title: Value of 18F-FDG PET versus iliac biopsy in the initial evaluation of bone marrow infiltration in the case of Hodgkin's disease:  a meta-analysis.
abstract: OBJECTIVE
  We carried out a meta-analysis to evaluate the performance of 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F-FDG) PET and PET/CT against bone marrow biopsy (BMB) in the initial diagnosis of bone marrow infiltration (BMI) in patients with Hodgkin's disease (HD).
  
  
  METHODS
  Retrospective and prospective studies with direct comparison of (18)F-FDG PET with BMB in the initial evaluation of BMI in HD were included. Seven eligible studies were included in the meta-analysis comprising a total of 687 patients.
  
  
  RESULTS
  Both (18)F-FDG PET and BMB had excellent specificity in detecting BMI. However, (18)F-FDG PET had excellent pooled sensitivity (94.5%; 95% confidence interval: 89.0-97.8%) in detecting BMI in the initial staging of HD patients, whereas the pooled sensitivity of iliac BMB was very poor (39.4%; 95% confidence interval: 30.8-48.4%). The diagnostic odds ratio, a measure of the overall diagnostic power of the test, was much higher for PET (pooled value of 1591) than for iliac BMB (pooled value of 137).
  
  
  CONCLUSIONS
  (18)F-FDG PET significantly outperforms iliac BMB in the detection of BMI in the initial staging of HD patients and therefore should be used as a first-line study. Iliac BMB has low sensitivity and a high rate of false-negative findings. Thus, a negative BMB finding cannot rule out marrow involvement in HD patients on initial staging.
authors.affiliation: Department of Radiology, Philadelphia VA Medical Center, Philadelphia, PA 19104, USA. gangcheng99@yahoo.com
authors.forename: Gang
authors.initials: G
authors.lastname: Cheng
authors.forename: Abass
authors.initials: A
authors.lastname: Alavi
mesh_terms: D001706:Biopsy / Q000379:methods*; D001853:Bone Marrow / Q000473:pathology*; D019788:Fluorodeoxyglucose F18; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D007085:Ilium / Q000473:pathology*; D049268:Positron-Emission Tomography / Q000379:methods*
chemical_list: D019788:Fluorodeoxyglucose F18