keeping with the negativization rate of interim PET in ABVD-treated HL (80%-85%) (25).…”

“…The most frequent reason for stage IV migration in HL is the detection of single or multiple sites of focally increased 18 F-FDG uptake in bone marrow (BM) without histologic evidence of HL in the iliac crest BM biopsy (BMB) (2,4). Many studies have shown a superior diagnostic sensitivity of PET/CT for bone marrow involvement (BMI) assessment over BMB, because the latter often fails to detect patchy BMI (4,(9)(10)(11). It is generally accepted that focally increased 18 F-FDG uptake in the BM with or without the presence of CT abnormalities is a sign of BMI, but the prognostic relevance of this finding is controversial (8,12).…”

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

“…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].…”

Bone Marrow Involvement in Hodgkin and Non-Hodgkin Lymphomas: The Role of Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

“…A more extensive evaluation concerning the role of FDG PET/CT to assess bone marrow involvement in patients with newly diagnosed Hodgkin lymphoma was performed in a systematic review and metaanalysis by Adams et al [14]: despite different methodological aspects among the selected studies, pooled sensitivity and specificity of FDG PET/CT in assessing bone marrow involvement, with respect to BMB and follow FDG PET/CT scans used as reference standard, were 96.9% and 99.7%, respectively. Overall accuracy was 98.6%.…”