18F-Fluorodeoxyglucose Positron Emission Tomography Versus Bone Marrow Biopsy for the Evaluation of Bone Marrow Infiltration in Newly Diagnosed Lymphoma Patients: Real-World Clinical Management of Patients at the National Cancer Institute, México

Background: Defining the extent of disease is essential for determining the prognosis and management of patients with Hodgkin (HL) and non-Hodgkin lymphoma (NHL) as the presence of advanced disease, including involvement of an extralymphatic site, is associated with inferior outcomes (Cheson et al, 2014). 18F-fluorodeoxyglucose positron emission tomography (FDG PET-CT) has an excellent diagnostic performance for evaluation of bone marrow infiltration (BMI) in patients with lymphoma but it is expensive and not always available at low and middle-income health care facilities. Unilateral bone marrow biopsy (BMB) is a more accessible test and has been the standard to identify lymphomatous BMI. Unfortunately, it is an unpleasant procedure for the patient and can be limited by technical constraints. The aim of this single-center retrospective cohort study was to evaluate the diagnostic performance of FDG PET-CT for BMI in lymphoma patients, comparing it with BMB as the gold standard. Also, we evaluated for discordant results between both studies along with its effect on patient treatment. Methods: Newly diagnosed lymphoma patients evaluated at the National Cancer Institute between July 2017 and December 2018 were identified from our institutional lymphoma data base. Five hundred patient files were reviewed for bone marrow evaluation at diagnosis by BMB and FDG PET-CT as well as for other clinical characteristics. Only 355 patients had both FDG PET-CT and BMB performed and adequately reported, so the rest were excluded from the analysis. Fisher's exact and Pearson Chi-square tests were used to compare categorical variables. Comparisons of continuous variables were performed using Mann-Whitney U test. Setting BMB as the gold standard, diagnostic performance of FDG PET-CT for detecting BMI was evaluated. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios (LR) and accuracy were calculated for the most common histological subtypes. Logistic regression model was used for univariate and multivariate analysis of predictors for positive BMB and positive FDG PET-CT for BMI. Results: The most common histologic type was diffuse large B-cell lymphoma (DLBCL) in 42.4% of cases, followed by HL in 20.4%, and follicular lymphoma (FL) in 11.2%. Median age was 53 years. B symptoms were present in 59.6% of cases and 71.4% debuted with advanced stage of disease (Ann Arbor III and IV). BMB was positive in 17% of all patients and 28% had a positive FDG PET-CT for BMI (Table 1). BMB was positive in 17.2% of HL, 12.3% of DLBCL, 29.8% of FL and 15.6% of other types of lymphoma patients. Overall, sensitivity of FDG PET-CT was 74.1%, specificity 80.1%, PPV 42.2%, NPV 94.1%, +LR 3.73, -LR 0.32 and accuracy 79.2%. The diagnostic performance of FDG PET-CT in patients with HL, DLBCL, FL and other types of lymphoma is shown in Table 2. As for predictors for BMB positivity, the presence of B symptoms, neutropenia and thrombocytopenia were independent factors for BMI with adjusted OR of 2.44, 95% CI (1.19, 4.99), 5.64, 95% CI (1.32, 24.08) and 4.12, 95% CI (1.66, 10.26), respectively. For positive FDG PET-CT, the presence of B symptoms, thrombocytopenia and advance stage remained significant with adjusted OR of 2.96, CI 95% (1.73, 5.05), 2.75, 95% CI (1.17, 6.48) and 19.22, 95% CI (5.90, 62.66), respectively. Seventy-four patients had discordant results between BMB and FDG PET-CT. The discrepancy in BMB and FDG PET-CT results did not have an effect on treatment. Conclusions: In addition to international clinical practice guidelines recommendations, in our center we recommend performing a BMB to those patients with HL and FDG PET-CT negative for BMI who present with cytopenias and B symptoms at the time of diagnosis. For patients with DLBCL our FDG PET-CT sensitivity was lower than expected, so we recommend a complementary BMB to all DLBCL patients with a positive FDG PET-CT for BMI (stage IV) that otherwise would be early stages (I and II) and would benefit from less aggressive therapy. In all other NHL including FL, we recommend performing a unilateral BMB with immunohistochemical analyses and flow cytometry, if available, for initial evaluation of BMI. Still in the absence of FDG PET-CT, a whole-body contrast-enhanced CT along with a unilateral posterior iliac crest BMB could adequately stage most types of lymphoma at low and middle-income health care facilities. Disclosures No relevant conflicts of interest to declare.

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Systematic review and meta-analysis on the diagnostic performance of FDG-PET/CT in detecting bone marrow involvement in newly diagnosed Hodgkin lymphoma: is bone marrow biopsy still necessary?

