scholarly journals Diagnostic value of baseline 18FDG PET/CT skeletal textural features in follicular lymphoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Julie Faudemer ◽  
Nicolas Aide ◽  
Anne-Claire Gac ◽  
Ghandi Damaj ◽  
Jean-Pierre Vilque ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Follicular Lymphoma ◽  
Fdg Pet ◽  
B Cell Lymphoma ◽  
Visual Assessment ◽  
Diagnostic Value ◽  
Textural Features ◽  
Lasso Regression ◽  
Pet Ct ◽  
Fdg Pet Ct

AbstractAt present, 18F-fluorodesoxyglucose (18FDG) positron emission tomography (PET)/computed tomography (CT) cannot be used to omit a bone marrow biopsy (BMB) among initial staging procedures in follicular lymphoma (FL). The additional diagnostic value of skeletal textural features on baseline 18FDG-PET/CT in diffuse large B-cell lymphoma (DLBCL) patients has given promising results. The aim of this study is to evaluate the value of 18FDG-PET/CT radiomics for the diagnosis of bone marrow involvement (BMI) in FL patients. This retrospective bicentric study enrolled newly diagnosed FL patients addressed for baseline 18FDG PET/CT. For visual assessment, examinations were considered positive in cases of obvious bone focal uptakes. For textural analysis, the skeleton volumes of interest (VOIs) were automatically extracted from segmented CT images and analysed using LifeX software. BMB and visual assessment were taken as the gold standard: BMB −/PET − patients were considered as bone-NEGATIVE patients, whereas BMB +/PET −, BMB −/PET + and BMB +/PET + patients were considered bone-POSITIVE patients. A LASSO regression algorithm was used to select features of interest and to build a prediction model. Sixty-six consecutive patients were included: 36 bone-NEGATIVE (54.5%) and 30 bone-POSITIVE (45.5%). The LASSO regression found variance_GLCM, correlation_GLCM, joint entropy_GLCM and busyness_NGLDM to have nonzero regression coefficients. Based on ROC analysis, a cut-off equal to − 0.190 was found to be optimal for the diagnosis of BMI using PET pred.score. The corresponding sensitivity, specificity, PPV and NPV values were equal to 70.0%, 83.3%, 77.8% and 76.9%, respectively. When comparing the ROC AUCs with using BMB alone, visual PET assessment or PET pred.score, a significant difference was found between BMB versus visual PET assessments (p = 0.010) but not between BMB and PET pred.score assessments (p = 0.097). Skeleton texture analysis is worth exploring to improve the performance of 18FDG-PET/CT for the diagnosis of BMI at baseline in FL patients.

The Clinical Utility of FDG PET-CT in Evaluation of Bone Marrow Involvement by Diffuse Large B Cell Lymphoma

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2661-2661
Author(s):  
Hyo Jung Kim ◽  
Boram Han ◽  
Dok Hyun Yoon ◽  
Ho Young Kim ◽  
Shin Kim ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Fdg Pet ◽  
Iliac Crest ◽  
Cell Lymphoma ◽  
Medical Center ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Large B Cell

