title: PET-CT staging of DLBCL accurately identifies and provides new insight into the clinical significance of bone marrow involvement.
abstract: We investigated whether positron emission tomography combined with computed tomography (PET-CT) identifies clinically important bone marrow involvement by diffuse large B-cell lymphoma (DLBCL) with sufficient accuracy to replace routine staging bone marrow biopsy. All patients from a single centre diagnosed as DLBCL since 2005 had data extracted from staging PET-CT, marrow biopsy, and treatment records. Of 130 patients, 35 (27%) were judged to have marrow involvement; 33 were identified by PET-CT compared with 14 by marrow histology. PET identified all clinically important marrow lymphoma, while biopsy did not upstage any patient. Sensitivity and specificity were 94% and 100% for PET-CT and 40% and 100% for marrow biopsy. As a secondary aim, we compared the prognosis of marrow involvement, as detected by PET-CT or biopsy. Cases with marrow deposits identified by PET-CT but not biopsy had progression-free survival (PFS) and overall survival similar to stage IV disease without involved marrow. Positive biopsy conferred significantly inferior PFS (P = .003); these cases frequently had other markers of poor-risk disease. These data confirm that in experienced hands PET-CT has a high level of accuracy for identifying marrow disease in DLBCL, and provide new insight into the nature and clinical significance of marrow involvement.
authors: Department of Haematology, Guy's and St Thomas' Foundation Trust, London, United Kingdom.
authors: Anjum Bashir
authors: AB
authors: Khan
authors: Sally Fiona
authors: SF
authors: Barrington
authors: Nabegh George
authors: NG
authors: Mikhaeel
authors: Alesia Abigael
authors: AA
authors: Hunt
authors: Laura
authors: L
authors: Cameron
authors: Tim
authors: T
authors: Morris
authors: Robert
authors: R
authors: Carr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001853:Bone Marrow / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D007085:Ilium / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009367:Neoplasm Staging / Q000379:methods; D049268:Positron-Emission Tomography; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D055815:Young Adult