Utility of Bone Marrow Biopsy and Aspirate for Staging of Diffuse Large B Cell Lymphoma in the Era of Positron Emission Tomography With 2-Deoxy-2-[Fluorine-18]fluoro-deoxyglucose Integrated With Computed Tomography

Vishnu, Prakash; Wingerson, Andrew; Lee, Marie; Mandelson, Margaret T.; Aboulafia, David M.

doi:10.1016/j.clml.2017.06.010

Cited by 20 publications

(29 citation statements)

References 27 publications

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“…However, results of bone marrow aspiration biopsy (BMAB) are subjected to sampling error, especially if the disease is focal or present in sites outside the pelvis biopsy site. In addition, BMB may be an unpleasant experience for the patient, associated with pain, anxiety, bleeding, and infection [5].…”

Section: Introductionmentioning

confidence: 99%

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

Elamir

Elazab

Owis

et al. 2020

Egypt J Radiol Nucl Med

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Background Bone marrow assessment is an important part in the Ann Arbor staging system in lymphoma. It is done routinely through posterior iliac crest bone marrow biopsy (BMB) which is an invasive technique with limited examination of one site. 18F-FDG PET/CT is now used for staging of lymphoma. The purpose of this study was to compare the sensitivity of PET/CT and BMB in detecting bone marrow infiltration (BMI) in lymphoma and determine agreement between both in assessing bone marrow and whether we can evaluate the bone marrow by PET/CT without the need of the routine BMB. Results PET/CT detected 24 (16.5%) cases with positive BMI that were missed by BMB. BMB detected only 2 (1.4%) cases that were missed by PET/CT. The PET/CT showed a higher sensitivity of 95.6% than BMB 46.7% in detecting BMI in lymphoma. We found a moderate agreement between PET/CT and BMB results in the whole cohort using Cohen’s k computation. It was found that 0.47 with p value less than 0.0001. Conclusions PET/CT can detect more bone marrow involvement in lymphoma compared with BMB. It can replace the routine invasive BMB in many cases, especially those showing multifocal uptake in both Hodgkin and non-Hodgkin lymphoma. PET/CT can also help to guide the site of the biopsy in some cases. Iliac crest BMB is still needed in cases showing diffuse FDG uptake to differentiate malignant uptake from reactive hyperplasia, and in those with limited FDG avidity and in some cases with negative uptake to exclude early infiltration if management will differ.

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Section: Introductionmentioning

confidence: 99%

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

Elamir

Elazab

Owis

et al. 2020

Egypt J Radiol Nucl Med

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“…16 PET has been evaluated in pretreatment staging, restaging, monitoring during therapy, posttherapy surveillance, assessment of transformation, and, more recently, as a surrogate marker in new drug development. 20 As we have recently reported, PET has a high sensitivity for evaluating bone marrow involvement in DLBCL and may, in certain circumstances, reduce the need to routinely perform a staging BMB and aspiration. 20 Incorporation of this finding led to a reduction in BMBs from 61.2% (101 of 165 patients) before QII to only 33.3% (8 of 24 patients) after QII (P¼.011).…”

Section: Discussionmentioning

confidence: 89%

“…20 As we have recently reported, PET has a high sensitivity for evaluating bone marrow involvement in DLBCL and may, in certain circumstances, reduce the need to routinely perform a staging BMB and aspiration. 20 Incorporation of this finding led to a reduction in BMBs from 61.2% (101 of 165 patients) before QII to only 33.3% (8 of 24 patients) after QII (P¼.011).…”

Section: Discussionmentioning

confidence: 89%

“…Figure 2B also shows a decrease in the number of BMBs for staging of lymphoma in the post-QII cohort: only onethird of patients (8 of 24) underwent a BMB compared with 61.2% of patients (101) in the pre-QII cohort (Figure 1). 20 There was an improved effort to assess prognosis and risk of recurrence by using the biological features of lymphoma (ie, BCL2, BCL6, and c-MYC) and revised International Prognostic Index in the post-QII cohort: 100% compared with 78.8% (138) previously (P¼.02) (Figures 1 and 2B).…”

Section: Resultsmentioning

confidence: 99%

“…Recent studies have reported that these additional metrics, alongside those incorporated in the ASH-PIM, have both prognostic and therapeutic implications that significantly impact the outcomes of patients with DLBCL. 14,[17][18][19][20] PATIENTS AND METHODS This study was reviewed and approved by the Institutional Review Board of Virginia Mason Medical Center (VMMC). The VMMC Tumor Registry was used to identify a longitudinal cohort of patients with histologic confirmation of DLBCL by using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code 200.7 for the years 2006-2015 and code C83.3 from the International Classification of Diseases, Tenth Revision, Clinical Modification for the years 2016 and 2017.…”