Abstract Abstract 2661 Background. In lymphoma, bone marrow (BM) involvement is a sign of extensive disease and BM biopsy is a standard method in the evaluation of BM infiltration by disease. Because of patchy BM involvement pattern by lymphoma, the reported rates of unilateral involvement in bilateral biopsies range from 10% to 50%. However BM biopsy is an invasive and painful procedure. The value of unilateral versus bilateral BM biopsy remains controversial. Fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) is a noninvasive imaging technique and currently it shows potential to detect BM involvement by lymphoma. Aims. We assess the abilities of FDG PET-CT to ascertain the presence of BM involvement in diffuse large B cell lymphoma (DLBCL) patients and to define the possibility that bilateral BM biopsies could be replaced by unilateral biopsy for DLBCL staging workup. Methods. We retrospectively reviewed medical records of histologically proven DLBCL patients from 2004 through 2010 at the Asan Medical Center and Hallym University Medical Center. All patients were examined by FDG PET-CT and bilateral BM biopsy at both posterior iliac crests for initial staging workup. Evaluation of PET studies was performed by board-certified nuclear medicine physicians of each institution. Quantitative analysis of FDG uptake was not performed. Data were expressed in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for FDG PET-CT in evaluation of BM involvement by DLBCL, using BM biopsy as the reference standard. Two sets (right & left biopsy site) of pathologic and imaging data were analyzed separately. Results. Study population comprised 478 patients (median age 57, range 17–85 years; 269 male) with newly diagnosed DLBCL. Ann Arbor stage I, II, III and IV patients were 96, 120, 40 and 222, respectively. Overall, BM involvement by DLBCL that confirmed by bilateral BM biopsy occurred in 63 patients (13.2%, 15, 12, and 36 at right, left and both side biopsy, respectively). From the data of right side biopsy and FDG PET-CT images, comparison of the former and the later results revealed concordant positive findings in 22 cases (4.6%) and concordant negative findings in another 418 cases (87.4%). In 29 patients (6.1%) in whom FDG PET-CT returned findings of normal marrow, iliac crest BM biopsy revealed lymphomatous infiltration. On the other hand, in 9 patients (1.9%) in whom bilateral iliac crest BM biopsy had failed to reveal any abnormality, FDG PET-CT showed increased uptake. The calculated values for FDG PET-CT in evaluation of right BM infiltration were 43.1% (22/51) of sensitivity, 97.9% (418/427) of specificity, 71% (22/31) of PPV and 93.5% (418/447) of NPV. The values oriented from left BM biopsy and FDG PET-CT images were similar (sensitivity 41.7% (20/48), specificity 97.9% (421/430), PPV 69% (20/29), NPV 93.7% (421/449)). Conclusions. This study has the largest DLBCL cases among ever reported articles, and demonstrates not excellent sensitivity of FDG PET-CT against the results of BM biopsy for the detection of BM involvement in DLBCL patients. BM biopsy could not be completely replaced with FDG PET-CT. But it has relatively good PPV, FDG PET-CT will be a useful tool for image-guided biopsy for DLBCL staging. And in daily practice, clinicians could consider the possibility to do efficient unilateral BM biopsy for DLBCL patients who have increased posterior iliac crest FDG uptake, instead of bilateral biopsy. Disclosures: Kim: Novartis: Research Funding.

scholarly journals Revisiting the Marrow Metabolic Changes after Chemotherapy in Lymphoma: A Step towards Personalized Care

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Bingfeng Tang ◽  
Malaykumar M. Patel ◽  
Regina H. Wong ◽  
Daniel Wood ◽  
Christiana O. Wong ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Fdg Pet ◽  
Bone Marrow Involvement ◽  
Standardized Uptake Value ◽  
B Cell Lymphoma ◽  
Metabolic Changes ◽  
Personalized Care ◽  
Pet Ct ◽  
Maximal Standardized Uptake Value ◽  
Fdg Pet Ct

Purpose. The aims were to correlate individual marrow metabolic changes after chemotherapy with bone marrow biopsy (BMBx) for its potential value of personalized care in lymphoma. Methods. 26 patients (mean age, 58 ± 15 y; 13 female, 13 male) with follicular lymphoma or diffuse large B-cell lymphoma, referred to FDG-PET/CT imaging, who had BMBx from unilateral or bilateral iliac crest(s) before chemotherapy, were studied retrospectively. The maximal standardized uptake value (SUV) was measured from BMBx site over the same area on both initial staging and first available restaging FDG-PET/CT scan. Results. 35 BMBx sites in 26 patients were evaluated. 12 of 35 sites were BMBx positive with interval decrease in SUV in 11 of 12 sites (92%). The remaining 23 of 35 sites were BMBx negative with interval increase in SUV in 21 of 23 sites (91%). The correlation between SUV change over the BMBx site before and after chemotherapy and BMBx result was significant (P<0.0001). Conclusions. This preliminary result demonstrates a strong correlation between marrow metabolic changes (as determined by FDG PET) after chemotherapy and bone marrow involvement proven by biopsy. This may provide a retrospective means of personalized management of marrow involvement in deciding whether to deliver more extended therapy or closer followup of lymphoma patients.

scholarly journals Role of FDG-PET/CT in the Staging of Patients with Follicular Lymphoma

