Assessment of Bone Marrow Involvement by FDG-PET in Patients with Follicular Lymphoma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 5108-5108
Author(s):  
Inas El- Najjar ◽  
Teresa Szyszko ◽  
Amy Mc Dowell ◽  
Janet Matthews ◽  
John G Gribben ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Quantitative Analysis ◽  
Follicular Lymphoma ◽  
Fdg Pet ◽  
Visual Analysis ◽  
Bone Marrow Involvement ◽  
High Specificity ◽  
Visual Assessment ◽  
Focal Lesions ◽  
Standardized Uptake Values

Abstract Abstract 5108 Background and Aims Several studies evaluating the role of FDG-PET in assessing bone marrow (BM) involvement in patients with lymphoma have been published. However, they have relied on visual analysis alone which has proved inadequate. The aim of this study was to assess the value of semi-quantitative assessment in identifying BM involvement in patients with follicular lymphoma (FL). Methods and statistical analysis This is a single centre retrospective analysis of 41 patients with grade 1–3a FL (female: 51%; median age: 64 years, range: 30 – 87) who underwent FDG -PET/CT and unilateral bone marrow biopsy (BMB) as part of the staging assessment. Thirty patients were newly diagnosed and 11 had their staging investigations at relapse. Amongst the latter, none of them had received any treatment in the previous 3 months. BM uptake was assessed both visually and with semi-quantitative analysis. On visual analysis, BM uptake was compared to the liver as the reference. Semi-quantitative analysis involved measuring the maximum standardized uptake values (SUVmax) at the sternum, both iliac blades and the T12 vertebra. An average of these 4 measurements was recorded as SUVav. The highest SUVmax recorded in any of the 4 bone sites, the SUVav, and the ratios SUVav/mediastinal blood pool (MBP) and SUVav/liver were compared by t-test according to whether patients had a positive or a negative BMB. Optimal SUVmax, SUVav, SUVav/liver and SUVav/MBP cutoffs were defined by receiver operating characteristic (ROC) curves. Results Sixteen patients (37%) had BM involvement on the BMB but 11 of them did not have increased uptake in the BM compartment on visual analysis of the FDG-PET. In contrast, 7 patients had BM involvement (focal lesions in 6, diffuse involvement in 1) on visual analysis of the FDG-PE but 2 had a negative BMB. All semi-quantitative measurements were significantly higher in patients with a positive BMB in comparison with those with a negative BMB (table). The optimal cutoff values were ≥2. 5 for SUVmax, ≥2 for SUVav, ≥0. 75 for SUVav/liver, and ≥1 for SUVav/MBP. The sensitivity and the specificity for the prediction of BM involvement utilising SUVmax ≥2. 5 at a single site was 56% and 84%. However, the SUVav ≥2 had a better sensitivity (63%) whilst maintaining a high specificity of 96%. The sensitivity was still further improved by normalizing these values as a ratio of the uptake: SUVav/liver ≥0. 75 had a sensitivity of 81% and a specificity of 80%, whereas the sensitivity and specificity of SUVav/MBP ≥1 were 88% and 80%, respectively. Conclusions Visual assessment of FDG-PET has a high specificity but a low sensitivity to detect BM involvement in FL patients. In contrast, semi-quantitative assessments can improve the sensitivity of FDG-PET to predict BM involvement from 31% to 88%. Were these results confirmed in further prospective studies, they may help to predict BM involvement in FL patients, which may result in sparing selected patients from having a BMB. Disclosures: Gribben: Celgene: Honoraria; Roche: Honoraria; Pharmacyclics: Honoraria; GSK: Honoraria; Mundipharma: Honoraria; Gilead: Honoraria.

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 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.

Utility of quantitative FDG-PET/CT for the detection of bone marrow involvement in follicular lymphoma: a histopathological correlation study

2014 ◽  
Vol 43 (9) ◽  
pp. 1231-1236 ◽  
Author(s):  
Hugo J. A. Adams ◽  
Thomas C. Kwee ◽  
Rob Fijnheer ◽  
Stefan V. Dubois ◽  
Peter E. Blase ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Follicular Lymphoma ◽  
Fdg Pet ◽  
Bone Marrow Involvement ◽  
Correlation Study ◽  
Histopathological Correlation ◽  
Pet Ct ◽  
Fdg Pet Ct

scholarly journals FDG PET/CT to detect bone marrow involvement in the initial staging of patients with aggressive non-Hodgkin lymphoma: results from the prospective, multicenter PETAL and OPTIMAL>60 trials

2021 ◽  
Author(s):  
Dominic Kaddu-Mulindwa ◽  
Bettina Altmann ◽  
Gerhard Held ◽  
Stephanie Angel ◽  
Stephan Stilgenbauer ◽  
...  
Keyword(s):  
Bone Marrow ◽  
B Cell ◽  
Hodgkin Lymphoma ◽  
Predictive Value ◽  
Fdg Pet ◽  
Bone Marrow Involvement ◽  
Non Hodgkin Lymphoma ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Initial Staging

