title: Prognostic Importance of Bone Marrow Uptake on Baseline18F-FDG Positron Emission Tomography in Diffuse Large B Cell Lymphoma.
abstract: OBJECTIVE
  To define the role of18F-flourodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in the detection of bone marrow (BM) involvement in patients with diffuse large B cell lymphoma (DLBCL).
  
  
  METHODS
  Fifty-four (mean age: 55.5 ± 18.3 years, 20 female and 34 male) DLBCL patients who underwent pretreatment18F-FDG PET/CT were included to the study. Focal or diffuse BM18F-FDG uptake that is higher than mediastinal blood pool uptake was accepted as positive. After staging of disease by CT and18F-FDG PET/CT, all the patients received R-CHOP treatment after diagnostic blinded bone marrow biopsy (BMB). Presence of positive BM uptake in18F-FDG PET/CT and histopathological examination results of BMBs were analyzed by Chi-square test. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of18F-FDG PET/CT in the detection of BM involvement were calculated. Prognostic importance of the presence of BM18F-FDG uptake was analyzed by Kaplan-Meier analysis.
  
  
  RESULTS
  BM18F-FDG uptake was detected in 8 patients. Histopathological examination of BMB revealed BM involvement in 6 out of 8 patients. BMB was negative in all patients who have no18F-FDG uptake in the evaluation of PET/CT images. Sensitivity, specificity, accuracy, PPV, and NPV of18F-FDG PET/CT in the detection of BM involvement were calculated as 100%, 96%, 96%, 75%, and 100%, respectively. In the Kaplan-Meier analysis, we found that presence of pretreatment18F-FDG uptake in BM has a prognostic importance. Whereas mean time to progression (TTP) in patients with BM uptake was 32.25 ± 10.9 months and mean TTP in those without was 51.69 ± 3.6 months (p = 0.013).
  
  
  CONCLUSIONS
  BM uptake in pretreatment18F-FDG PET/CT is an important prognostic factor in DLBCL patients. Moreover, in consideration of high NPV,18F-FDG PET/CT could eliminate unnecessary BMB in FDG-negative patients.
authors.affiliation: 1 Department of Nuclear Medicine, Ankara University Medical Faculty , Ankara, Turkey .
authors.forename: Cigdem
authors.initials: C
authors.lastname: Soydal
authors.affiliation: 2 Department of Medical Oncology, Ankara University Medical Faculty , Ankara, Turkey .
authors.forename: Elif Berna
authors.initials: EB
authors.lastname: Koksoy
authors.affiliation: 2 Department of Medical Oncology, Ankara University Medical Faculty , Ankara, Turkey .
authors.forename: Arzu
authors.initials: A
authors.lastname: Yasar
authors.affiliation: 3 Department of Biostatistics, Medical Faculty, Hitit University , Corum, Turkey .
authors.forename: Ebru
authors.initials: E
authors.lastname: Turgal
authors.affiliation: 4 Department of Biostatistics, Ankara University Medical Faculty , Ankara, Turkey .
authors.forename: Beyza Doganay
authors.initials: BD
authors.lastname: Erdogan
authors.affiliation: 2 Department of Medical Oncology, Ankara University Medical Faculty , Ankara, Turkey .
authors.forename: Hakan
authors.initials: H
authors.lastname: Akbulut
authors.affiliation: 1 Department of Nuclear Medicine, Ankara University Medical Faculty , Ankara, Turkey .
authors.forename: Nuriye Ozlem
authors.initials: NO
authors.lastname: Kucuk
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001706:Biopsy; D001853:Bone Marrow / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000473:pathology; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000032:analysis / Q000493:pharmacokinetics*; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000032:analysis / Q000493:pharmacokinetics*; D012189:Retrospective Studies; D000069283:Rituximab; D016019:Survival Analysis; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: 18F-FDG positron emission tomography/computed tomography; bone marrow involvement; diffuse large B cell lymphoma