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confidence: 99%

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Quality Initiative in Clinical Practice: A Single-Institution Appraisal of Quality Metrics in the Management of Newly Diagnosed Diffuse Large B-Cell Lymphoma

Bischin

Vishnu

Chen

et al. 2019

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objective: To assess our adherence to treatment guidelines for diffuse large B-cell lymphoma (DLBCL) established by the American Society of Hematology in 2014 through implementation of a quality improvement initiative (QII) at our institution in 2015. Patients and Methods: Patients with newly diagnosed DLBCL treated from January 1, 2006, through December 31, 2017, were identified. Electronic medical records were reviewed for documentation of American Society of Hematology Practice Improvement Module quality measures (eg, key pathologic features of DLBCL, lymphoma staging, and screening for hepatitis B virus [HBV] infection in patients receiving rituximab-based chemotherapy). We also reviewed assessment of prognosis by revised International Prognostic Index score, testing for hepatitis C virus, HBV, and HIV, chemotherapy education, and the addition of rituximab in the treatment regimen of CD20 þ DLBCL. Results: Following QII implementation, we saw improvements in most metrics, including reporting of key molecular features (fluorescence in situ hybridization for c-MYC, BCL2, and BCL6, from 45.5% [75 of 165 patients] before QII to 91.7% [22 of 24 patients] after QII; P<.001), screening for HBV (41.8% [69 of 165 patients] to 91.7% [22 of 24 patients]; P<.001) and HIV infections (33.9% [56 of 165 patients] to 87.5% [21 of 24 patients]; P<.0001), providing chemotherapy education (92.7% [153 of 165 patients] to 100%), and use of rituximab for CD20 þ DLBCL (83.6% [138 of 165 patients] to 100%; P¼.05). All patients had positron emission tomographyecomputed tomography for DLBCL staging, and there was significantly lower use of bone marrow biopsy (P¼.011). Conclusion: Implementating a QII and employing standardized metrics can aid in improving quality of care for patients with newly diagnosed DLBCL and allow opportunities to build and ensure better adherence to evolving patient care guidelines.

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How useful is bone marrow study as an initial investigative tool without lymph node biopsy in malignant lymphoma?: Eleven years of experience at a single institution

Kwoun

Ahn

Park

et al. 2019

Clinical Laboratory Analysis

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BackgroundBone marrow (BM) study plays an important role as initial investigation specimen of lymphoma as well as staging lymphoma. This study aimed to investigate the utility of BM studies for classification of lymphoma and evaluate features of BM involvement by lymphoma over a period of 11 years.MethodsA total of 1162 cases of BM studies for lymphoma evaluation were reviewed for the incidence of lymphoma subtypes, the percentage of marrow involvement, the pattern of involvement and discordance with histopathologic diagnoses of lymph nodes and other tissues.ResultsA total of 255 of 1162 cases underwent BM study without pathologic information, and 108 cases show lymphoma involvement. Lymph node biopsy underwent in 66 cases, and 10 cases show discordant result between BM and lymph node biopsy. Seven discordant cases were due to insufficient further studies. Lymphoma was diagnosed only by BM study in 38 cases. Abnormal lymphocytes were found in BM aspiration in 34 cases. Also, abnormal clonal lymphocytes were detected by flow cytometry in 26 cases. Four cases showed disease‐related chromosomal abnormalities. FISH analysis detected abnormal findings in two cases, however, discordant with other additional studies.ConclusionsDiscrepancies between the BM study and lymph node biopsy were due to insufficient further study and discordance of immunohistochemical stain result. BM study can be utilized as initial diagnosis of lymphoma by the combination of morphological feature, involvement pattern, and additional tests such as flow cytometry, chromosomal analysis, and FISH analysis. Thus, BM study with further analysis is an essential choice when lymph node biopsies are unavailable.

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Utility of Bone Marrow Biopsy and Aspirate for Staging of Diffuse Large B Cell Lymphoma in the Era of Positron Emission Tomography With 2-Deoxy-2-[Fluorine-18]fluoro-deoxyglucose Integrated With Computed Tomography

Cited by 20 publications

References 27 publications

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

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

Quality Initiative in Clinical Practice: A Single-Institution Appraisal of Quality Metrics in the Management of Newly Diagnosed Diffuse Large B-Cell Lymphoma

How useful is bone marrow study as an initial investigative tool without lymph node biopsy in malignant lymphoma?: Eleven years of experience at a single institution

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