title: Routine bone marrow biopsy has little or no therapeutic consequence for positron emission tomography/computed tomography-staged treatment-naive patients with Hodgkin lymphoma.
abstract: OBJECTIVE
  To investigate whether bone marrow biopsy (BMB) adds useful information to [(18)F]fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) staging in patients with Hodgkin lymphoma (HL).
  
  
  METHODS
  Newly diagnosed patients with HL undergoing a pretherapeutic staging that encompasses both PET/CT and BMB were included in this retrospective study. The pattern of skeletal FDG uptake was categorized as uni-, bi-, or multifocal (≥ three lesions). Clinical stage, risk assessment, and treatment plan were determined with and without the contribution of BMB results according to the Ann Arbor classification and the guidelines from the German Hodgkin Study Group.
  
  
  RESULTS
  A total of 454 patients with HL were included of whom 82 (18%) had focal skeletal PET/CT lesions and 27 (6%) had positive BMB. No patients with positive BMB were assessed as having stage I to II disease by PET/CT staging. BMB upstaged five patients, assessed as being stage III before BMB; none of the 454 patients would have been allocated to another treatment on the basis of BMB results. Focal skeletal PET/CT lesions identified positive and negative BMBs with a sensitivity and specificity of 85% and 86%, respectively. The positive and negative predictive values of focal skeletal PET/CT lesions for BMB results were 28% and 99%, respectively.
  
  
  CONCLUSIONS
  A consistent finding of this study was the absence of positive BMBs in PET/CT-assessed stage I to II disease. The omission of staging BMB would not have changed the risk assessment or treatment strategy in this cohort of 454 newly diagnosed patients with HL.
authors.affiliation: Aarhus Hospital, Aarhus University Hospital, Aarhus, Denmark. tarec.galaly@gmail.com
authors.forename: Tarec Christoffer
authors.initials: TC
authors.lastname: El-Galaly
authors.forename: Francesco
authors.initials: F
authors.lastname: d'Amore
authors.forename: Karen Juul
authors.initials: KJ
authors.lastname: Mylam
authors.forename: Peter
authors.initials: P
authors.lastname: de Nully Brown
authors.forename: Martin
authors.initials: M
authors.lastname: Bøgsted
authors.forename: Anne
authors.initials: A
authors.lastname: Bukh
authors.forename: Lena
authors.initials: L
authors.lastname: Specht
authors.forename: Annika
authors.initials: A
authors.lastname: Loft
authors.forename: Victor
authors.initials: V
authors.lastname: Iyer
authors.forename: Karin
authors.initials: K
authors.lastname: Hjorthaug
authors.forename: Anne Lerberg
authors.initials: AL
authors.lastname: Nielsen
authors.forename: Ilse
authors.initials: I
authors.lastname: Christiansen
authors.forename: Charlotte
authors.initials: C
authors.lastname: Madsen
authors.forename: Hans-Erik
authors.initials: HE
authors.lastname: Johnsen
authors.forename: Martin
authors.initials: M
authors.lastname: Hutchings
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D001853:Bone Marrow / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18