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5010-5010 ◽  
Author(s):  
Sayako Yuda ◽  
Dai Maruyama ◽  
Hiroaki Kurihara ◽  
Akiko Miyagi Maeshima ◽  
Kosuke Toyoda ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Follicular Lymphoma ◽  
Fdg Pet ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Response Assessment ◽  
Bone Marrow Examination ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Introduction The Lugano Classification incorporating recommendations of 18-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography/computed tomography (PET/CT) in the staging and response assessment of FDG-avid lymphomas was published. This classification is based on plenty of reports that suggested that evaluation with FDG-PET/CT improved the accuracy of the staging and response assessment of FDG-avid lymphomas, especially of diffuse large B-cell lymphoma and Hodgkin lymphoma. However, we are not sure of the role of FDG-PET/CT in indolent B-cell lymphomas, such as follicular lymphoma (FL). Patients and Methods Patients who were initially diagnosed as having FL of grade 1 to 3a at our institution between 2010 and 2012 were included in this study. We analyzed the number of nodal areas and the location of extranodal diseases identified by FDG-PET/CT added to the conventional evaluation consisting of CT, bone marrow examination and upper gastrointestinal endoscopy. The clinical stage by the conventional evaluation was compared to that by the Lugano Classification using FDG-PET/CT. It was also investigated whether adding PET/CT to the conventional evaluation might have had any influence on the decision regarding the initial treatment for patients with FL. Results A total of 67 patients with a median age of 62 years (range: 39-85) were included in this analysis. In comparison with CT, FDG-PET/CT identified a higher number of nodal areas in 11 patients (16%). Most of the extranodal sites except bone marrow and gastrointestinal tract were more frequently detected by PET-CT. Bone marrow examination detected 22 patients (33%) with bone marrow involvement, while PET-CT detected only 4 patients (6%). Gastrointestinal lesions were identified in 15 patients (22%) with conventional evaluation and in 4 patients (6%) by PET-CT (Table 1). In one of these 4 patients, endoscopic biopsy revealed that the PET-CT positive lesion was adenoma. In seven patients (10%), upstaging occurred through conventional evaluation plus PET-CT: 3 patients were upstaged from stage I to II, 2 from stage II to IV, 1 from stage II to III, and 1 from stage III to IV (Table 2). International Prognostic Index (IPI) and Follicular Lymphoma International Prognostic Index (FLIPI) were revised upward in 9 patients (13%) and 12 patients (18%), respectively. However, the change of stage, IPI, or FLIPI did not affect the decision regarding the initial treatment. Conclusion Our data suggest that FDG-PET/CT cannot take the place of the conventional evaluation, especially in patients with FL, because of the low sensitivity of involvements in bone marrow and gastrointestinal tract, although it may be helpful to use FDG-PET/CT in the staging of FL. Moreover, FDG-PET/CT might not have had any impact on the decision regarding the treatment strategy in FL. That may be partly because the lesions detected only by FDG-PET/CT did not affect the judgment of tumor burden. Prospective evaluation of the influence of FDG-PET/CT on the clinical outcomes is needed to establish an appropriate evaluation in the staging of patients with FL. Disclosures Maruyama: Takeda Pharmaceutical Company Limited: Honoraria; Eisai Co., Ltd.: Honoraria. Kobayashi:Nippon Shinyaku: Honoraria; Pfizer: Research Funding. Tobinai:Gilead Sciences: Research Funding.

scholarly journals Correlation of FDG-PET-CT with Bone Marrow Aspiration and Biopsy at the Initial Staging in Follicular Lymphoma: Can We Omit Bone Marrow Biopsy in Some?

