Abstract
Biopsy is the standard for assessment of bone marrow involvement in mantle cell lymphoma (MCL). We investigated whether [18F]FDG-PET radiomic texture features can improve prediction of bone marrow involvement in MCL, compared to standardized uptake values (SUV), and whether combination with laboratory data improves results. Ninety-seven MCL patients were retrospectively included. SUVmax, SUVmean, SUVpeak and 16 co-occurrence matrix texture features were extracted from pelvic bones on [18F]FDG-PET/CT. A multi-layer perceptron neural network was used to compare three combinations for prediction of bone marrow involvement—the SUVs, a radiomic signature based on SUVs and texture features, and the radiomic signature combined with laboratory parameters. This step was repeated using two cut-off values for relative bone marrow involvement: REL > 5% (>5% of red/cellular bone marrow); and REL > 10%. Biopsy demonstrated bone marrow involvement in 67/97 patients (69.1%). SUVs, the radiomic signature, and the radiomic signature with laboratory data showed AUCs of up to 0.66, 0.73, and 0.81 for involved vs. uninvolved bone marrow; 0.68, 0.84, and 0.84 for REL ≤ 5% vs. REL > 5%; and 0.69, 0.85, and 0.87 for REL ≤ 10% vs. REL > 10%. In conclusion, [18F]FDG-PET texture features improve SUV-based prediction of bone marrow involvement in MCL. The results may be further improved by combination with laboratory parameters.
Highlights
Unilateral iliac crest bone marrow biopsy (BMB) is still a standard procedure in the majority of lymphomas, as bone marrow involvement is a criterion for stage IV disease [1]
The goal of the present study was to determine (1) whether [18F]FDG-PET radiomic texture features can improve prediction of bone marrow involvement in mantle cell lymphoma (MCL) patients, compared to traditional standardized uptake values (SUV); (2) whether the degree of marrow infiltration has an impact on the predictive value of radiomic features for assessment of bone marrow involvement; (3) whether combination of [18F]FDG-PET radiomic features and routine laboratory data, as recommended by guidelines for radiomic study design [23], can further improve prediction of bone marrow involvement; and (4) whether radiomic features can predict the Ki-67 proliferation index
Our study results suggest that addition of [18F]FDG-PET radiomic texture features to SUVs clearly improves the assessment of bone marrow involvement in MCL, and PET-based evaluation of cell proliferation
Summary
Unilateral iliac crest bone marrow biopsy (BMB) is still a standard procedure in the majority of lymphomas, as bone marrow involvement is a criterion for stage IV disease [1]. Cancers 2020, 12, 1138 replaces BMB [2,3], and diffuse large B-cell lymphoma (DLBCL), where no BMB is required for confirmation of focal FDG-avid bone (marrow) lesions on PET/CT [4,5], BMB is the recommended test to rule out bone marrow involvement in lymphoma patients [1,5]. This includes mantle cell lymphoma (MCL), which accounts for 7% of NHL cases, and shows bone marrow involvement in. A single study in DLBCL has used [18F]FDG-PET radiomic features, and reported a good performance for disease prediction, as well as prognostic potential of this technique [22]
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