title: Use of FDG PET/CT in identification of bone marrow involvement in diffuse large B cell lymphoma and follicular lymphoma: comparison with iliac crest bone marrow biopsy.
abstract: Background Non-Hodgkin's lymphoma (NHL) accounts for around 4% of new cancer cases annually. Bone marrow involvement is important for staging and management. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is used increasingly to identify this, in addition to bone marrow biopsy (BMB), which is seen as "gold" reference standard. Purpose To compare determination of bone marrow involvement by FDG PET/CT against BMB in diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). Material and Methods This was a retrospective study of patients with histologically confirmed NHL at a single UK cancer center undergoing pre-treatment FDG PET/CT and BMB between June 2010 and February 2013. Information was collected from patient notes, cancer registry, histological and imaging reports. Diagnostic accuracy of FDG PET/CT was determined, compared to BMB as the reference standard. Results Twenty-four patients with DLBCL and 12 with FL were included. Five DLBCL patients had bone marrow involvement on PET/CT; all were confirmed on BMB. Three FL patients had marrow involvement on PET/CT but not on BMB; one FL patient had positive BMB but negative PET/CT. Using BMB as the reference standard, the sensitivity and specificity of FDG PET/CT for detecting bone marrow involvement in DLBCL were 100% and 100%, respectively, and in FL were 0% and 72.7%, respectively. Conclusion FDG PET/CT is accurate for detection of bone marrow involvement in newly diagnosed DLBCL, but not FL. In DLBCL, positive FDG PET/CT may negate the need for routine BMB, although BMB in addition or combination may be appropriate if this would influence management or prognosis.
authors.affiliation: 1 Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors.forename: Alexandra R
authors.initials: AR
authors.lastname: Teagle
authors.affiliation: 1 Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Barton
authors.affiliation: 2 Department of Haematology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Charles-Edwards
authors.affiliation: 1 Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.|3 Clinical Imaging Science Centre, Brighton and Sussex Medical School, University of Brighton and Sussex, Brighton, UK.|4 Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
authors.forename: Sabina
authors.initials: S
authors.lastname: Dizdarevic
authors.affiliation: 2 Department of Haematology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.|4 Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
authors.forename: Timothy
authors.initials: T
authors.lastname: Chevassut
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001853:Bone Marrow / Q000000981:diagnostic imaging / Q000473:pathology; D019046:Bone Marrow Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000556:secondary; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007085:Ilium / Q000473:pathology; D008224:Lymphoma, Follicular / Q000473:pathology*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Diffuse large B-cell lymphoma; bone marrow examination; follicular lymphoma; lymphoma; non-Hodgkin/radionuclide imaging; positron emission tomography (PET)