The Role of Integrated Positron Emission Tomography/Computed Tomography (PET/CT) and Bone Marrow Examination in Staging Large B-Cell Lymphoma

Abstract

Introduction: In the era of routine use of positron emission tomography/computed tomography (PET/CT) for staging, it is not yet clear whether PET/CT can replace bone marrow biopsy for the assessment of bone marrow involvement in large B-cell lymphoma. Objectives: To compare the clinical utility of bone marrow biopsy and PET/CT scanning in the staging of large B-cell lymphoma. Methods: This was a retrospective analysis of all patients who presented to single center over a 4-year period with large B-cell lymphoma who had concurrent PET/CT and bone marrow biopsy performed in the assessment and staging of the lymphoma. Results: Out of 89 patients, 24 had bone marrow involvement either by PET/CT, by bone marrow biopsy, or by both. Bone marrow biopsy identified 12 patients (sensitivity 50%, specificity 100%, negative predictive value 84%), whereas PET/CT identified 23 patients (sensitivity 96%, specificity 100%, negative predictive value 98%). No patients were upstaged by the bone marrow biopsy result, and no patients had their treatment plan changed based on the bone marrow biopsy result. Conclusion: The results show that PET-CT is more sensitive and has better negative predictive value than bone marrow biopsy. This suggests that PET-CT could replace bone marrow biopsy in detecting bone marrow involvement for staging of large B-cell lymphoma.

FDG PET/CT versus Bone Marrow Biopsy for Diagnosis of Bone Marrow Involvement in Non-Hodgkin Lymphoma: A Systematic Review

“…This systematic review involved some limitations. In some studies PET/CT images were interpreted using qualitative criteria [15][16][17]19,20,22,26,29,31,[34][35][36][37][38][39]42,43,47,48,50,[52][53][54], whereas in other studies both qualitative and quantitative criteria were used [18,21,[23][24][25]27,28,30,32,33,40,41,[44][45][46]49,51,55]. As the qualitative evaluation is based on a subject's experience, this might underestimate the PET/CT diagnostic performance.…”

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

“…Repeat PET-CT after treatment to assess if uptake resolves with the resolution of involved nodal sites ( 18 ).…”

“…Al-Sabbagh et al. found that none of the patients displaying diffuse bone marrow changes on PET-CT had a positive bone marrow biopsy, and conversely, none of the patients with a positive bone marrow biopsy exhibited diffuse bone marrow uptake on PET without a focal lesion ( 18 ). In contrast, another study reported that diffuse bone marrow uptake on PET-CT scans, conducted for patients with aggressive NHL, was frequently associated with a positive bone marrow biopsy ( 56 ).…”

“…The negative predictive value and specificity of PET-CT for bone marrow involvement detection are exceptionally high, ranging between 85-98% and nearly 100%, respectively ( 3 , 16 , 34 , 40 ). Rare instances have been documented where PET-CT produced negative results for bone marrow involvement, while bone marrow biopsy came back positive ( 18 , 57 , 61 ). These compelling findings have encouraged some groups to advocate for omitting routine bone marrow biopsy if PET-CT scan is positive ( 12 , 18 ).…”

“…Rare instances have been documented where PET-CT produced negative results for bone marrow involvement, while bone marrow biopsy came back positive ( 18 , 57 , 61 ). These compelling findings have encouraged some groups to advocate for omitting routine bone marrow biopsy if PET-CT scan is positive ( 12 , 18 ). One study reported no false-positive results for bone marrow involvement detected by PET-CT ( 18 ).…”