ROLE OF F-18 FDG-PET/CT IN DETECTING LYMPHOMATOUS BONE MARROW INVOLVEMENT IN THE INITIAL STAGING OF PATIENTS WITH LYMPHOMA
(Abstract release date: 05/18/17)
EHA Library. Hernandez Ruiz B. 05/18/17; 182593; PB1879
Belén Hernandez Ruiz
Contributions
Contributions
Abstract
Abstract: PB1879
Type: Publication Only
Background
The role of F-18 FDG-PET/CT for the assessment of bone marrow involvement in the staging of newly diagnosed patients with lymphoma was reviewed in the Recommendations of Lugano Classification. They conclude that if a PET/CT is performed, a bone marrow biopsy is no longer indicated for a routine staging of Hodgkin lymphoma (HL) and most difusse large cell lymphoma (DLBCL). Data are insufficient in follicular lymphoma (FL) and bone marrow biopsy is always recommended.
Aims
We study the value of F-18 FDG-PET/CT for the detection of bone marrow involvement in the initial staging of patients with lymphoma.
Methods
Newly diagnosed patients with HL, DLBCL and FL who underwent F-18 FDG PET/CT and bone marrow biopsy for initial staging between January 2007 and June 2016 were included. We analyze sensitivity, specificity and concordance of PET/CT compared with bone marrow biopsy. In discordant cases, we review if there was any difference in the staging.
Results
161 patients were included,69 DLBCL(38 male,31 female, median age 59 years),44 HL(24male,20female, me32y),48 FL (23male,25female, me55y)
Four of the 44 patients with HL had bone marrow infiltration in bone marrow biopsy (BMB+) and PET/CT detected bone marrow involvement in all of these patients. PET/CT was positive in bone marrow (BMPET+) in 7 of the 40 patients without bone marrow infiltration in bone marrow biopsy (BMB-), these patients had bone marrow lesions on locations other than iliac crest. Six of the 7 patients were in advanced stage regardless of bone marrow involvement and a patient had sternal involvement by contiguity.
Seven of the 69 patients with DLBCL had BMB+, 6 patients with DLBCL and 1 patient DLBCL and FL. PET/TC had detected bone marrow involvement in all of them.
Sixty-two patients of 69 DLCL did not have bone marrow infiltration by biopsy(BMB-), but nine of them had BMPET+. Seven of the 9 patients were in stage IV because of extranodal involvement of other organs. One patient had primary bone involvement of jaw and another patient had vertebral involvement by contiguity.
Fourteen patients of 48 patients with FL had BMB+. Of these 14 patients with bone marrow involvement by biopsy, 5 patients had BMPET- and PET/CT could not detect another extranodal involvement in three of these five patients. Of the 34 patients without bone marrow infiltration by biopsy BMO-, 8 patients had PET-TAC+, and 6/8 could be classified in stage IV regardless of bone marrow involvement.
n | BMB+ | BMB- | ||||||
PET+ | PET- | PET+ | PET- | Sensitivity | Specificity | Concordance | ||
HL | 44 | 4 | 0 | 7 | 33 | 100% | 82,5% | 84% |
DLBCL | 69 | 7 | 0 | 9 | 53 | 100% | 85% | 87% |
FL | 48 | 9 | 5 | 8 | 26 | 64,2% | 86,6% | 72,9% |
Conclusion
Our series confirms that PET/CT is useful to detect bone marrow involvement in the initial staging of Hodgkin Lymphoma and DLBCL. We can avoid bone marrow biopsy in these hystological variants of lymphoma .
In follicular lymphoma, PET/CT did not detect more than one third of patients with bone marrow infiltration by biopsy. These results support the histological assesment of bone marrow in the initial staging of follicular lymphoma.
Session topic: 19. Indolent Non-Hodgkin lymphoma - Clinical
Keyword(s): PET, Bone marrow biopsy
Abstract: PB1879
Type: Publication Only
Background
The role of F-18 FDG-PET/CT for the assessment of bone marrow involvement in the staging of newly diagnosed patients with lymphoma was reviewed in the Recommendations of Lugano Classification. They conclude that if a PET/CT is performed, a bone marrow biopsy is no longer indicated for a routine staging of Hodgkin lymphoma (HL) and most difusse large cell lymphoma (DLBCL). Data are insufficient in follicular lymphoma (FL) and bone marrow biopsy is always recommended.
Aims
We study the value of F-18 FDG-PET/CT for the detection of bone marrow involvement in the initial staging of patients with lymphoma.
Methods
Newly diagnosed patients with HL, DLBCL and FL who underwent F-18 FDG PET/CT and bone marrow biopsy for initial staging between January 2007 and June 2016 were included. We analyze sensitivity, specificity and concordance of PET/CT compared with bone marrow biopsy. In discordant cases, we review if there was any difference in the staging.
Results
161 patients were included,69 DLBCL(38 male,31 female, median age 59 years),44 HL(24male,20female, me32y),48 FL (23male,25female, me55y)
Four of the 44 patients with HL had bone marrow infiltration in bone marrow biopsy (BMB+) and PET/CT detected bone marrow involvement in all of these patients. PET/CT was positive in bone marrow (BMPET+) in 7 of the 40 patients without bone marrow infiltration in bone marrow biopsy (BMB-), these patients had bone marrow lesions on locations other than iliac crest. Six of the 7 patients were in advanced stage regardless of bone marrow involvement and a patient had sternal involvement by contiguity.
Seven of the 69 patients with DLBCL had BMB+, 6 patients with DLBCL and 1 patient DLBCL and FL. PET/TC had detected bone marrow involvement in all of them.
Sixty-two patients of 69 DLCL did not have bone marrow infiltration by biopsy(BMB-), but nine of them had BMPET+. Seven of the 9 patients were in stage IV because of extranodal involvement of other organs. One patient had primary bone involvement of jaw and another patient had vertebral involvement by contiguity.
Fourteen patients of 48 patients with FL had BMB+. Of these 14 patients with bone marrow involvement by biopsy, 5 patients had BMPET- and PET/CT could not detect another extranodal involvement in three of these five patients. Of the 34 patients without bone marrow infiltration by biopsy BMO-, 8 patients had PET-TAC+, and 6/8 could be classified in stage IV regardless of bone marrow involvement.
n | BMB+ | BMB- | ||||||
PET+ | PET- | PET+ | PET- | Sensitivity | Specificity | Concordance | ||
HL | 44 | 4 | 0 | 7 | 33 | 100% | 82,5% | 84% |
DLBCL | 69 | 7 | 0 | 9 | 53 | 100% | 85% | 87% |
FL | 48 | 9 | 5 | 8 | 26 | 64,2% | 86,6% | 72,9% |
Conclusion
Our series confirms that PET/CT is useful to detect bone marrow involvement in the initial staging of Hodgkin Lymphoma and DLBCL. We can avoid bone marrow biopsy in these hystological variants of lymphoma .
In follicular lymphoma, PET/CT did not detect more than one third of patients with bone marrow infiltration by biopsy. These results support the histological assesment of bone marrow in the initial staging of follicular lymphoma.
Session topic: 19. Indolent Non-Hodgkin lymphoma - Clinical
Keyword(s): PET, Bone marrow biopsy
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