The Diagnostic Value of 18F-FDG PET/CT Bone Marrow Uptake Pattern in Detecting Bone Marrow Involvement in Pediatric Neuroblastoma Patients.

Jun Liu,Xia Lu,Cuicui Li,Mingyu Zhang,Jigang Yang,Xu Yang,Luodan Qian,Wei Wang,Ying Kan,Reza Vali

doi:10.1155/2022/7556315

Abstract

Objectives To explore the diagnostic value of 18F-FDG PET/CT bone marrow uptake pattern (BMUP) in detecting bone marrow involvement (BMI) in pediatric neuroblastoma (NB) patients. Methods Ninety-eight NB patients were enrolled in BMI analysis. Four patterns of bone marrow uptake were categorized based on pretreatment cF-FDG PET/CT images. Some crucial inspection indexes and 18F-FDG PET/CT metabolic parameters were analyzed. The BMUP was divided into BMUP1, BMUP2, BMUP3, and BMUP4. Paired-like homeobox 2b (PHOX2B) of bone marrow and blood, bone marrow biopsy (BMB) result, and 18F-FDG PET/CT were compared to detect BMI. All patients were followed up for at least six months. Results BMUP had excellent consistency among different physicians. Kappa coefficients of two residents and two attending physicians and between the resident and attending physician, were 0.857, 0.891, and 0.845, respectively. The optimal cut-off value of SUVmax-Bone/Liver was 2.08 to diagnose BMI for BMUP3 patients, and the area under curve (AUC) was 0.873. AUC of PHOX2B of bone marrow (PHOX2B of BM), PHOX2B of blood, BMB, and 18F-FDG PET/CT were 0.916, 0.811, 0.806, and 0.904, respectively. There was no significant difference between PHOX2B of BM and PET/CT. Positive predictive value, negative predictive value, sensitivity, and specificity in diagnosis of BMI were 92.9%, 92.9%, 97.0%, and 83.9% for PET/CT and 96.7%, 80.6%, 89.6%, and 93.5% for PHOX2B of BM, respectively. Conclusions BMUP of pretreatment 18F-FDG PET/CT is a simple and practical method, which has a relatively high diagnostic efficiency in detecting BMI and might decrease unnecessary invasive inspections in some pediatric NB patients.

Highlights

Neuroblastoma (NB) is one of the most common malignant tumors in children, which originates from neural-crest cells, and related with about 12% to 15% of pediatric cancer deaths [1, 2]
We further investigated the diagnostic accuracy of 18FFDG PET/CT, bone marrow biopsy (BMB), Paired-like homeobox 2b (PHOX2B) of blood, and PHOX2B of BM in the different bone marrow uptake pattern (BMUP)
We proposed 18F-FDG PET/CT BMUP and evaluated the value of BMUP in detecting bone marrow involvement (BMI) compared with PHOX2B of blood and PHOX2B of BM in newly diagnosed NB

Summary

Introduction

Neuroblastoma (NB) is one of the most common malignant tumors in children, which originates from neural-crest cells, and related with about 12% to 15% of pediatric cancer deaths [1, 2]. Bone marrow is the most common metastasis site of NB, and patients without bone marrow involvement (BMI) would have a more favorable prognosis than those with BMI [5]. Cytology of aspirates and histology of biopsies have been the gold standard to evaluate BMI in NB for many years. These methods have limited sensitivity when NB involvement is less than 10% and could seriously underestimate the prevalence of BMI [5, 7, 8]. Bone marrow biopsy (BMB) only contains a limited part of bone marrow, which might miss the region of malignant infiltration and should not be considered as a gold standard in childhood malignancy [9, 10]. There are some techniques to precisely detect BMI, including immunocytology, multiparameter flow cytometry, and reverse transcriptase-

Objectives

Methods

Results

Conclusion