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Abstract
ObjectiveTo determine and compare the value of 18F–fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) to blind bone marrow biopsy (BMB) of the posterior iliac crest in detecting metastatic bone marrow involvement in newly diagnosed Ewing sarcoma.Materials and methodsThis retrospective study included 20 patients with newly diagnosed Ewing sarcoma who underwent pretreatment FDG-PET/CT and a total of 38 blind BMBs (two unilateral and 18 bilateral) of the posterior iliac crest. FDG-PET/CT scans were evaluated for bone marrow involvement, both in the posterior iliac crest and other sites, and compared to blind BMB results.ResultsFDG-PET/CT was positive for bone marrow involvement in 7/38 posterior iliac crests, whereas BMB was positive in 5/38 posterior iliac crests. FDG-PET/CT and BMB results in the posterior iliac crest agreed in 36/38 cases (94.7%, 95% confidence interval [CI]: 82.7–98.5%). On a patient level, FDG-PET/CT was positive for bone marrow involvement in 4/20 patients, whereas BMB of the posterior iliac crest was positive in 3/20 patients. On a patient level, FDG-PET/CT and BMB results agreed in 19/20 patients (95.0%, 95% CI: 76.4–99.1%). The only discrepancies between FDG-PET/CT and BMB were observed in two BMBs of one patient. Both BMBs in this patient were negative, whereas FDG-PET/CT indicated bilateral posterior iliac crest involvement and also extensive bone marrow involvement elsewhere.ConclusionsFDG-PET/CT appears to be a valuable method for metastatic bone marrow assessment in newly diagnosed Ewing sarcoma. The routine use of blind BMB of the posterior iliac crest should be reconsidered when FDG-PET/CT is available.
Highlights
Ewing sarcoma is an aggressive primary tumor of bone and soft tissue occurring at any age with a peak incidence in adolescents and young adults [1], and an overall incidence of approximately 2.93 cases/1,000,000 [2]
A total of 22 patients were potentially eligible for inclusion. One of these patients was excluded because bone marrow biopsy (BMB) was not performed, and one patient was excluded because the time interval between FDG-positron emission tomography (PET)/computed tomography (CT) and BMB was 115 days
In 14 patients, FDG-PET/CT was performed before BMB, and in six patients FDG-PET/CT was performed after BMB
Summary
Ewing sarcoma is an aggressive primary tumor of bone and soft tissue occurring at any age with a peak incidence in adolescents and young adults [1], and an overall incidence of approximately 2.93 cases/1,000,000 [2]. 26– 28% of newly diagnosed Ewing sarcoma patients have been reported to present with distant metastases, with lung and bone marrow being the most frequent sites of metastatic disease [2]. Metastatic status at diagnosis is the strongest prognostic factor across different treatment strategies [1]. Fiveyear overall survival is approximately 30% for patients with initially metastatic disease [1]. Metastatic status is the most important factor in the risk-adapted treatment strategy that is currently employed in both North America and Europe [1]. Accurate staging is crucial because of its prognostic and therapeutic implications
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