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4436-4436
Author(s):  
Manju Sengar ◽  
Hasmukh Jain ◽  
Venkatesh Rangarajan ◽  
Archi Agrawal ◽  
Hari Menon ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Follicular Lymphoma ◽  
Bone Marrow Biopsy ◽  
Predictive Value ◽  
Fdg Pet ◽  
Early Stage ◽  
Bone Marrow Involvement ◽  
Bone Marrow Uptake ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Introduction: The role of FDG PET-CT in follicular lymphoma is limited to accurate assessment of disease extent in early stage patients and selection of biopsy site in cases of suspected high- grade transformation. Despite the known FDG avidity of follicular lymphoma, FDG PET-CT has not yet been included as part of standard staging procedures in these patients. FDG PET-CT has shown significant correlation with bone marrow biopsy in Hodgkin and diffuse large B-cell lymphomas. In this retrospective analysis we have assessed the correlation of PET-CT with that of bone marrow biopsy, the reference standard for assessment of bone marrow infiltration in follicular lymphoma. Methods: We retrospectively analyzed electronic medical records and database of patients with newly diagnosed follicular lymphoma registered at Tata Memorial Centre from July 2009 to Jun 2014, who underwent complete staging workup as per the current recommendations along with whole body 18FDG-PET/CT. The demographic features, performance status, stage, LDH, nodal sites, haemoglobin, follicular lymphoma international prognostic index (FLIPI), FDG PET-CT findings (bone marrow involvement, pattern of involvement- focal or diffuse, sites of marrow involvement, liver and spleen uptake, SUVmax of most FDG avid lesion) and bone marrow aspiration/biopsy (morphology, immunohistochemistry and immunophenotyping on aspirate, where available) findings were recorded. Focal uptake in marrow on baseline PET-CT was considered as marrow involvement if post therapy PET-CT showed resolution of these lesions. The sensitivity, specificity, negative and positive predictive value of PET-CT in detecting bone marrow infiltration was assessed taking bone marrow biopsy as gold standard. The factors responsible for discordant results were analyzed. Results: A total of 54 patients (males-38, females-16) were included in analysis with median age of 50 years, (range 22-73 years). At diagnosis 83% (45 patients) had stage III or IV disease and 57% patients had high-risk FLIPI score. Approximately 88% patients had good performance status (ECOG-<2). Bone marrow showed infiltration in approximately 60% (32 patients) on biopsy and immunophenotyping. PET-CT showed bone marrow involvement in 18 patients (focal-12, diffuse -6). In 4 patients with focal PET-CT positivity, bone marrow was uninvolved. However, post therapy these lesions showed resolution, thus confirming the presence of disease pretherapy. The sensitivity, specificity, positive and negative predictive value of PET/CT with respect to biopsy was 43.7%, 81.2%, 77.8% and 50% respectively. However, if we include the above mentioned 4 cases as true positives, then specificity and positive predictive value improves to 100% each. In addition, PET-CT could accurately predict absence of bone marrow involvement in stage I and stage II disease (100% concordance). The median SUVmax of most FDG avid lesion was 13.1 (5.25-34.93). However the SUVmax did not correlate with grade of lymphoma as the node biopsy was not done based on PET-CT results. Conclusion: This study shows that in patients with advanced stage follicular lymphoma bone marrow biopsy can be omitted if PET-CT shows focal or diffuse bone marrow uptake. Similarly, patients with early stage disease with no bone marrow uptake on PET-CT can be spared from bone marrow biopsy. Disclosures No relevant conflicts of interest to declare.

scholarly journals FDG-PET in Follicular Lymphoma Management

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
C. Bodet-Milin ◽  
T. Eugène ◽  
T. Gastinne ◽  
E. Frampas ◽  
S. Le Gouill ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Fdg Pet ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Induction Treatment ◽  
Standard Clinical Practice ◽  
Pet Ct ◽  
Noninvasive Characterization ◽  
Fdg Pet Ct ◽  
Initial Staging

18-Fluoro-deoxyglucose positron emission tomography/computerised tomography (FDG PET/CT) is commonly used in the management of patients with lymphomas and is recommended for both initial staging and response assessment after treatment in patients with diffuse large B-cell lymphoma and Hodgkin lymphoma. Despite the FDG avidity of follicular lymphoma (FL), FDG PET/CT is not yet applied in standard clinical practice for patients with FL. However, FDG PET/CT is more accurate than conventional imaging for initial staging, often prompting significant management change, and allows noninvasive characterization to guide assessment of high-grade transformation. For restaging, FDG PET/CT assists in distinguishing between scar tissue and viable tumors in residual masses and a positive PET after induction treatment would seem to predict a shorter progression-free survival.

