title: The value of routine bone marrow biopsy in patients with diffuse large B-cell lymphoma staged with PET/CT: a Danish-Canadian study.
abstract: The added diagnostic and prognostic value of routine bone marrow biopsy (BMB) in patients with diffuse large B-cell lymphoma (DLBCL) undergoing positron emission tomography combined with computed tomography (PET/CT) staging is controversial.
  
  
  
  Patients with newly diagnosed DLBCL who underwent both staging PET/CT and BMB were retrospectively identified in British Columbia, Aalborg, and Copenhagen. Original written PET/CT and pathology reports were retrospectively reviewed to determine Ann Arbor stage and outcomes, with and without the contribution of BMB.
  
  
  
  A total of 530 patients were identified: 146 (28%) had focal bone marrow (BM) lesions on PET/CT and 87 (16%) had positive BMB. Fifty-two of 146 patients (36%) with positive PET/CT had a positive BMB [39 DLBCL, 13 indolent non-Hodgkin lymphoma (iNHL)], while 35 of 384 patients (9%) with negative PET/CT had positive BMB (12 DLBCL, 23 iNHL). BMB upstaged 12/209 (6%) of stage I/II patients to stage IV, although this was the case for only 3 (1%) patients with DLBCL in the BMB. PET/CT identified BM involvement by BMB with sensitivity 60%, specificity 79%, positive predictive value 36%, and negative predictive value 91%. Concordant histological involvement of the BM by DLBCL was associated with worse overall survival and progression-free survival than discordant or no involvement in univariate and multivariate analyses.
  
  
  
  In patients with DLBCL, staging PET/CT can miss BM involvement with concordant DLBCL (less common) or discordant iNHL (more common). Routine BMB does not add relevant diagnostic or prognostic value over PET/CT alone in the majority of patients with DLBCL.
authors.affiliation: Department of Hematology, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: M
authors.initials: M
authors.lastname: Alzahrani
authors.affiliation: Department of Hematology and Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg.
authors.forename: T C
authors.initials: TC
authors.lastname: El-Galaly
authors.affiliation: Departments of Hematology.
authors.forename: M
authors.initials: M
authors.lastname: Hutchings
authors.affiliation: Departments of Hematology.
authors.forename: J W
authors.initials: JW
authors.lastname: Hansen
authors.affiliation: Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen.
authors.forename: A
authors.initials: A
authors.lastname: Loft
authors.affiliation: Department of Hematology and Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg.
authors.forename: H E
authors.initials: HE
authors.lastname: Johnsen
authors.affiliation: Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: V
authors.initials: V
authors.lastname: Iyer
authors.affiliation: Department of Functional Imaging, British Columbia Cancer Agency and the University of British Columbia, Vancouver.
authors.forename: D
authors.initials: D
authors.lastname: Wilson
authors.affiliation: Division of Medical Oncology.
authors.forename: L H
authors.initials: LH
authors.lastname: Sehn
authors.affiliation: Division of Medical Oncology.
authors.forename: K J
authors.initials: KJ
authors.lastname: Savage
authors.affiliation: Division of Medical Oncology.
authors.forename: J M
authors.initials: JM
authors.lastname: Connors
authors.affiliation: Department of Pathology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, Vancouver, Canada.
authors.forename: R D
authors.initials: RD
authors.lastname: Gascoyne
authors.affiliation: Department of Pathology, Aalborg University Hospital, Aalborg.
authors.forename: P
authors.initials: P
authors.lastname: Johansen
authors.affiliation: Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: E
authors.initials: E
authors.lastname: Clasen-Linde
authors.affiliation: Departments of Hematology.
authors.forename: P
authors.initials: P
authors.lastname: Brown
authors.affiliation: Division of Medical Oncology. Electronic address: dvilla@bccancer.bc.ca.
authors.forename: D
authors.initials: D
authors.lastname: Villa
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001853:Bone Marrow / Q000000981:diagnostic imaging* / Q000473:pathology; D002170:Canada; D003718:Denmark; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000627:therapeutic use; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D011379:Prognosis
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: PET; bone marrow biopsy; concordant; diffuse large B-cell lymphoma; discordant