title: Biopsy versus FDG PET/CT in the initial evaluation of bone marrow involvement in pediatric lymphoma patients.
abstract: OBJECTIVE
  The objective is to assess the role of (18)F-2-fluoro-2-deoxy-D: -glucose (FDG) positron emission tomography (PET)/CT versus bone marrow biopsy (BMB) in the initial evaluation of bone marrow (BM) involvement in pediatric lymphoma patients.
  
  
  METHODS
  Fifty-four pediatric patients with pathologically proven lymphoma [31 Hodgkin's disease (HD), 23 non-Hodgkin's lymphoma (NHL)] were included in this study. All patients had soft tissue biopsy and BMB and had FDG PET/CT scans within 2 weeks of biopsy.
  
  
  RESULTS
  Among the 31 HD patients, FDG PET/CT revealed positive BM involvement in 4 patients, while BMB revealed BM involvement in 2 patients who were also positive on FDG PET/CT imaging. Among the 23 NHL patients, FDG PET/CT revealed positive BM involvement in 8 patients, while biopsy revealed BM involvement in 5 patients on initial studies (4 of them were also positive on FDG PET/CT, and 1 was BMB positive but was negative on FDG PET/CT), plus 1 false-negative BMB study initially but positive on repeat biopsy after FDG PET/CT. The overall sensitivity of detecting BM involvement by lymphoma was 92 and 54% (p < 0.05) for FDG PET/CT and BMB, respectively. It is noted that there were more positive BMB findings in patients with abnormal FDG activities seen in the biopsy sites on PET/CT.
  
  
  CONCLUSIONS
  Our study demonstrates that FDG PET/CT has high sensitivity and accuracy and a substantial complementary value to BMB in the initial diagnosis of pediatric lymphoma, and should be employed as a first-line study.
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, USA. gangcheng99@yahoo.com
authors.forename: Gang
authors.initials: G
authors.lastname: Cheng
authors.forename: Wengen
authors.initials: W
authors.lastname: Chen
authors.forename: Wichana
authors.initials: W
authors.lastname: Chamroonrat
authors.forename: Drew A
authors.initials: DA
authors.lastname: Torigian
authors.forename: Hongming
authors.initials: H
authors.lastname: Zhuang
authors.forename: Abass
authors.initials: A
authors.lastname: Alavi
mesh_terms: D000293:Adolescent; D019046:Bone Marrow Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D002648:Child; D005260:Female; D019788:Fluorodeoxyglucose F18; D006689:Hodgkin Disease / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18