Annals of Oncology ◽

10.1093/annonc/mdt533 ◽

2014 ◽

Vol 25 (5) ◽

pp. 921-927 ◽

Cited By ~ 71

Author(s):

H.J.A. Adams ◽

T.C. Kwee ◽

B. de Keizer ◽

R. Fijnheer ◽

J.M.H. de Klerk ◽

...

Keyword(s):

Systematic Review ◽

Bone Marrow ◽

Hodgkin Lymphoma ◽

Fdg Pet ◽

Diagnostic Performance ◽

Meta Analysis ◽

Bone Marrow Involvement ◽

Newly Diagnosed ◽

Pet Ct ◽

Fdg Pet Ct

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Diagnostic performance of 18F-FDG PET/CT in pediatric lymphoma infiltrating bone marrow: a meta-analysis

Clinical and Translational Imaging ◽

10.1007/s40336-021-00452-x ◽

2021 ◽

Author(s):

Xianwen Hu ◽

Dandan Li ◽

Guomei Hu ◽

Qi Huang ◽

Pan Wang ◽

...

Keyword(s):

Bone Marrow ◽

Fdg Pet ◽

Diagnostic Performance ◽

Meta Analysis ◽

Pediatric Lymphoma ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Bone marrow MRI versus 18F-FDG-PET/CT for detecting multiple myeloma lesions: diagnostic performance and clinical relevance

Clinical Lymphoma Myeloma & Leukemia ◽

10.1016/j.clml.2019.09.053 ◽

2019 ◽

Vol 19 (10) ◽

pp. e35-e36

Author(s):

Frédéric Lecouvet ◽

Dimitar Boyadzhiev ◽

Laurence Collette ◽

Maude Berckmans ◽

Nicolas Michoux ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Fdg Pet ◽

Clinical Relevance ◽

Diagnostic Performance ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Role of FDG-PET/CT for Detection of Occult Bone Marrow Involvement in Patients from the Middle East and North Africa Region with Hodgkin Lymphoma

Blood ◽

10.1182/blood.v128.22.5348.5348 ◽

2016 ◽

Vol 128 (22) ◽

pp. 5348-5348

Author(s):

Moussab Damlaj ◽

Giamal Edin Mohamed Gmati ◽

Ghulam Syed ◽

Mohsen Al Zahrani ◽

Khadega Ahmed Abuelgasim ◽

...

Keyword(s):