scholarly journals Diagnostic Accuracy of Immunoglobulin Heavy Chain Rearrangement, FDG-PET/CT and Unilateral Bone Marrow Trephination for Detecting Bone Marrow Involvement in Diffuse Large B Cell Lymphoma

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4236-4236
Author(s):  
Seung-Yeon Jung ◽  
Sung-Hoon Jung ◽  
Seo-Yeon Ahn ◽  
Je-Jung Lee ◽  
Hyeoung-Joon Kim ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Diagnostic Accuracy ◽  
Fdg Pet ◽  
Bone Marrow Involvement ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Igh Rearrangement ◽  
Low Sensitivity ◽  
Fdg Pet Ct

Abstract Bone marrow involvement (BMI) has important clinical implication in diffuse large B cell lymphoma (DLBCL) as a component of staging and International Prognostic Index (IPI). However, there are some limitations of BMI assessment using iliac bony trephination, such as low sensitivity to patchy or focal lymphomatous involvement, inter-observers variability, inappropriately obtained specimens in terms of technical problem. This study investigated that whether the combined evaluation with 18F-FDG PET/CT and molecular analysis of monoclonal Immunoglobulin heavy chain (IgH) rearrangement could increase the diagnostic accuracy of BMI at the time of diagnosis in DLBCL. Methods This observational study conducted in 100 patients with newly diagnosed DLBCL from January 2017 to May 2018 from single institution. The specimens for IgH rearrangement polymerase chain reaction (PCR) to detect the clonality were obtained by fine-needle aspiration and unilateral trephination biopsy. In addition, 18F-FDG PET/CT assessment was performed at the time of diagnosis and classified into two patterns (focal vs diffuse) based on the type of bony FDG uptakes. The section specimens were reviewed by hematopathologists according to the World Health Organization (WHO) classification. Results 53 patients were diagnosed with advanced stage and 9 patients (9%) were confirmed morphologic BMI (mBMI) by section biopsy. IgH monoclonality (IgH BMI) was detected in 17 patients (17%) and bony involvement on PET/CT assessment (PET BMI) was observed in 16 patients (16%), respectively. All nine patients with mBMI were linked together with either IgH BMI or PET BMI. Of 17 patients with IgH BMI, 6 patients (35.2%) were concordant with mBMI. Overall diagnostic accuracy of IgH BMI for detection of mBMI was 86%, and it`s sensitivity and specificity was 66.7% and 87.9% with 96.4% of negative predictve value (NPV), respectively. In addition, among the patients with PET BMI, 11 patients were sub-classified into focal type (68.8%, 11/16) with median 7.9 of SUVmax compared to diffuse type with median 5.6 of SUVmax. 5 patients (31.3%, 5/16) were concordant with mBMI. Two of these five concordant cases were focal type. PET/CT assessment showed 85% of diagnostic accuracy with 55.6% of sensitivity, 87.9% of specificity and 95.2% of NPV, respectively. However, the combination of IgH rearrangement with PET/CT assessment resulted in 100% of sensitivity and 79.1% of specificity with 100% of NPV, respectively. Total 28 patients had positive results either IgH rearrangement or PET BMI. 11 patients showed only PET BMI, and another 12 showed only IgH BMI. Conclusion Each PET/CT assessment and PCR-technique for IgH rearrangement was associated with low sensitivity and high NPV for detecting mBMI. However, combined evaluation with IgH monoclonality and initial PET/CT could give more information to predict bone marrow involvement of DLBCL Disclosures No relevant conflicts of interest to declare.

scholarly journals 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

2017 ◽  
Vol 58 (12) ◽  
pp. 1476-1484 ◽  
Author(s):  
Alexandra R Teagle ◽  
Hannah Barton ◽  
Elizabeth Charles-Edwards ◽  
Sabina Dizdarevic ◽  
Timothy Chevassut
Keyword(s):  
Bone Marrow ◽  
Fdg Pet ◽  
Cell Lymphoma ◽  
Bone Marrow Involvement ◽  
B Cell Lymphoma ◽  
Reference Standard ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Large B Cell

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.

Sign in / Sign up

Export Citation Format

Share Document