The Diagnostic Accuracy of Bone Marrow Biopsy Versus PET/CT Scan in Identifying Bone Marrow Involvement in Diffuse Large B Cell Lymphoma Patients at a Cancer Hospital

Abstract

BackgroundIt is of great importance to assess bone marrow involvement (BMI) in diffuse large B cell lymphoma (DLBCL) for staging, prognostic, and therapeutic purposes. The gold standard method used for the identification of bone marrow involvement is bone marrow biopsy (BMB), but it has certain drawbacks. In recent years, positron emission tomography/computed tomography (PET/CT) has become a highly effective method in the diagnosis and staging of lymphoma. ObjectiveThe objective of this study is to estimate the diagnostic accuracy of PET/CT in identifying bone marrow involvement in DLBCL patients in a cancer care hospital in Lahore, using BMB as a reference standard.

A comprehensive review of the role of bone marrow biopsy and PET-CT in the evaluation of bone marrow involvement in adults newly diagnosed with DLBCL

“…The gold standard for assessing bone marrow involvement in lymphomas has been a random unilateral, occasionally bilateral, posterior iliac crest trephine bone marrow biopsy and aspirate. Previously, this procedure was a crucial part of the staging process ( 2 – 4 , 8 , 21 ). This procedure is usually performed blindly (i.e., not directed towards a lesion) at the bedside under local anesthesia and aseptic precautions.…”

“…This procedure is usually performed blindly (i.e., not directed towards a lesion) at the bedside under local anesthesia and aseptic precautions. While there is no universally accepted definition for an adequate sample size, consensus suggests an acceptable range of 0.5 – 1 cm, but optimally 2 – 3 cm ( 8 , 17 , 22 ). Although bone marrow biopsy is considered relatively safe, it has its risks and limitations ( Table 2 ) ( 2 , 3 , 8 ).…”

“…Consequently, a more aggressive therapeutic approach may be warranted for patients with bone marrow involvement. Notably, the standard iliac crest bone marrow biopsy demonstrates a limited ability to detect BM involvement in DLBCL, identifying only 27% of patients with confirmed bone marrow involvement ( 4 , 7 , 8 , 20 ). The inclusion of other diagnostic techniques, including flow cytometry, enhances the biopsy’s sensitivity in detecting bone marrow involvement ( 2 , 7 ).…”

“…The inclusion of other diagnostic techniques, including flow cytometry, enhances the biopsy’s sensitivity in detecting bone marrow involvement ( 2 , 7 ). PET-CT frequently identifies bone marrow involvement in a focal or diffuse uptake distribution, while bone marrow biopsy relies on the morphological examination of slides, immunohistochemistry stains, and flow cytometry to detect lymphoma cells and specific clusters of differentiation (CD) markers ( 8 ).…”

“…The diagnosis of DLBCL depends on histological confirmation, complemented by clinical and radiological findings ( 2 ). DLBCL is recognized for its variable biological and clinical features, along with frequent extra-nodal site infiltration, which has a momentous impact on the staging and, consequently, management and prognosis ( 2 , 7 , 8 ). Accurate staging of DLBCL is crucial for optimal management, with the Ann Arbor staging system being one of the most recognized systems, initially relying on physical examination and bone marrow biopsy ( 2 ).…”