Bone Marrow ◽

Sensitivity And Specificity ◽

Fdg Pet ◽

Stage Iii ◽

Newly Diagnosed ◽

Mena Region ◽

Bone Marrow Disease ◽

Pet Ct ◽

Fdg Pet Ct ◽

Initial Staging

Abstract Background: Routine bone marrow biopsy (BMB) for the initial staging of Hodgkin Lymphoma (HL) is not recommended in the era of FDG-PET/CT staging (J Clin Oncol. 2014;32(27):3059). However, patients from the Middle East and North Africa (MENA) region have epidemiologic and clinical features of lymphoma that are different from patients of other ethnicities (J Natl Compr Canc Net2010;8:S-29-S-35). Therefore, it is unknown whetherFDG-PET/CT can substitute for staging BMB in this population.At our center, we perform routine BMB for all newly diagnosed lymphoma cases. Aim: To investigate whether routine BMB is essential in detecting bone marrow disease where FDG-PET/CT is used in initial staging for HL in patients from the MENA region. Methods: Patients with HL at our institution between 2010 - 2015 were identified. Inclusion criteria included newly diagnosed patients who had BMB and FDG-PET/CT as part of initial staging. All baseline and laboratory features were retrospectively extracted. Pathology reports of bone marrow aspirate and trephine biopsies were reviewed by two independent Hematologists. All written FDG-PET/CT reports were retrieved and carefully reviewed and cases with positive skeletal uptake were re-interpreted by an experienced radiologist. Pattern of skeletal FDG-PET/CT uptake was determined and classified as unifocal or multifocal. Sensitivity and specificity was computed while defining bone marrow disease by positive BMB and / or focal skeletal uptake on FDG-PET/CT. Categorical and continuous variables were analyzed using Pearson's chi-squared and Student's t-test, respectively. Results: A. Baseline characteristics: A total of92 patients met the inclusion criteria and were considered for this analysis. All patients were from the MENA region and > 90% were from the Arabian peninsula. From this cohort, bone marrow disease was detected in 7 (7.6%) patients using BMB while 20 (21.7%) patients had unifocal or multifocal bone marrow uptake on FDG-PET/CT. An additional 21 patients (23%) had diffuse homogenous FDG uptake and was not considered to represent HL. The cohort was characterized by a male to female ratio of 1.4 and a median age at diagnosis of 27 years (6-83). About two thirds of the cases were classical HL of the nodular sclerosis subtype (Table 1). Almost 60% of cases were stage III - IV with corresponding median IPS of 2 (0-6). Incidence of bulky disease and B-symptoms among the entire cohort was 32% and 50%, respectively. B. Comparison of FDG-PET/CT and BMB No patient with involved BMB (iBMB) had early stage disease on FDG-PET/CT and BMB identified only one patient with positive BM involvement yet negative skeletal uptake on FED-PET/CT. Involvement by BMB upstaged 3 patients previously assessed by CT scan as having stage III, however, none of the patients were allocated to a different treatment plan based on the BMB result. On the other hand, FDG-PET/CT upstaged 24 patients (26%); 9 patients from stage III to IV and 14 patients from early to advanced stage resulting in change of therapeutic plan in the latter group. Focal skeletal FDG-PET/CT lesions identified positive marrow disease with a sensitivity and specificity of 95.2% and 70.4%, respectively. On the other hand, sensitivity and specificity of BMB was 35% and 100%, respectively (Table 2). Abnormal skeletal FDG uptake was seen in a total of 20 patients (21.7%); 11 (55%) had unifocal / bifocal while 9 (45%) had multifocal disease of the axial skeleton. Patients with iBMB compared to those with negative BMB but positive unifocal / multifocal skeletal FDG-PET/CT lesions were more likely to be male (p = 0.002), have B-symptoms (p = 0.028), extranodal disease (p = 0.017) and more likely to have multifocal uptake on FDG-PET/CT (0.017) (Table 3). Conclusion:To our knowledge, this is the first analysis to examine the role of FDG-PET/CT for detection of bone marrow involvement in HL in a patient cohort from the MENA region. We observed that FDG-PET/CT had a higher sensitivity and negative predictive value compared to BMB leading to a treatment change in a significant proportion of patients. This analysis highlightsthat FDG-PET/CT can substitute for BMB in routine staging for newly diagnosed patients with HL from the MENA region. Disclosures No relevant conflicts of interest to declare.

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The Utility of Metabolic Parameters on Baseline F-18 FDG PET/CT in Predicting Treatment Response and Survival in Paediatric and Adolescent Hodgkin Lymphoma

Journal of Clinical Medicine ◽

10.3390/jcm10245979 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5979

Author(s):

Janet Denise Reed ◽

Andries Masenge ◽

Ane Buchner ◽

Fareed Omar ◽

David Reynders ◽

...

Keyword(s):

Positron Emission Tomography ◽

Bone Marrow ◽

Treatment Response ◽

Hodgkin Lymphoma ◽

Fdg Pet ◽

Emission Tomography ◽

Metabolic Parameters ◽

Positron Emission ◽

Pet Ct ◽

Fdg Pet Ct

Lymphoma is the third most common paediatric cancer. Early detection of high-risk patients is necessary to anticipate those who require intensive therapy and follow-up. Current literature shows that residual tumor avidity on PET (Positron Emission Tomography) following chemotherapy corresponds with decreased survival. However, the value of metabolic parameters has not been adequately investigated. In this retrospective study, we aimed to evaluate the prognostic value of metabolic and other parameters in paediatric and adolescent Hodgkin lymphoma. We recorded tMTV (total Metabolic Tumor Volume), TLG (Total Lesion Glycolysis), and SUVmax (maximum Standard Uptake Value) on baseline PET, as well the presence of bone marrow or visceral involvement. HIV (human immunodeficiency virus) status and baseline biochemistry from clinical records were noted. All patients received stage-specific standard of care therapy. Response assessment on end-of-treatment PET was evaluated according to the Deauville criteria. We found that bone marrow involvement (p = 0.028), effusion (p < 0.001), and treatment response (p < 0.001) on baseline PET, as well as HIV status (p = 0.036) and baseline haemoglobin (p = 0.039), were significantly related to progression-free survival (PFS), whereas only effusion (p = 0.017) and treatment response (p = 0.050) were predictive of overall survival (OS). Only baseline tMTV predicted treatment response (p = 0.017). This confirms the value of F-18 FDG PET/CT (Fluoro-deoxy-glucose Positron Emission Tomography/Computed Tomography) in prognostication in paediatric and adolescent Hodgkin lymphoma; however, further studies are required to define the significance of metabolic parameters.