Abstract Purpose Fluorine-18 fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG PET/CT) is the standard for staging aggressive non-Hodgkin lymphoma (NHL). Limited data from prospective studies is available to determine whether initial staging by FDG PET/CT provides treatment-relevant information of bone marrow (BM) involvement (BMI) and thus could spare BM biopsy (BMB). Methods Patients from PETAL (NCT00554164) and OPTIMAL>60 (NCT01478542) with aggressive B-cell NHL initially staged by FDG PET/CT and BMB were included in this pooled analysis. The reference standard to confirm BMI included a positive BMB and/or FDG PET/CT confirmed by targeted biopsy, complementary imaging (CT or magnetic resonance imaging), or concurrent disappearance of focal FDG-avid BM lesions with other lymphoma manifestations during immunochemotherapy. Results Among 930 patients, BMI was detected by BMB in 85 (prevalence 9%) and by FDG PET/CT in 185 (20%) cases, for a total of 221 cases (24%). All 185 PET-positive cases were true positive, and 709 of 745 PET-negative cases were true negative. For BMB and FDG PET/CT, sensitivity was 38% (95% confidence interval [CI]: 32–45%) and 84% (CI: 78–88%), specificity 100% (CI: 99–100%) and 100% (CI: 99–100%), positive predictive value 100% (CI: 96–100%) and 100% (CI: 98–100%), and negative predictive value 84% (CI: 81–86%) and 95% (CI: 93–97%), respectively. In all of the 36 PET-negative cases with confirmed BMI patients had other adverse factors according to IPI that precluded a change of standard treatment. Thus, the BMB would not have influenced the patient management. Conclusion In patients with aggressive B-cell NHL, routine BMB provides no critical staging information compared to FDG PET/CT and could therefore be omitted. Trial registration NCT00554164 and NCT01478542

scholarly journals The Value of PET/CT in Detecting Bone Marrow Involvement in Patients With Follicular Lymphoma

Medicine ◽  
2016 ◽  
Vol 95 (9) ◽  
pp. e2910 ◽  
Author(s):  
Chava Perry ◽  
Hedva Lerman ◽  
Erel Joffe ◽  
Nadav Sarid ◽  
Odelia Amit ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Follicular Lymphoma ◽  
Bone Marrow Involvement ◽  
Pet Ct

scholarly journals 11C-acetate positron emission tomography is more precise than 18F-fluorodeoxyglucose positron emission tomography in evaluating tumor burden and predicting disease risk of multiple myeloma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Miao Chen ◽  
Wenjia Zhu ◽  
Jianhua Du ◽  
Chen Yang ◽  
Bing Han ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Multiple Myeloma ◽  
Bone Marrow ◽  
Disease Progression ◽  
Fdg Pet ◽  
Tumor Burden ◽  
Emission Tomography ◽  
Focal Lesions ◽  
Bone Marrow Uptake ◽  
Positron Emission

AbstractThe optimal method of tumor burden evaluation in newly diagnosed multiple myeloma (NDMM) is yet to be determined. This study aimed to compare the value of 11C-acetate positron-emission tomography (PET)/computed tomography (CT) (AC-PET and 18F-fluorodeoxyglucose PET/CT (FDG-PET) in the assessment of tumor burden in NDMM. This study evaluated 64 NDMM patients between February 2015 and July 2018. AC-PET and FDG-PET were used to assess myeloma lesions. The clinical data, imaging results, and their correlations were analyzed. Diffuse bone marrow uptake in AC-PET was significantly correlated with biomarkers for tumor burden, including serum hemoglobin (P = 0.020), M protein (P = 0.054), the percentage of bone marrow plasma cells (P < 0.001), and the Durie–Salmon stage of the disease (P = 0.007). The maximum standard uptake value (SUVmax) of focal lesions and high diffuse bone marrow uptake in AC-PET showed stronger correlations with high-risk disease (P = 0.017, P = 0.013) than those in FDG-PET. Moreover, the presence of diffuse bone marrow uptake, more than ten focal lesions, and an SUVmax of focal lesions of > 6.0 in AC-PET, but not in FDG-PET, predicted a higher probability of disease progression and shorter progression-free survival (P < 0.05). AC-PET outperformed FDG-PET in tumor burden evaluation and disease progression prediction in NDMM.

Successful in vivo purging of CD34-containing peripheral blood harvests in mantle cell and indolent lymphoma: evidence for a role of both chemotherapy and rituximab infusion

Blood ◽  
2000 ◽  
Vol 96 (3) ◽  
pp. 864-869 ◽  
Author(s):  
Michele Magni ◽  
Massimo Di Nicola ◽  
Liliana Devizzi ◽  
Paola Matteucci ◽  
Fabrizio Lombardi ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Follicular Lymphoma ◽  
Mantle Cell Lymphoma ◽  
Cell Lymphoma ◽  
Bone Marrow Involvement ◽  
Hematopoietic Stem ◽  
Mantle Cell

Abstract Elimination of tumor cells (“purging”) from hematopoietic stem cell products is a major goal of bone marrow–supported high-dose cancer chemotherapy. We developed an in vivo purging method capable of providing tumor-free stem cell products from most patients with mantle cell or follicular lymphoma and bone marrow involvement. In a prospective study, 15 patients with CD20+ mantle cell or follicular lymphoma, bone marrow involvement, and polymerase chain reaction (PCR)–detectable molecular rearrangement received 2 cycles of intensive chemotherapy, each of which was followed by infusion of a growth factor and 2 doses of the anti-CD20 monoclonal antibody rituximab. The role of rituximab was established by comparison with 10 control patients prospectively treated with an identical chemotherapy regimen but no rituximab. The CD34+ cells harvested from the patients who received both chemotherapy and rituximab were PCR-negative in 93% of cases (versus 40% of controls;P = .007). Aside from providing PCR-negative harvests, the chemoimmunotherapy treatment produced complete clinical and molecular remission in all 14 evaluable patients, including all 6 with mantle cell lymphoma (versus 70% of controls). In vivo purging of hematopoietic progenitor cells can be successfully accomplished in most patients with CD20+ lymphoma, including mantle cell lymphoma. The results depended on the activity of both chemotherapy and rituximab infusion and provide the proof of principle that in vivo purging is feasible and possibly superior to currently available ex vivo techniques. The high short-term complete-response rate observed suggests the presence of a more-than-additive antilymphoma effect of the chemoimmunotherapy combination used.

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