Abstract
BackgroundTo investigate whether PET/CT-guided bone marrow biopsy adds complementary information for evaluation of bone marrow involvement (BMI) in newly diagnosed lymphomas.MethodsPatients with newly diagnosed lymphomas that received both 18F-FDG PET/CT and bone marrow biopsy (BMB) were included in this retrospective study. PET/CT classification of bone lesions was classified as isolated, multifocal (2 lesions or more), diffuse (homogeneous uptake of the entire axial skeleton), or negative. BMBs included PET/CT-guided targeted BMB and/or the routine unilateral iliac crest biopsy. Of 34 patients with focal lesions on PET/CT scan, 30 received both PET/CT-guided targeted BMB and iliac crest biopsy, and 4 patients received targeted biopsy without iliac crest biopsy. The final diagnosis of BMI depends on BMB results.ResultsA total of 299 patients with lymphomas were included. PET/CT classification of bone lesions was isolated (16/5.4%), multifocal (67/22.4%), diffuse (52/17.4%), and negative (164/54.8%). If only positive iliac crest biopsy was considered as the reference standard, the sensitivity of 18F-FDG PET/CT for identifying focal and diffuse BMI was 48 and 56%, respectively, and the respective specificities were 70 and 83%. Three of 30 patients (10.0%) with focal lesions on PET/CT were confirmed to be false-positive by targeted BMB, and 25 of 30 patients (83.3%) with focal lesions on PET/CT were confirmed as false-negative by iliac crest biopsy.ConclusionIt is insufficient to evaluate BMI in newly diagnosed lymphomas using both 18F-FDG PET/CT and routine iliac crest biopsy. 18F-FDG PET/CT imaging should be performed before BMB. In focal bone lesions, PET/CT-guided targeted BMB may complement the results of possible false-positive PET/CT and false-negative iliac crest biopsy findings. However, in diffuse and negative lesions, iliac crest biopsy cannot be safely omitted.
Highlights
To investigate whether PET/CT-guided bone marrow biopsy adds complementary information for evaluation of bone marrow involvement (BMI) in newly diagnosed lymphomas
Bone marrow (BM) is an important extent site, which occurs in 5–15% of Hodgkin lymphomas (HLs), and 20– 40% of non-Hodgkin lymphomas (NHLs), depending on the histological subtype [2, 3].The evaluation of BM status is of critical importance in newly diagnosed lymphomas, as it is stage, diagnosis, and if prolonged chemotherapy or radiotherapy may be required
According to the National Comprehensive Cancer Network (NCCN) guidelines for HL and NHL, routine iliac crest biopsy is essential in all lymphomas where treatment is considered, and is the gold standard for bone marrow staging
Summary
To investigate whether PET/CT-guided bone marrow biopsy adds complementary information for evaluation of bone marrow involvement (BMI) in newly diagnosed lymphomas. Methods: Patients with newly diagnosed lymphomas that received both 18F-FDG PET/CT and bone marrow biopsy (BMB) were included in this retrospective study. BMBs included PET/CT-guided targeted BMB and/or the routine unilateral iliac crest biopsy. Bone marrow (BM) is an important extent site, which occurs in 5–15% of Hodgkin lymphomas (HLs), and 20– 40% of non-Hodgkin lymphomas (NHLs), depending on the histological subtype [2, 3].The evaluation of BM status is of critical importance in newly diagnosed lymphomas, as it is stage, diagnosis, and if prolonged chemotherapy or radiotherapy may be required. According to the National Comprehensive Cancer Network (NCCN) guidelines for HL and NHL, routine iliac crest biopsy is essential in all lymphomas where treatment is considered, and is the gold standard for bone marrow staging. Previous studies have demonstrate bilateral core biopsies can improves the diagnostic yield, ranging between 10 and 60% [4,5,6], an additional biopsy means more risk of complications such as bleeding, pain, and anxiety [7, 8]
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