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Myocardial Glucose Metabolism Is Increased in Newly Diagnosed Lung Adenocarcinoma

Cardiology ◽

10.1159/000515473 ◽

2021 ◽

pp. 1-9

Author(s):

Jiaoyan Wu ◽

Li Wang ◽

Yuetao Wang ◽

Min-Fu Yang

Keyword(s):

Bone Marrow ◽

Glucose Metabolism ◽

Lung Adenocarcinoma ◽

Fdg Pet ◽

Arterial Wall ◽

Left Ventricular ◽

Newly Diagnosed ◽

Myocardial Glucose Metabolism ◽

Pet Ct ◽

Fdg Pet Ct

Background: Cardiac metabolism alterations may be involved in abnormalities of cancer patients’ cardiovascular system. This study aimed to explore whether left ventricular myocardial glucose metabolism is altered and its related factors in newly diagnosed patients with lung adenocarcinoma (LAD) who underwent fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT). Methods: From our 18F-FDG PET/CT imaging database, 171 patients with newly diagnosed LAD and 43 nononcologic subjects with matched age and sex were retrospectively analyzed. The included patients underwent conventional 18F-FDG PET/CT imaging with a >12-h fasting before 18F-FDG administration. The standardized uptake values (SUVs) of the left ventricular (LV) myocardium, arterial wall, epicardial adipose tissue (EAT), spleen, and bone marrow were separately measured. Laboratory parameters and echocardiographic results were collected as well. LAD patients were divided into 2 groups based on the 95th percentile of LV maximal SUV (SUVmax) obtained from the 43 nononcologic subjects. Univariate analysis and multiple logistic regression analysis were used to identify significant factors. Results: Higher LV SUVmax was found (3.8 [2.4, 7.7] vs. 3.0 [2.0, 5.4], p = 0.052) in LAD than that in nononcologic patients, whereas no significant differences of 18F-FDG uptake were found in the arterial wall, EAT, spleen, or bone marrow between LAD patients and controls. The maximum diameter (Dmax) of the LAD lesion, SUVmax of spleen, and SUVmax of EAT were related to LV SUVmax in LAD. Conclusions: Myocardial glucose metabolism is increased in patients with newly diagnosed LAD. Dmax of LAD lesion, spleen activity, and EAT activity contribute to the increased LV activity in LAD.

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Diagnostic Performance of PET or PET/CT with Different Radiotracers in Patients with Suspicious Lung Cancer or Pleural Tumours according to Published Meta-Analyses

Contrast Media & Molecular Imaging ◽

10.1155/2020/5282698 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Filippo Lococo ◽

Barbara Muoio ◽

Marco Chiappetta ◽

Dania Nachira ◽

Leonardo Petracca Ciavarella ◽

...

Keyword(s):

Lung Cancer ◽

Positron Emission Tomography ◽

Fdg Pet ◽

Diagnostic Performance ◽

Emission Tomography ◽

Evidence Based ◽

Positron Emission ◽

Pet Ct ◽

Meta Analyses ◽

Fdg Pet Ct

Purpose. Several meta-analyses have reported data about the diagnostic performance of positron emission tomography or positron emission tomography/computed tomography (PET or PET/CT) with different radiotracers in patients with suspicious lung cancer (LC) or pleural tumours (PT). This review article aims at providing an overview on the recent evidence-based data in this setting. Methods. A comprehensive literature search of meta-analyses published in PubMed/MEDLINE and Cochrane Library database from January 2010 through March 2020 about the diagnostic performance of PET or PET/CT with different radiotracers in patients with suspicious LC or PT was performed. This combination of keywords was used: (A) “PET” OR “positron emission tomography” AND (B) “lung” OR “pulmonary” OR “pleur∗” AND (C) meta-analysis. Only meta-analyses on PET or PET/CT in patients with suspicious LC or PT were selected. Results. We have summarized the diagnostic performance of PET or PET/CT with fluorine-18 fluorodeoxyglucose (18F-FDG) and other radiotracers taking into account 17 meta-analyses. Evidence-based data demonstrated a good diagnostic performance of 18F-FDG PET or PET/CT for the characterization of solitary pulmonary nodules (SPNs) or pleural lesions with overall higher sensitivity than specificity. Evidence-based data do not support the routine use of dual time point (DTP) 18F-FDG PET/CT or fluorine-18 fluorothymidine (18F-FLT) PET/CT in the differential diagnosis of SPNs. Even if 18F-FDG PET/CT has high sensitivity and specificity as a selective screening modality for LC, its role in this setting remains unknown. Conclusions. Evidence-based data about the diagnostic performance of PET/CT with different radiotracers for suspicious LC or PT are increasing, with good diagnostic performance of 18F-FDG PET/CT. More prospective multicenter studies and cost-effectiveness analyses are warranted.

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